Covid: 5 factors that could threaten the end of the public health emergency announced in Brazil

The Minister of Health, Marcelo Queiroga, declared on Sunday (17) that Covid-19 will no longer be considered a public health emergency in Brazil.

The decision, which will repeal a series of regulations and laws that have marked the past two years, has generated controversy among experts.

“I am concerned about the end of the national emergency at a time when the World Health Organization (WHO) still understands that we are facing a pandemic, or an international public health emergency”, criticizes epidemiologist Ethel Maciel, a professor at the Federal University of Espírito Santo. Saint (Ufes).

“And it is still not clear what this will mean in practice and what the plan will be if things get worse again”, highlights Leonardo Bastos, a researcher at the Oswaldo Cruz Foundation (FioCruz).

The announcement by the Ministry of Health comes at a time when the moving averages of cases and deaths from Covid-19 are falling in the country – and the relaxation of preventive policies, such as the use of masks and the prevention of agglomerations, was already in practice. for weeks in several cities and states.

It is worth noting that the repeal of the Public Health Emergency of National Interest (Espin) does not mean the end of the pandemic, as explained by Minister Queiroga himself.

“We will continue to live with the virus. The Ministry of Health remains vigilant and prepared to adopt all necessary actions to guarantee the health of Brazilians in full respect of the Federal Constitution”, he said.

But what if cases, hospitalizations and deaths from covid-19 start to rise again in some part of the country? Experts interviewed by BBC News Brasil list the five factors that could threaten the end of the public health emergency announced by the government – and what should be done to combat them.

1. Cold season

Every year, the arrival of autumn and winter is usually accompanied by an increase in cases of respiratory infections, such as flu and cold.

And this is more related to people’s behavior than the viruses themselves: in the cold, we tend to stay longer in closed places, with little air circulation, and close to each other.

This is the perfect scenario for the transmission of pathogens such as influenza, which causes the flu, and respiratory syncytial virus, bocavirus, or rhinovirus, which are behind the cold.

The fluctuation of cases of respiratory diseases according to the season, in fact, is a determining factor in public health policies.

The flu vaccination campaign, for example, always starts in early autumn in most Brazilian regions. The objective is to ensure, before influenza circulates with more intensity, greater protection against severe cases of the disease, especially in vulnerable groups.

Regarding Covid-19, it has not yet been possible to establish when the increases and decreases in the infection rate will occur – as we are in the middle of a pandemic of an absolutely new virus, to which we had no immunity, these curves go up and down. in any season of the year.

“We don’t have a very clear answer if the coronavirus will have this pattern similar to what we see in other respiratory infections”, understands Bastos.

“But it is natural to think that something similar, with an increase in cases in times of cold, will also happen with covid”, he adds.

And a good part of Brazil is just now entering this period of falling temperatures. Will this influence the transmission of the coronavirus? Only the monitoring of statistics in the coming weeks can answer this question.

2. Outbreaks elsewhere

As a global phenomenon, the pandemic has repercussions on every continent – ​​and what happens on the other side of the world may spill over here in some way.

This has been observed several times over the past two years. Just remember that the first cases of Covid were observed in China and soon appeared in Europe. Subsequently, the coronavirus was detected in North America and, later, in Brazil.

Between 2020 and 2021, this flow repeated itself a few times: waves of cases and deaths that started somewhere in Europe were soon repeated in the United States or Latin America (and vice versa).

The omicron variant itself, originally detected in South Africa in November last year, spread with unprecedented speed and set off record infections in the following months in several parts of the world.

It is worth noting that, with the advancement of vaccination and the high number of individuals who have had Covid, the influence of the international situation in the context of each country becomes less relevant – a population with a high degree of immunity tends to suffer less from new outbreaks than residents of a location that hasn’t experienced big waves recently.

Even so, experts consider it premature to completely ignore a worsening in numbers anywhere in the world, especially at a time of abandoning restrictive measures and increasing the movement of people.

Maciel explains that, within a pandemic, there are some moments of crisis and others of calm.

“We have waves and interpandemic periods, marked by a decrease in cases, hospitalizations and deaths”, he says.

“And it is still too early to say whether what we are experiencing now is precisely this interpandemic period, and soon we will see a new increase in numbers, or will we really move to the endemic, with a stabilization of the scenario”, continues the epidemiologist.

The way to determine where we are currently involves monitoring what is happening around the world, especially in the countries with which Brazilians have the most contact and a constant flow of travel.

If the situation tightens in these places, it may be necessary to make new restrictions and improve the control of positive cases of Covid in ports, airports and borders.

3. Destructuring of the system

Maciel also fears that the end of the national public health emergency will dismantle surveillance and patient care services that were created in the last two years.

“The Espin decree allows for a series of purchases, bids and rules to respond to the health crisis that involves the shipment of vaccines, the expansion of hospital beds, the distribution of supplies…”, he lists.

“The Federal Government cannot end the decree without making a transition period, so that states and municipalities can plan actions from then on.”

The Ufes professor emphasizes that it is time to maintain health services and even strengthen the surveillance system for cases and hospitalizations by Covid.

It is precisely this continuous monitoring that makes it possible to identify a growth in infections prematurely, before the problem spreads, and to take action to contain it.

“What if we go through a new change of scenario, in which cases, hospitalizations and deaths from Covid increase again?”, asks Bastos.

“It is necessary to make it clear what will be done if the Covid situation worsens again”, completes the researcher.

4. Appearance of new variants

One of the great fears of experts is the emergence of a new version of the coronavirus that is even more transmissible, aggressive or capable of “circumventing” the immunity obtained through vaccination or previous infections.

“This is a risk that is posed and that we have already dealt with a few times in this pandemic”, points out virologist Fernando Spilki, a professor at Feevale University, in Rio Grande do Sul.

The variants of concern recorded to date appeared in places where there was a high rate of transmission of the pathogen. This was the case for the alpha variant in the UK, the gamma variant in Brazil, the delta variant in India and the omicron variant in South Africa.

Nothing guarantees that this phenomenon will repeat itself in the months to come, even more so in a scenario where the virus circulates freely and without restrictions.

The good news is that, as seen so far, vaccines continue to offer a good level of protection against the most serious forms of Covid, which cause hospitalization and death.

“We also see that there is a kind of convergence and similarity between the variants that we have identified so far: some mutations appeared simultaneously and independently in different places”, analyzes Spilki, who also coordinates the Corona-Omics Network of the Ministry of Science, Technology and Innovations.

“The trend is that, over time, we will have fewer and fewer deaths from Covid. But we can also suffer outbreaks of high proportions, especially if more diverse variants emerge and that manage to escape immunity”, adds the specialist.

To prevent this pessimistic possibility from becoming a reality, the way forward is to carry out genomic surveillance and early identification of new variants that emerge.

5. Fall of protection

To top it off, it’s still not 100% clear how long immunity lasts after vaccination or coronavirus infection.

This protection must even vary according to a series of characteristics. Younger individuals, for example, may be well protected from infection (or its more serious repercussions) after taking three doses of the immunizer.

Older people, or those who have had a transplant or are undergoing cancer treatment, tend to have a weakened immune system that does not respond as well to infectious threats.

And that, in turn, can impact Covid numbers: if immunity declines even over the months, it is possible that there will be a new increase in cases, hospitalizations and even deaths, especially in the groups that are most vulnerable.

This phenomenon, by the way, has already been seen at other times of the pandemic: when the first vaccines were approved, two doses were recommended for everyone. After some time, scientists began to notice a drop in antibodies and an increase in the rates of infections and hospitalizations.

There was a consensus, then, that it was necessary to offer a third application of the immunizing agent – ​​first in the elderly and immunosuppressed, then for all those over 18 years of age.

“From the studies we have so far, three doses are enough to protect a healthy adult from all circulating variants”, informs immunologist Cristina Bonorino, a professor at the Federal University of Health Sciences of Porto Alegre, in Rio Grande do Sul.

“For individuals with lower immunity, such as the elderly, cancer patients, and transplant recipients, a fourth dose is already necessary”, he adds.

The specialist, who also represents the Brazilian Society of Immunology, understands that we will only know about the relevance of new vaccine boosters from scientific studies, which will assess how immunity behaves from now on.

“It’s time to monitor, test and follow what is happening in the world and also in Brazil.”

“It may be that, in six months, so many cases appear that it will be necessary to institute a fourth dose for everyone. For now, there is still no need for that”, concludes the immunologist.

Finally, it should be noted that, in the case of Brazil, vaccination coverage against Covid remains uneven in many parts of the country: while São Paulo, Piauí, Paraíba and Ceará have more than 80% of the population immunized, Amapá, Roraima, Acre and Maranhão did not reach 60% coverage.

Regarding the third dose, São Paulo is the only state to have more than 50% of adults with the reinforcement against the coronavirus.