Testing reaches lowest level in SUS in two years

The SUS (Unified Health System) carried out, in April, the lowest number of tests for covid-19 in two years. According to data from the GAL (Laboratory Environment Manager), of the Ministry of Health, only 179,000 tests for covid-19 were carried out last month – which points to a drop of almost 90% compared to January, when the country experienced a new crisis. wave of disease, caused by the ômicron variant.

The first tests to detect the new coronavirus arrived in the country in March 2020 – in the same month, 35,500 were carried out. The following month, the number reached 182,514.

The GAL is a system created to gather data from the entire public health laboratory network in the country. It does not include data from private laboratories and pharmacies, which are recorded in another database. The data in the following chart was taken from the system on Tuesday (3).

In addition to GAL data, the column analyzed partial data from Abrafarma (Brazilian Association of Pharmacy and Drugstore Networks), which also point to a reduction in the number of rapid pharmacy tests.

In April, until the 24th, only 195,000 tests were carried out. For comparison, in January of this year there were 2.47 million tests carried out by drugstores — these numbers do not include self-tests. The complete data for last month should not be released until next week.

no radar

Officially, there is no justification for the drop in the number of tests performed.

experts heard by UOL consider the lack of mass testing to be a mistake by the authorities. Without the data, they say, there is no way to know if the virus is circulating more and causing a greater number of cases of the disease.

To the network coordinator corona-omic from the Ministry of Science, Technology and Innovations, Fernando spilkithe country did not have any defined testing strategy during the pandemic.

We never had a consistent plan, but there were important initiatives at the state and municipal levels, which have now been lost.”
Fernando Spilki, coordinator of the Corona-omica network

Now, there are already indications of a rise in viral circulation. One of the factors that draws attention is that the national moving average of deaths, which had been falling and stabilized over two weeks, with slight increases. States such as Rio Grande do Sul and São Paulo once again recorded an increase in hospitalizations and deaths.

“When we see deaths in the country growing faster than the number of cases, added to this reduction in tests, it starts to get worried”, says Isaac Schrarstzhauptfrom the Covid-19 Analysis Network.

According to him, there is no way to be sure whether the extra deaths hide an increase in cases, since the number reported daily by state secretariats does not specify the day of death – but when the official record was made.

Hospitalization and death rates are indicators of ‘harvest’, that is: when they start to increase, we are already super late for any action.”
Isaac Schrarstzhauptfrom the Covid-19 Analysis Network

In a bulletin released on Wednesday (4), Fiocruz (Fundação Oswaldo Cruz) pointed out that the country started a curve “with a moderate sign of growth in the long and short-term trends” of SARS (Severe Acute Respiratory Syndrome) cases. ) —which includes cases of covid and other diseases caused by respiratory viruses.

high positivity

At the same time that the number of known tests for covid-19 has fallen, the rate of positive results has been rising for at least three weeks – in both the public and private systems. This index is pointed out as one of the main initial markers to understand the circulation of the new coronavirus.

When the positivity percentage rises, it is suggested that there is more viral circulation. It is an indication of the resurgence of the pandemic, according to Anderson Brito, a virologist and scientific researcher at the ITpS (All for Health Institute).

“It’s a warning sign because we’ve already seen this pattern precede the waves [de contaminação]”, says Brito, citing the wave of January, when the positivity index reached 60%.

In the case of GAL, the positivity index has been rising for three consecutive weeks — albeit slowly. The index reached 7.91% of the total number of exams in the week ended last Saturday (30).

In drugstores, in the last week of March, 7.2% of the tests were positive. In the third week of April, this percentage reached 15.3%.

In addition to the data from the GAL, the ITpS, where Brito works, also conducts a survey of the positivity of tests carried out in three laboratory networks in the country. The samples are national, but 95% of them are concentrated in the Southeast and Midwest. The index rose:

  • From 8.4% in the week between April 10 and 16,
  • For 13% in the week between the 24th to the 30th of the same month.

BA.2 dominant

The increase in positivity, says Brito, coincides with the moment when the BA.2 sub-variant became the dominant one in the country. He believes that it is still not possible to understand the dimension of the impact of BA.2, but the variant is directly associated with the rise in indicators of the pandemic in Brazil and that it was responsible for waves of cases in other countries.

“We saw waves in several regions of the United Kingdom, but in South Africa we did not observe this. We would have to wait for more data to have an idea of ​​the impact here”, he says.

However, he fears that, with the arrival of the BA.4 and BA.5 sub-variants —which have an even greater immune leak—the country could experience a greater acceleration of the pandemic, as has already been happening in South Africa and other countries. countries.

“They have increased the number of hospitalizations, which BA.2 has not been able to produce there. And this trend coincides with the genomic surveillance data that BA.4 and BA.5 are already the main circulating strains. for about three to four weeks there”, he says.

Another point that he considers important in Brazil is that the entry into circulation of self-tests can increase underreporting – in these cases, the person with suspected covid-19 takes the exam at home and there is no obligation to notify the doctor. government.

“The official recommendation is, if it is positive, go to a health center for confirmation. But if there is no such search, there is no communication and it becomes an underreported case. Then we lose a little of the notion of how the situation is , this is worrying”, he points out.

Testing center in Manaus had high demand in January this year - Rodrigo Santos/Secretariat of Health of Amazonas - Rodrigo Santos/Secretary of Health of Amazonas

Testing center in Manaus had high demand in January this year

Image: Rodrigo Santos/Secretariat of Health of Amazonas

For Alexandre Naime, vice president of SBI (Brazilian Society of Infectious Diseases), it is still too early to be sure if we will have a considerable increase in cases. “It is still punctual data, we need a longer interval so that a quality epidemiological assessment can be carried out”, he evaluates.

He recalls that, in the pandemic, the country is expected to face rebounds, with an increase in cases for some period.

For Naime, the best way to minimize the impacts of an eventual rise in viral circulation is to accelerate the vaccination booster – according to data from the press consortium, more than 87 million Brazilians took the first booster dose.

the low rates [de reforço] are a risk. Studies show that for adequate protection, three doses are needed in the general population. So, those who haven’t updated, should do it as soon as possible.”
Alexandre Naime, vice president of SBI

Vaccination against Covid-19 at UBS Santa Cecília, in downtown São Paulo - Danilo Verpa/Folhapress - Danilo Verpa/Folhapress

Vaccination against Covid-19 at UBS Santa Cecília, in downtown São Paulo

Image: Danilo Verpa/Folhapress

“General released”

The epidemiologist Paul petryteacher of UFRGS (Federal University of Rio Grande do Sul), attributes the drop in the number of tests to the speech that the pandemic is over. “But a pandemic does not end by decree”, he says.

“With this emergency downgrade and everything that has been trumpeting, restrictions were removed. This sent a false message that the pandemic was over. What worries us most is that this reached mortality”, he adds.

Spilki, from the Corona-ómica network, points out that the increase in deaths in recent days may be the result of these easing in recent months – and there is a risk that the increase in cases has not been noticed precisely because of the lack of testing.

“We have great difficulty in evaluating the scenario today because we don’t know if we are making diagnoses in the correct number”, he says.

However, Spilki believes that very large variations are not expected in the coming weeks. “We are not betting on large fluctuations or large outbreaks in the near horizon. But the easing conditions placed in the country may lead, later on, to having larger outbreaks, unfortunately.”

In response to the column just this Friday, the Ministry of Health reported that the delivery of RT-PCR tests for covid-19 takes place “according to the demand of the Central Public Health Laboratories (LACEN) of the Federation Units”. “Since the beginning of the pandemic, more than 30 million RT-PCR tests have been distributed. In 2020, 11.6 million were distributed, and in 2021, 16.5 million were delivered. This year, so far, 2 have been made available, 8 million tests”, he says.

Also according to the folder, “since the launch of the PNE-Teste, in September 2021, until the beginning of May 2022, a total of 60.73 million rapid antigen tests were distributed”. “The quantity of tests has been agreed according to the current demand for tests by each federative entity, for the best storage and distribution, thus avoiding any loss of inputs”, he concludes.

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