The high level of transmissibility of the Ômicron variant, associated with the relaxation of social isolation measures in Rio Grande do Norte at the turn of 2021 to 2022, culminated in an increase in hospitalizations in the public and private health networks in the state due to Covid-19 in 296%. The state broke records for new confirmed cases of the infection and the number of deaths rose again at the beginning of this year. The data are from the State Department of Public Health (Sesap/RN) and were analyzed by the Santos Dumont Institute (ISD).

In absolute numbers, there were 103 patients hospitalized with the infection caused by the coronavirus on December 30, 2021. A month later, the number had jumped to 408 hospitalized patients. In the same period, 134 deaths from the disease were recorded. As of Friday, February 4, Rio Grande do Norte had recorded 7,768 lives lost to the coronavirus, with deaths occurring in all 167 cities in the state. The occupancy of Intensive Care Unit (ICU) beds specifically for treating the infection was at 80.26% – one of the highest levels since the start of vaccination against SARS-CoV-2.

Emergency rooms in public and private hospitals are overwhelmed by patients with symptoms of COVID-19, which can be confused with those of influenza, seeking care. With a strain with greater transmissibility, more people are becoming infected, and teams of doctors, nurses, nursing technicians, pharmacists and other specialists are understaffed, which creates an even greater burden on the health system. The increase in confirmed cases among children and adults is drawing the attention of specialists.

“We are seeing a much higher number of infections than we had in 2020 and 2021. Omicron is much more transmissible. In January, we were in a period of vacations, parties, summer, and crowds, and this resulted in an absurd number of cases that we have seen in recent weeks here in the state. And this is unfortunately reflected in infections among children. If I have more infected adults, if I have more exposed children, and infected children. Notifications in children are increasing, increasing here in the state, and hospitalizations are also increasing,” says Carolina Damásio, multidisciplinary preceptor in infectious diseases at the Santos Dumont Institute (ISD).

According to Diana Rêgo, deputy coordinator of Epidemiology at Sesap/RN, the increase in reported cases gained momentum from the first week of January and broke records in February. “Sesap has been warning everyone to maintain non-pharmacological measures, especially wearing a mask and, as far as possible, social distancing. In addition, vaccination is prioritized. Our number of deaths has already exceeded the number we had in December (2021) and the profile is of elderly people, with comorbidities and who did not have the complete vaccination cycle (for COVID-19). We need people to complete the cycle, take the third dose, which is our most efficient strategy against the coronavirus”, she highlights. Rio Grande do Norte has 203,615 people who are behind on their COVID vaccination cycle, according to data from the RN + Vacina Platform.

Critical percentage

The Covid-19 Observatory of the Oswaldo Cruz Foundation (Fiocruz) issued a Technical Note on Thursday, the 3rd, detailing the occupancy rates of Covid-19 ICU beds for adults in the Unified Health System (SUS). According to the entity, the numbers indicate an increase in demand and require “attention and continuous monitoring”. The Fiocruz Covid-19 Observatory analyzes the pandemic scenario in the country and points out that “13 states have shown an increase in occupancy rates and nine Federative Units are in the critical alert zone with an indicator higher than 80%. Among the 25 capitals with published rates, 13 are in the critical alert zone, nine are in the intermediate alert zone and eight are outside the alert zone”. Natal is among the capitals in the critical alert zone, with an estimated occupancy rate of 89%.

“The Technical Note highlights that the current scenario is not the same as that recorded between March and June 2021, considered the most critical phase of the pandemic, and emphasizes that even with the increase in beds observed in recent weeks, availability is much lower. The document reinforces that the growth in occupancy rates of SRAG/Covid-19 ICU beds for adults in the SUS is worrying, especially given the low vaccination coverage in several areas of the country, where healthcare resources are more precarious. The researchers warn that a considerable proportion of the population that did not receive the booster dose, and the unvaccinated population, are more susceptible to more severe forms of infection with Ômicron and emphasize again that the extremely high transmissibility of the variant can result in significant numbers of hospitalizations in ICU beds, even with a lower probability of severe cases occurring.”

The Technical Note reinforces the need to advance vaccination, including the requirement for a vaccination passport. The researchers also suggest mandatory use of masks in public places, campaigns to inform the population and self-isolation when presenting symptoms, to avoid transmission.

Mato Grosso do Sul (103%), Goiás (91%) and the Federal District (97%) remained in the critical alert zone, which Amazonas (80%) and Mato Grosso (91%) also entered. Pará (74%), Amapá (69%), Tocantins (78%), Ceará (67%), Bahia (74%), Rio de Janeiro (62%), São Paulo (72%), Paraná (72%) remained in the intermediate alert zone, and Alagoas (69%) and Santa Catarina (76%), which were outside the alert zone, entered. Outside the alert zone were Acre (57%), Maranhão (59%), Paraíba (41%), Sergipe (37%), Minas Gerais (37%) and Rio Grande do Sul (54%), in addition to Rondônia (58%) and Roraima (52%), which were in the intermediate alert zone.

Among the 25 capitals with published rates, 13 are in the critical alert zone: Manaus (80%), Macapá (82%), Teresina (83%), Fortaleza (80%), Natal (estimated percentage of 89%), Maceió (81%), Belo Horizonte (86%), Vitória (80%), Rio de Janeiro (95%), Campo Grande (109%), Cuiabá (92%), Goiânia (91%) and Brasília (97%). Nine are in the intermediate alert zone: Porto Velho (77%), Rio Branco (70%), Palmas (72%), São Luís (64%), Recife (77%, considering only municipal public beds), Salvador (68%), São Paulo (75%), Curitiba (71%) and Florianópolis (68%). Boa Vista (52%), João Pessoa (58%) and Porto Alegre (55%) are outside the alert zone.

Panorama

Municipalities with the most deaths from covid-19 in RN

Christmas – 2,816

Mossoro – 607

Parnamirim – 562

241

Macaiba – 180

Caico – 170

Açu – 159

Ceara-Mirim – 122

White Sand – 110

Apodi – 101

Source: Laboratory of Technological Innovation in Health (LAIS/UFRN)

Interview with Carolina Damásio, infectious disease medical preceptor at ISD

Regarding the Omicron variant, how does it differ from the others?

We still don't have much data regarding Omicron and children, to know if it would be worse, better, more severe or less severe. This is still being studied. What we have seen in other countries, and what is now happening in Brazil, is an increase in hospitalizations of children that we had not seen in other times. Children are part of a population that is still vulnerable, because they have not been vaccinated. This vaccination took a long time. It was approved in December and only started in January. So, COVID is affecting children, for the most part, who have not completed the vaccination schedule, who have not yet been vaccinated against COVID. We cannot say whether this increase is only because they are not vaccinated or whether this variant could be worse in children. This data does not yet exist.

Brazil has always been a world leader in terms of immunizing its population. Why is the COVID-19 vaccine so controversial and divisive?

This is a very worrying thing. At a time when we need to vaccinate the most, this hesitation is at its greatest. This is something that has been worrying many experts. I was seeing data from Brazil that most adult patients hospitalized have not been vaccinated incompletely or not at all. The vaccine that was developed and is being administered to children is very safe. We saw data that was released in recent days by the Centers for Disease Control and Prevention in the United States, showing that in the more than eight million doses administered to children, there were very few serious side effects. No deaths related to the vaccine.

Is this vaccine safe?

It is as safe or safer than most other vaccines administered in the vaccination schedule for children in Brazil. Unfortunately, with everything that is happening, with the spread of fake news and things that are not true, we are suffering and our children are suffering the consequences. This is a very worrying thing. Parents who are reading or watching this interview, your children can now be vaccinated and update their cards as soon as possible. We are reopening schools, with the highly transmissible variant that is reaching children.

In RN, is there an increase in hospitalizations of children?

We are monitoring the increase in hospitalizations of children here in Rio Grande do Norte. We have already had cases this year, in Brazil and in the state, of deaths in this age group. We need to vaccinate as quickly as possible to reduce these hospitalizations and mortality.

Between 2020 and 2021, more than 1,400 children died in Brazil from COVID-19. If the vaccine had existed earlier, could this number have been lower?

By the end of 2021, around 1,500 deaths related to COVID-19 in children had been reported. If the vaccine had arrived earlier, these deaths would probably have been much lower or even non-existent. COVID-19 is a preventable disease. We know how to prevent it and there is already a vaccine. We should not be losing children to a disease that we already know how to prevent and for which there is already a vaccine.

Specifically in Rio Grande do Norte, cases have risen alarmingly again. Is this due to the high transmissibility rate of Ômicron, the availability of more rapid tests?

This is a scenario that is happening internationally. Several countries have broken records in the number of infected people since the beginning of the pandemic and in 2021. This is probably due to the greater transmissibility of the variant, associated with the reduction of social distancing. With the advance of vaccination, cases were more controlled, we were in a better epidemiological scenario and isolation and distancing measures no longer existed, and added to the summer, vacations, parties and several other events that led to crowds. We had a combination of two things: the circulation of a more transmissible variant and the reduction of social distancing.

How has this impacted the State's emergencies and urgent care?

Overcrowding. The emergency rooms are full, the professionals are tired. There are many infected professionals, many teams are understaffed. This also hinders the treatment of other diseases, as patients continue to get sick from other things and need to access emergency services. And we have difficulty getting care for these patients. This also affects the pressure on the health system in terms of hospitalizations. We have a higher number of infected people and a higher number of complications due to COVID-19, because most of the people hospitalized have not completed their vaccination cycle or have not even been vaccinated, and end up needing hospitalization and subsequently increasing mortality.

What is your advice?

What we have been saying since the beginning of the pandemic and reinforcing last year: vaccination, mask and hand washing, in addition to avoiding crowds.