Dear editor,
The history of the COVID-19 epidemic implied important changes in the way we conceive public health, mainly contributing to discussions about the social dynamics in health, making political and economic issues more acute. The epidemic led to a rearrangement and intensification of prevention practices, at the same time that better-structured theories to understand and modify people's behavior in the face of the risks identified in epidemiological models were formulated. A good review of the literature on this disease has been published by Harapan and colleagues [1], however, developing these strategies is not an easy task.
Brazil has the largest public health system in the world, Brazilian Unified Health System (SUS) serving a population of more than 200 million people [2]. SUS was created to guarantee universal health care and among the changes that took place in Brazilian public health there was a reduction in inequalities and a sharp drop in mortality from communicable diseases, maternal and child morbidity and mortality, and this impacted the increase in life expectancy. This made SUS an example for other countries. However, despite Brazil having this health system and though it was an advance in of coping with the COVID-19, government officials as well as health agents were not able to respond sufficiently to socio-political-economic contingencies with the increase of the epidemic in the poorest and least literate population.
The epidemic has challenged health systems to such an extent that today Brazil there are clear signs that infections are moving inland into smaller cities in the country at absurd speed, and the worst thing is that these cities have inadequate health conditions, many without hospitals, without ICUs and much less ventilatory support. Regarding health care systems and epidemics, one recent article in the present journal touched the problem. Juan Carlos Navarro and your group [3] report the implications and influence dengue eco-epidemiological dynamics as well as the COVID-19 epidemic in Ecuador and other countries in Latin America. Interestingly, according to the author a high probability of co-infections of both viruses can worsen the epidemiological situation of diagnostic, control and treatment in Latin America, as well as the number of seriously ill patients will exceed the availability of a bed and the health system will collapse.
We read also with interest the arguments by Gialloreti and collaborators [4] about developing a public health surveillance system to be also essential for monitoring the effectiveness of the health interventions. The basic step to understand the health needs of a population is to have in place an effective health monitoring system. Highlights that, develop strategies and evidence-based decisions are fundamentals. Nevertheless, although there is much research going on in country, the epidemic is out of control.
A study by Frieden and Lee [5] comments very precisely the factors that contribute to spreading and implications for control of SARS-CoV-2. Highlights that the targeted and rapidly implemented public health interventions to prevent and mitigate this pandemic beyond the early engagement of communities are critical for early interruption of transmission. Based on evidence from several other pathogens to facilitate an approach, among these factors are cited; (i) pathogen-specific factors as binding site, environmental persistence, virulence, and infectious dose; (ii) host factors (duration of infection, location, the burden of infection, and symptoms); (iii) environmental factors that including population density and the availability and use of infection prevention and control measures; (iv) and behavioral factors that include cough hygiene, social customs, and adherence to public health guidance.
The current pandemic is clearly an international public health problem, but Brazil today, we can add the political instability as another big factor that contributes to the dissemination of COVID-19 because domestic political factors and a possible economic recession hampers the government's ability to strengthen its health systems response in a timely manner to COVID-19 control. What we see with this is an escalation in the number of cases and deaths by COVID-19. This same snapshot has been seen in the largest countries in the world.
From all that has been said, we can reach a fundamental conclusion: COVID-19 agitates at the society, challenges public health and the economy. In Brazil, the pandemic has brought to light major political conflicts. The true legacy that COVID-19 will leave us is that science showed how big it is and we need more than ever to invest in Science. And public health? Brazil's response to COVID-19 highlights important lessons and concerns. Political instability can overcome positively responding to COVID-19 and it is worth mentioning that this response would be much more difficult, perhaps even impossible, without SUS. Going forward, not only in Brazil but all other countries must find innovative ways to ensure that public health receives the funding and human resources needed to guarantee continuity of care for persons affected by pandemics. The aftermath of this course can, paradoxically, offer a new opportunity to manage toward better working public health systems.
Funding
This study was supported by CNPq, CAPES and FAPEMIG. This letter was based on observations and reflections about COVID-19 pandemic during studies supported by the funding agencies.
Ethical approval
Not required.
Declaration of competing interest
The author(s) declared no potential conflicts of interest concerning for to the research, authorship, and/or publication of this article.
References
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