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This Friday, Brazil reached the 600,000 deaths caused by covid-19, marked by an erratic national policy, but, finally, with the pandemic in slowdown. Although it registers more than 400 deaths from the virus daily, the data is similar to those registered in November last year, before the gamma variant devastated Manaus and spread across the country. The last 100,000 deaths were reported over three months, while the previous 100,000 occurred in just over a month and a half. And, contrary to what has happened so far, the perspective is that the future will continue to bring good news, as vaccines against the virus have proven effective. A little more than 45% of the population is immunized and the sense of security has grown, which has led managers to adopt less restrictive measures, some of them controversial, such as dispensing with the use of masks.
Experts interviewed by EL PAÍS agree that the current stage of the pandemic in Brazil inspires optimism and that it is possible to resume activities, prioritizing those outdoors and with caution. But they assess that continuing towards the control of transmission will depend on variables such as the behavior of the population, whether a new strain of virus concern will appear and what answers science will give about the duration of protection afforded by vaccines and the “natural immunity” of those who contracted the disease. For now, there is a consensus among researchers that it is not prudent to talk about an end to the pandemic in the short term. “We estimate that a pandemic of this magnitude is considered controlled when we have a very small number of disease-related deaths, a very small bed occupancy rate and a complete immunization coverage of at least 80% of the population”, says the researcher of Fiocruz, Margareth Dalcolmo, in a video of the institution. She doesn’t see this scenario as likely for later this year. “We are in a positive situation, but the coronavirus is still a problem. Care is still essential. Of course, we must discuss flexibility, but always with caution. And with the clarity that everything is changeable, nothing is definitive”, adds the researcher at Infogripe, Marcelo Gomes.
No consensus to release masks
The positive numbers have made mayors and governors announce increasingly larger openings. More activities are released with the adoption of some protocols, test events rehearse the opening of audiences in football stadiums and musical shows with reduced capacity. In the midst of this, there are more controversial measures, such as the removal of the obligatory nature of masks in some cities. Caxias do Sul, in Rio de Janeiro, was the first to bring down protective equipment in open or closed places. “Mask the population almost no longer uses. Nobody will live with a mask for the rest of their lives. Anyone who wants to use it can use it, but mandatory use has already been done”, said Mayor Washington Reis (MDB). Prosecutor’s Office and Defender’s Office try to reverse the decision. On the other side of the country, in Ceará, Nova Olinda also decided to release the use of masks, but only in open spaces. One of the largest cities in Brazil, São Paulo, is also studying a similar measure this October.
Therefore, the National Council of State Secretaries of Health (Conass) issued a note with a request for managers not to rush. “We need to be aware of the frustrating experiences of some countries that, believing they have overcome the risks, suspended the mandatory use of masks, relaxed prevention measures and, for this very reason, had a significant increase in the number of cases and deaths, forcing them to back down”, argues the entity. Throughout the crisis, masks were an important protection tool and there is no consensus among researchers about when to abandon them.
“We cannot reduce the discussion on whether or not to release the mask, but we should think about more focused measures. We should be discussing flexibilization in open spaces and in closed spaces separately”, defends Vitor Mori, a researcher at the University of Vermont. He says that, at the current moment of the pandemic, it is unfeasible to think about releasing masks in closed places, where the population should wear masks that provide greater protection due to the higher risk. However, he believes that giving up the equipment in certain outdoor locations may already be possible. “We are not very strict. People continue to wear loose cloth masks indoors. We need to be more rigorous. But, for open spaces, I think the scenario is different and the impact would not be that great”, he argues.
Nurse Thereza Maria Magalhães Moreira, a professor of Epidemiology at the State University of Ceará, argues that masks must be kept mandatory. “The volume of people on the streets and in places as a whole should increase, which will reduce social distance, so facial protection is essential to reduce transmission”, he says. Marcelo Gomes adds that the discussion about protective equipment is an important part of the equation to control the pandemic, as well as social distancing and other protective measures even with the advance of vaccination against the disease. “If we facilitate the transmission of the virus a lot, even if today the vaccines put a scenario in which it takes many more cases to generate a death, if the transmission increases a lot, there will end up having an increase in deaths”, he defends.
The Infogripe researcher remembers the case of Rio de Janeiro, which relaxed the protection measures and then had to back down and go back to restricting face-to-face classes after an increase in serious cases in the elderly, months after the vaccinations. A similar movement, he points out, takes place in the Federal District. “These are occasional cases. These divergences serve as a warning: we have to maintain vigilance and follow-up so that we are not surprised”, he says.
Good news and caution
In recent days, Governor João Doria was one of those who celebrated the cooling of the pandemic. “Of the 645 municipalities in São Paulo, 467 cities had no deaths from covid-19 in the last week. There are 72% of the municipalities in the state. Another 276 cities had no deaths from the disease in the last month,” he wrote on Twitter. It’s good news, but it needs to be read with caution, experts say. Marcelo Gomes does not rule out, for example, that the delta variant, of concern at the moment, is still a problem, although its arrival in the country has so far caused lesser damage than experts anticipated. Delta arrived in Brazil at a time of “scorched earth” by Gama and advances in vaccination. In other words, it found a smaller susceptible population, as there were many people newly immunized or still with natural protection for having had covid-19. But the future on her is still uncertain, especially given the fall of this protection over time. “The most worrying projections have not been confirmed so far, but that does not guarantee that it cannot come to cause damage in a few months. We can’t dismiss the problem”, he ponders.
In any case, the need for care should still remain for some time. The researchers point out that even with the permission of activities such as concerts and football matches, for example, there will be a need for protective measures such as reduced public and distance, negative tests and proof of vaccination. The world will not be the same in the short term. Marcelo Gomes does not rule out that even after controlling the pandemic, the country will adopt actions similar to those of Asian countries, using masks to show signs of possible flu outbreaks. When this crisis control will come, however, researchers do not venture to predict. “It will take time for covid-19 to be an endemic disease. She is still pandemic. Then we will have an Pandemic and finally an endemic [quando circula habitualmente, sem trazer maiores riscos, como a gripe]. It is still not possible to estimate with certainty when the pandemic should end, but as we had a second giant wave and we have advanced in vaccines, Brazil will move in that direction”, projects Magalhães.
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