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Why did deaths from other diseases also trigger the pandemic?

Photo: Jair Amaral/EM/DAPress

Fear of covid-19 and the strangulation of medical services due to the pandemic meant that 51-year-old personnel supervisor Alex José de Oliveira Ferreira, a resident of Itabirito, in the central region of Minas Gerais, had to wait weeks for an appointment by the private agreement.

While the delay aggravated his hypertension condition, despite taking care of himself using the prescribed medication, he also stopped going to the emergency room when he felt unwell, to avoid the emergency care unit.

With only two days to go before she was finally able to consult, this husband, father of two daughters, had a heart attack.

In addition to the more than 55,000 lives lost in Minas Gerais to the new coronavirus (Sars-CoV-2), the weakening of the health system and often the fear of leaving isolation silently killed thousands of patients from other controllable diseases, as occurred with Alex.

In the supervisor’s city alone, which has 53,000 inhabitants and is one of the richest in the region, the number of daily deaths not related to covid-19 or to external causes, such as accidents and crimes, increased by 29% from January to September 2021 compared to 2019 (last pre-pandemic year).

The data are from the State Department of Health of Minas Gerais (SES-MG), compiled by the report from the State of Minas.

The survey indicates that in 2020, 391 municipalities in Minas Gerais (46% of the total of 853) registered more daily non-covid-19 deaths than in the previous year. In 2021, this amount was already 333 until September (39%). The average increase in comparative deaths was 17% in 2020 and 20% in 2021.

The greatest volume of deaths is related to cerebrovascular and cardiac diseases, many of them needing follow-up and prescription medication.

This was the case with Alex, according to his wife, the administrative supervisor Mônica Lúcia dos Reis Ferreira, 48.

“His appointment was scheduled for May 11, but days before he started to feel sick. From the 7th to the 8th, I asked if we could go to the UPA in the city, but he didn’t want to. He preferred to rest and get better, he thought the appointment was close and would be safer than the emergency. But, on the 9th, he was very ill, was taken by firefighters to the UPA, but he didn’t resist. For us it was unexpected, because he looked good and took care of himself”, said Mônica.

Also resident of Itabirito, the administrator Fábio Júnior Ribeiro, 41, and his wife need specialized care, but have avoided attending medical services for fear of crowding and possible contagion by the new coronavirus.

“She has to remove the uterus and I need to remove the gallbladder, but we are afraid to go to a hospital or see us at health centers. With the advance of vaccination now, we will feel safer”, says the administrator.

Housewife Margareth Silva, 57, lost her aunt Luzia Silva, 84, to a cancer that has spread.

“She had health monitoring, but after the coronavirus started to circulate, she no longer left the house for anything. One day, he got sick and had no more treatment”, he says. The bakery attendant Cássia Maria da Silva, 45, lost her aunt Iracilda Silva, 60, who is cardiac, who lives in the municipality of Moeda. “She was afraid to consult, to arrive at the health centers all full of people suspected of having COVID-19. The worst thing is that they tried to bury her as if she had the disease, but we managed to reverse it and she could at least have an open burial, which many did not have, since COVID-19 forces the wake to be closed”, he says.

Physician Carlos Starling, an infectious disease specialist and member of the Belo Horizonte City Hall’s Committee to Combat COVID-19, considers that this increase in deaths is an indirect effect of a pandemic such as the one faced today, with the need for isolation and social precautions.

“They are consequences of several factors in the pandemic, such as the overcrowding of the system due to a disease. As people needed to move away, there was also a reduction in monitoring of other health conditions, postponement of surgeries and treatments. Certainly, it was very harmful for those who already had a health condition that got worse,” observes Starling.

“The overcrowding of the health system with one disease does not allow for the treatment of other important diseases. In the pandemic, not only those infected who needed care were affected, but also those who lost the opportunity for treatment. The situation was not worse because many reference cities, such as Belo Horizonte, knew how to adapt to these demands, including with fundamental partnerships with the private health sector”, considers the infectious disease specialist.

Non-respiratory disease lethality increased by 43%

In Brazil, the increase in the rate of daily deaths from non-respiratory diseases is noteworthy, which had an increase of almost 43%, compared to 2019, the last pre-pandemic year, with this year’s data, only until September 10th.

In the Southeast Region, the increase was 44.3% in the same daily comparison.

The rise in deaths on the national scene is observed in data from the Ministry of Health sent for the report, relating to patients who did not resist non-respiratory diseases.

However, it may contain distortions, as it includes conditions in which doctors still reported deaths caused by covid-19, such as “other undetermined infectious diseases”.

According to the figures, in Brazil, in 2019, 3,254 people died daily, on average, from non-respiratory causes (excluding accidents, crimes and other external factors).

The number increased in 2020, the first year of the pandemic, to 3,866 deaths per day, a growth of 19%, but in 2021 it suffered a 43% jump compared to 2019, with deaths of 4,640 patients every 24 hours.

The regions that showed the highest percentage increase in deaths from non-respiratory diseases per day in 2021, compared to 2019, were the Midwest (62%), South (51%), North (50%), Southeast (44%) and Northeast (28%).

The diseases that showed the greatest increase in deaths in 2021 were ischemic heart disease, with a rate of 274 deaths per day; the cerebrovascular, which reach 246 every 24 hours; and diabetes, with 184 daily deaths.

In Minas Gerais, cerebrovascular diseases are the biggest cause of death. Only in the West, East and Southeast macro-health regions are there more deaths from ischemic heart disease.

Reflections of the suspension of appointments and surgeries

The SES-MG confirms that many patients were affected by the pandemic, even without having contracted covid-19, since elective procedures, such as surgeries and consultations, were suspended as a way to prevent possible overload in the public health network.

“They also had their face-to-face care suspended, partially or totally, outpatient services with assistance aimed at people in need of rehabilitation, hypertensive patients, diabetics and (patients) dentistry, among others,” he added.

The folder highlights, however, that since the end of 2020 and throughout 2021, the resumption of elective outpatient and hospital services has taken place “in a responsible and organized manner, through the strategic action Cuida de Minas, a program that seeks to ensure comprehensiveness and continuity of care for SUS users with chronic conditions and other health conditions that need to be assisted even during a pandemic. It is also worth noting that the urgency and emergency services never stopped”, informed the secretariat.

At the moment, the SES-MG informs evaluating the hiring of health service providers and a new hospital management plan for elective surgeries.

The Ministry of Health claims to provide unrestricted support to local SUS managers (states and municipalities) for performing surgeries, and adds that it released R$ 350 million in extra resources, transferred after proving the procedures.

“As a result of the more than 300 million doses of covid-19 vaccine distributed throughout the country, Brazil surpasses the mark of more than 100 million Brazilians fully vaccinated, surpassing 60% of the target audience immunized with the two doses of vaccine or with the single-dose immunizer. The result of the effort of the federal government, together with the states and municipalities, is a cooler pandemic scenario, with a drop in the number of cases and deaths, and a less pressured public health system”.

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