Health inflates transfers for dengue and distorts data – 03/18/2024 – Health

The Ministry of Health has released inconsistent data on the lethality of dengue in 2024, in addition to inflating announcements of transfers to states and municipalities against health emergencies.

The ministry says that the lethality of the disease this year is lower than in 2023, but it uses information that has not yet been consolidated for comparison, which for experts would be a mistake considering that more than half of the deaths are under investigation.

“The fatality rate, at 0.3% of cases, is still less than half of last year (0.7%), despite a slight increase compared to last week (0.2%). We are taking better care of our cases, and people are more attentive to the warning signs”, said the Minister of Health, Nísia Trindade, on social media this Wednesday (13).

For Alexandre Naime Barbosa, scientific coordinator at SBI (Brazilian Society of Infectious Diseases) and professor at Unesp (Universidade Estadual Paulista) in Botucatu, data from 2024 should not be used for comparison with last year, because information on deaths from 2023 is already are consolidated.

In 2023, 1,094 deaths were confirmed out of 1.6 million probable cases. This Friday (15), Brazil surpassed last year’s probable cases and reached 513 confirmed deaths, with another 903 being investigated. In other words, if the lethality rate in 2024 were calculated with the sum of deaths under investigation, it would be higher than that in 2023.

According to epidemiologist Wanderson de Oliveira, the lethality indicator measures the number of deaths by the number of cases. It may be useful for monitoring a dengue epidemic, but should be interpreted with caution due to its limitations.

This is because there are several factors that can influence the result, such as mild cases that may not be reported, difficulty in accessing treatment, in addition to the quality of the healthcare system, which can lead to a false impression that the disease is less serious than it really is. It is.

“At the current time, the priority should be to implement a task force to investigate deaths and understand whether the causes of these deaths were due to the characteristics of the people or the quality of the services provided. This post was very unfortunate, as it is cold and It gives the impression that these are numbers. For those who have lost a loved one, the fatality rate is 100%”, said Oliveira, who served as national secretary of Health Surveillance at the Ministry of Health from 2019 to 2020.

Another issue highlighted by Oliveira is the delay in updating microdata, which makes it difficult for researchers to accurately monitor the scenario not only in the country, but in states and municipalities. As an example, this Friday (15), the most recent data available was from March 9th.

The Ministry of Health was asked about the lethality data, but only said that the death investigation process is careful and time-consuming, in addition to involving the participation of 5,570 municipalities.

“Some diseases present symptoms similar to dengue fever, such as Oropouche fever. This factor makes it necessary for a more in-depth investigation into the true cause of death”, informed Health.

The ministry also states that it has increased the amount available to combat health emergencies, including dengue fever, to R$1.5 billion. The amount, however, is not yet available in the department’s budget.

In a statement, Health declared that the billion-dollar figure is made up “of discretionary resources that will be reallocated to deal with health emergencies.”

Technicians from the ministry itself state, with reservations, that the announced resource is an estimate of what can be transferred per month for health emergencies.

In practice, around R$60 million were released more than a month after the funding was announced. The municipality of Rio de Janeiro leads the transfers, with R$16.2 million, followed by the Federal District, which received R$5.5 million.

States and municipalities need to declare a health emergency and present an action plan to receive emergency funding. The ministry requires that this document shows the epidemiological situation and the scenario of the health care network, among other points.

So far, Health has distributed the resource to five states and more than 180 municipalities. “Requests from three other states – São Paulo, Amapá and Espírito Santo – are being analyzed for fulfillment in the coming days,” said the ministry.

On February 9, the ministry published the ordinance that sets out rules for releasing extra funds for health emergencies. The extra resources are transferred to state and municipal health funds.

The money is used to cover the costs of providing services to the population. In other words, it can pay teams and other costs to maintain or expand the functioning of the local health network.

The ordinance prevents the use of funds for “construction or expansion of buildings and acquisition of permanent material”. “The funding resources may be used to pay staff, purchase medicines, logistics and other current expenses within the scope of the emergency response”, says the document.

At the end of last year, the ministry had allocated R$256 million to states and municipalities for actions to “prevent endemic diseases with an emphasis on arboviruses”, such as dengue.

In addition to cases of increased contagion of a certain disease, states and municipalities can declare a health emergency and request extra funding when there are environmental disasters or situations of lack of assistance to the population, according to the ministry’s rules.