High dengue fever and Covid should overwhelm the health service – 02/13/2024 – Health

With the increase in dengue cases and the spread of Covid, state and municipal health managers foresee a greater overload of services in the coming weeks and are already planning changes to the units’ opening hours and the increase and training of teams.

In the first six weeks of the year, dengue cases quadrupled, according to the Ministry of Health. There are 512,353 suspected cases, compared to 128,842 registered in the same period in 2023 (128,842). The country has 75 deaths.

At the same time, the number of new weekly Covid cases is above 36,000, with a consistent increase over the last five weeks. As of February 8, there were a total of 194 deaths. This scenario has not been observed since April 2023, according to the Conass (National Council of Health Secretaries) monitoring panel.

As revealed by Sheetin two weeks, the moving average of Covid cases in the capital of São Paulo rose from 168 to 404 cases, an increase of 140%.

According to Jurandi Frutuoso, executive secretary of Conass, the pressure caused by the rise in dengue fever and Covid represents an additional challenge for the health services of the SUS (Unified Health System), a situation that is expected to worsen in the coming weeks.

“Growings of people, as occurs during Carnival and the return to school, are direct factors in intensifying the transmission of Covid-19. At the same time, an increase in dengue cases is expected as the disease has not yet reached its peak” , explains.

He says that the two diseases present symptoms that can be confused, making differential diagnosis difficult. “Dengue cases can be managed in observation beds and, if this is done properly, few cases will require hospitalization or ICU beds [Unidade de Terapia Intensiva].”

According to him, managers from the three spheres of the SUS are committed to tackling the increase in dengue cases, with efforts aimed at expanding teams, opening hours of health units and training professionals.

According to doctor Geraldo Reple Sobrinho, president of Cosems-SP (Council of Municipal Health Secretariats of São Paulo), most municipalities have already created crisis committees and are aligned with the actions of the São Paulo government. However, he reports that smaller cities face a lack of material resources and personnel.

“We have not yet had a significant increase in hospitalizations due to dengue, but we already have serious cases and deaths. The impression is that we will soon have a generalized epidemic. The amount of vaccine is negligible for this year.”

In a note, the State Department of Health reported that the first measure of the COE (Emergency Operations Center), created last week, was to allocate R$ 200 million from the IGM (Municipal Management Incentive, from SUS in São Paulo) to the 645 municipalities of the state to combat the dengue mosquito.

He also said that 600 portable and heavy equipment for field actions such as nebulization, known as fumigation, are available for use in cities. The work will be coordinated by the State Civil Defense.

For Wallace Casaca, coordinator of Infotracker, a platform created by researchers from USP (University of São Paulo) and Unifesp (Federal University of São Paulo) that monitors Covid in the state of São Paulo, the efforts of managers are mobilized to respond to cases of dengue, but greater attention is needed to Covid.

“Cases have increased considerably and more structures in health services will possibly be needed to meet these two demands”, he states.

Infectious disease specialist Rosana Richtmann, from the Emilio Ribas Institute, says that the scenario of having two viruses co-circulating at the same time should worsen after Carnival.

“It won’t be anything new for us to start seeing an increase in the number of dengue cases in places where there weren’t so many records.”

Although there is no transmission of dengue from person to person, someone infected in an epidemic location can return to their place of origin, be bitten by the Aedes aegypti mosquito, which will then bite other people and start new transmission cycles.

Regarding Covid, the situation is worse because the strain that is circulating in the country has a very high transmission rate.

“My concern is not who went to Carnival, because they are healthier people [saudáveis]. The problem is that, when they return home, they will meet their grandmothers, their relatives. Then we may not only have an increase in cases, but an important demand in terms of public health.”

Ritchmann remembers that this older population is vulnerable because they received the dose of the bivalent vaccine some time ago, and the vaccine is not specific to the strain that is circulating.

“We have a combination of problems. Lack of better vaccines [versões atualizadas para as novas cepas] and the co-circulation of two important diseases in terms of demand.”

For the infectious disease specialist, it is essential that the health network is well prepared for diagnosis and correct management. “No one should die from dengue. These are preventable deaths as long as there is an adequate structure to recognize and classify patients as quickly as possible and adopt appropriate measures.”

In a note, the Municipal Health Department of São Paulo informed that all health units, such as UBSs (Basic Health Units), UPAs (Emergency Care Units) and PSs (Emergency Rooms) are properly prepared to provide care to cases of both diseases.

“If necessary, specific beds can be activated. Care flows for patients with Covid-19 and other respiratory diseases occur separately.”

According to the secretariat, patients go through a reception process at the UBSs, or screening in the urgency and emergency network, and are referred according to their needs. It also reinforces that health units have tests available for both diseases.

On the 6th, a tent dedicated to caring for patients with dengue symptoms was opened 24 hours a day in Itaquera, in the east of the capital. Other tents may be installed depending on demand, according to the ministry.

The State Department of Health also reported that it is constantly monitoring the epidemiological scenario of the two diseases throughout the state and reinforces the importance of vaccination against Covid, especially booster doses.

Since the end of last year, the Ministry of Health has established a booster dose of the bivalent vaccine for people over 60 years of age and for immunocompromised people over 12 years of age who received the last dose more than six months ago.