Paper: Comparisons between the Neighboring States of Amazonas and Pará in Brazil in the Second Wave of COVID-19 Outbreak and a Possible Role of Early Ambulatory Treatment
"Amazonas and Pará, the two largest neighboring states in Brazil, were in a similar situation during the worse period of the first wave of COVID-19 outbreak in May 2020, and each state and the municipalities separately adopted procedures to contain the first wave of COVID-19 outbreak, such as partial lockdown in some cities and used several measures of prevention. However, the Pará state government, after 21 May 2020, started a strong support to early ambulatory treatment in the public healthcare system. The outcome was that Pará presented the faster reduction in Brazil of daily deaths after the maximum of the first wave: the 7-day average deaths per day decreased 95% in 70 days (from 25 May 2020 to 3 August 2020).
Now, in the second wave of COVID-19 outbreak, the state of Amazonas faced a serious situation, mainly from the middle of January to the middle of February 2021; meanwhile, the state of Pará has presented a much smaller growth in the death rates, presenting an accumulated mortality during the second wave much smaller than that of Amazonas, the other neighboring states of Amazonas, and also most of the other states of Brazil. The accumulated mortality per population so far in the second wave of COVID-19 outbreak, (from 11 November 2020 to 15 March 2021) of Amazonas and Pará are 1645 and 296 deaths per million people, respectively. This means that Amazonas is presenting an accumulated mortality per population in the second wave more than five times that of Pará, which is a significant difference. Fortunately, this large difference is decreasing because Amazonas has implemented several measures of prevention (mainly from January 2021); the vaccination program, which started in late January 2021, is also slightly contributing to decrease the daily deaths.
Although it is necessary to have future in-depth research to provide a grounded answerto explain with clarity this significant difference between Amazonas and Pará in the second wave of COVID-19 outbreak, mainly in January–February 2021 (when the virus variant P.1 was already present in the North region and in some states of Brazil), it is likely that the strong support of the Pará state government, after 21 May 2020, to early ambulatory treatment, and the adhering of the municipalities and their physicians in the public healthcare system to early ambulatory treatment, may have played a role in the good result of Pará for controlling COVID-19 (even with the presence of the virus variant P.1) in comparison with the states of the region and many states of Brazil. The comparisons offered in the present work indicates that early ambulatory treatment is an option that should not be a priori neglected in the public healthcare policies to combat COVID-19.
...
Concerning the need for a prescription for the medicines, in the beginning of the pandemic,only azithromycin, because it is an antibiotic, needed a medical prescription in Brazil. Hydroxychloroquine and ivermectin were over-the-counter drugs that could be obtained without a prescription. However, shortly after the beginning of the pandemic, a prescription was necessary to purchase hydroxychloroquine after 20 March 2020 [56] and ivermectin after 22 July 2020 [57]. The need for a prescription for ivermectin was revoked on 1 September 2020 [58], but that for hydroxychloroquine is still maintained. With regard to the availability of medicines, shortly after the start of the pandemic, the press, and the social networks, mainly messaging apps such as WhatsApp, reported the possibility of using some medicines, such as those above mentioned, to combat COVID-19. It was also reported that some of the medicines might not work and that they could cause side effects. Even with the critical news, there was a great demand for these medicines in Brazil, and the price of two of them (hydroxychloroquine and ivermectin) increased substantially, and they were practically sold out in the pharmacies for some months. Therefore, the purchase of two of the medicine by patients individually was very restricted, even for those who had a prescription and had financial resources to purchase them. The purchase of these medicines by healthcare plan operators of the private medical network, such as Unimed Belém, was possible because the purchase was made directly from manufacturers or representatives.
Regardless of the pandemic, the purchase of medicines by the public healthcare system for distribution to patients is particularly important in Brazil, especially for low SES patients. In many cases, when public healthcare units do not provide the medications to the patients, even with a prescription and the medications available at pharmacies, many low SES patients have financial difficulties to purchase them. In Brazil, public organizations must make the purchase of medicines and other supplies through a bidding process, which requires time and work, in addition to financial resources. If there is urgency, as in the case of the beginning of the pandemic, the bidding process may be simplified, but the public organization lawyers must prepare and publish a document with grounded justifications for the procedure, as the municipality of Afuá-PA did on 13 May 2020 [43]. However, this is laborious and requires determination, in addition to depending on financial resources. The great difference of the state of Pará in relation to Amazonas and the other states of Brazil was that the state government made the purchase process in a centralized way for all municipalities in the state. The public healthcare system received the medications in their municipalities without having to follow the entire purchase process, which involve bureaucratic issues, publication of documents, search for suppliers, payment and, finally, the receipt of the medications.
In that situation of May 2021, with a high mortality rate, the physicians in the public healthcare system of the state of Pará were able to choose the approach of early ambulatory treatment after 21 May 2020, because: (1) the results of the other approach were not so successful (the number of deaths was increasing steadily); (2) the actions for COVID-19 of Unimed Belém and the municipality of Ourilândia do Norte-PA for their patient in the beginning of May 2020 [42,44] was an incentive; and (3) in Pará the medicines were available and provided free of charge by the state government. In the public medical healthcare units of Pará, the patients received the medicines directly at the end of the medical consultation; they did not need to go to the pharmacy. The particularly good practical result achieved from the fourth week of May 2020 in Pará gave credibility to the early ambulatory treatment in the public healthcare system. In Amazonas, early ambulatory treatment was difficulted in the public healthcare system mainly because the state government did not support early ambulatory treatment, and, therefore, did not purchase the medicines."
[-] TehCaster | 5 points | Apr 04 2021 22:43:35
"Amazonas and Pará, the two largest neighboring states in Brazil, were in a similar situation during the worse period of the first wave of COVID-19 outbreak in May 2020, and each state and the municipalities separately adopted procedures to contain the first wave of COVID-19 outbreak, such as partial lockdown in some cities and used several measures of prevention. However, the Pará state government, after 21 May 2020, started a strong support to early ambulatory treatment in the public healthcare system. The outcome was that Pará presented the faster reduction in Brazil of daily deaths after the maximum of the first wave: the 7-day average deaths per day decreased 95% in 70 days (from 25 May 2020 to 3 August 2020).
Now, in the second wave of COVID-19 outbreak, the state of Amazonas faced a serious situation, mainly from the middle of January to the middle of February 2021; meanwhile, the state of Pará has presented a much smaller growth in the death rates, presenting an accumulated mortality during the second wave much smaller than that of Amazonas, the other neighboring states of Amazonas, and also most of the other states of Brazil. The accumulated mortality per population so far in the second wave of COVID-19 outbreak, (from 11 November 2020 to 15 March 2021) of Amazonas and Pará are 1645 and 296 deaths per million people, respectively. This means that Amazonas is presenting an accumulated mortality per population in the second wave more than five times that of Pará, which is a significant difference. Fortunately, this large difference is decreasing because Amazonas has implemented several measures of prevention (mainly from January 2021); the vaccination program, which started in late January 2021, is also slightly contributing to decrease the daily deaths.
Although it is necessary to have future in-depth research to provide a grounded answerto explain with clarity this significant difference between Amazonas and Pará in the second wave of COVID-19 outbreak, mainly in January–February 2021 (when the virus variant P.1 was already present in the North region and in some states of Brazil), it is likely that the strong support of the Pará state government, after 21 May 2020, to early ambulatory treatment, and the adhering of the municipalities and their physicians in the public healthcare system to early ambulatory treatment, may have played a role in the good result of Pará for controlling COVID-19 (even with the presence of the virus variant P.1) in comparison with the states of the region and many states of Brazil. The comparisons offered in the present work indicates that early ambulatory treatment is an option that should not be a priori neglected in the public healthcare policies to combat COVID-19.
...
Concerning the need for a prescription for the medicines, in the beginning of the pandemic,only azithromycin, because it is an antibiotic, needed a medical prescription in Brazil. Hydroxychloroquine and ivermectin were over-the-counter drugs that could be obtained without a prescription. However, shortly after the beginning of the pandemic, a prescription was necessary to purchase hydroxychloroquine after 20 March 2020 [56] and ivermectin after 22 July 2020 [57]. The need for a prescription for ivermectin was revoked on 1 September 2020 [58], but that for hydroxychloroquine is still maintained. With regard to the availability of medicines, shortly after the start of the pandemic, the press, and the social networks, mainly messaging apps such as WhatsApp, reported the possibility of using some medicines, such as those above mentioned, to combat COVID-19. It was also reported that some of the medicines might not work and that they could cause side effects. Even with the critical news, there was a great demand for these medicines in Brazil, and the price of two of them (hydroxychloroquine and ivermectin) increased substantially, and they were practically sold out in the pharmacies for some months. Therefore, the purchase of two of the medicine by patients individually was very restricted, even for those who had a prescription and had financial resources to purchase them. The purchase of these medicines by healthcare plan operators of the private medical network, such as Unimed Belém, was possible because the purchase was made directly from manufacturers or representatives.
Regardless of the pandemic, the purchase of medicines by the public healthcare system for distribution to patients is particularly important in Brazil, especially for low SES patients. In many cases, when public healthcare units do not provide the medications to the patients, even with a prescription and the medications available at pharmacies, many low SES patients have financial difficulties to purchase them. In Brazil, public organizations must make the purchase of medicines and other supplies through a bidding process, which requires time and work, in addition to financial resources. If there is urgency, as in the case of the beginning of the pandemic, the bidding process may be simplified, but the public organization lawyers must prepare and publish a document with grounded justifications for the procedure, as the municipality of Afuá-PA did on 13 May 2020 [43]. However, this is laborious and requires determination, in addition to depending on financial resources. The great difference of the state of Pará in relation to Amazonas and the other states of Brazil was that the state government made the purchase process in a centralized way for all municipalities in the state. The public healthcare system received the medications in their municipalities without having to follow the entire purchase process, which involve bureaucratic issues, publication of documents, search for suppliers, payment and, finally, the receipt of the medications.
In that situation of May 2021, with a high mortality rate, the physicians in the public healthcare system of the state of Pará were able to choose the approach of early ambulatory treatment after 21 May 2020, because: (1) the results of the other approach were not so successful (the number of deaths was increasing steadily); (2) the actions for COVID-19 of Unimed Belém and the municipality of Ourilândia do Norte-PA for their patient in the beginning of May 2020 [42,44] was an incentive; and (3) in Pará the medicines were available and provided free of charge by the state government. In the public medical healthcare units of Pará, the patients received the medicines directly at the end of the medical consultation; they did not need to go to the pharmacy. The particularly good practical result achieved from the fourth week of May 2020 in Pará gave credibility to the early ambulatory treatment in the public healthcare system. In Amazonas, early ambulatory treatment was difficulted in the public healthcare system mainly because the state government did not support early ambulatory treatment, and, therefore, did not purchase the medicines."
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[-] RogerKnights | 1 points | Apr 05 2021 15:01:59
Typo: “In that situation of May 2021 ....” Should be 2020.
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