Brazil is close to collapsing its health system, given that the SUS ICU beds are already at the limit of their capacity and the private ICU beds are not sufficiently capable to absorb the demands. In view of this catastrophic situation for the health system in Brazil, there is no alternative but to adopt the "lockdown" immediately to stop the growth in the number of infected and of deaths that already exceeds 1,179 deaths per day. This “lockdown” must be adopted especially in cities and regions that are critical from the point of view of the health system's capacity to serve.

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BRAZIL TOWARDS THE COLLAPSE OF THE HEALTH SYSTEM
Fernando Alcoforado*
On 5/19/2020, 17,509 deaths caused by Covid-19 and 262,545 confirmed cases of the
disease were recorded in Brazil. The latest update from the Ministry of Health shows that,
in the last 24 hours, 1,179 deaths from the disease caused by the new Coronavirus were
recorded, with an average of one death every 73 seconds. Growth rate and lethality of the
disease in Brazil is among the 10 worst countries studied worldwide and the increase in
lethality is the worst in Latin America. Among the 291 cases of the new Coronavirus in
Brazil, 28 are hospitalized - the equivalent of only one in ten infected. The information
appears in the daily bulletin released by the Ministry of Health.
From January 2020, when the first case of Covid-19 was registered in Brazil, until May
20, 2020, that is, about 5 months, there were an average of 3,502 deaths per month. It is
estimated that between 5% and 15% of the total number of people infected with the new
Coronavirus are among these most serious cases, requiring, consequently, the attendance
in ICUs. The average stay of patients in ICUs in Brazil is 12 to 21 days or approximately
15 days and each ICU bed can serve, therefore, 2 patients per month. In Brazil, 17.9
thousand of the 40.6 thousand ICU beds in the country are in the SUS (Public Health
System). The Brazilian Association of Intensive Care Medicine (AMIB) informs that
private ICU beds have an average occupancy rate of 75%, those of SUS have 95%. This
means that the SUS ICU beds are already fully occupied, while only 25% of private ICU
beds remain, that is, 5,675 beds.
One of the most dramatic consequences of the skyrocketing cases of Covid-19 is the
crowding of ICUs. The supply of beds has been decreasing day by day in several capitals
and, in Amazonas, public hospitals have already collapsed. Ceará became the first state
to have full occupancy of the ICU beds. And the threat of collapse reaches the capitals
across the country. In São Paulo, at least seven hospitals in the city already have the
capacity for ICU beds occupied above 70%. The Emílio Ribas hospital, a reference in
the treatment of infectious diseases, reached 100% of ICU occupations with patients of
the new Coronavirus.
To assess how long the health system will be able to serve the population infected with
the new Coronavirus, it was admitted that there is no longer availability of SUS ICU beds
and that the following simplifying hypotheses should be considered:
• If demand occurs with 5% of current infected: 13,127 ICU beds (0.05 x 262,545
confirmed cases)> 5,675 private ICU beds available
• If demand occurs with 10% of current infected: 26,254 ICU beds (0.10 x 262,545
confirmed cases)> 5,675 private ICU beds available
• If there is a demand with 15% of current infected: 39,382 ICU beds (0.15 x 262,545
confirmed cases)> 5,675 private ICU beds available
If we consider that the total capacity of private ICU beds of 22,700 beds is available, it
could not meet a demand for infected patients exceeding 10% of the total, that is, 26,254
ICU beds. It is concluded, therefore, the impossibility of private ICU beds to meet the
demands of infected people above 10% of the current total number of infected people in
Brazil.

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Taking into account the calculations performed, it can be said that Brazil is close to
collapsing its health system, given that the SUS ICU beds are already at the limit of their
capacity and the private ICU beds are not sufficiently capable (5,675 beds) to absorb the
demands considering 5%, 10% and 15% of infected patients. In view of this catastrophic
situation for the health system in Brazil, there is no alternative but to adopt the
"lockdown" immediately to stop the growth in the number of infected and of deaths that
already exceeds 1,179 deaths per day. This “lockdown” must be adopted especially in
cities and regions that are critical from the point of view of the health system's capacity
to serve.
One fact is indisputable: Brazil has fewer beds than countries that have already collapsed
their health systems in the face of Covid-19, such as Spain and Italy, record-breaking
deaths from the new Coronavirus. These countries have about 3 hospital spaces for every
thousand inhabitants, while Brazil has only 1.95 per thousand inhabitants. To overcome
Brazil's problems, it is necessary to be inspired by the countries that are managing to slow
the progress of the new Coronavirus.
Article signed by Camilla Veras Mota under the title Modelo matemático aponta colapso
do sistema de saúde a partir de 21 de abril (Mathematical model points out the collapse
of the health system as of April 21), available on the website
<https://www.bbc.com/portuguese/brasil-52300278> confirms our conclusions about the
imminent collapse of the Brazilian health system. This study concludes that, at the current
pace of evolution of the Covid-19 pandemic in Brazil, the volume of intensive care units
(ICUs) available in the country would not be sufficient to meet demand from the week of
April 21. At the current pace of evolution of the Covid-19 pandemic in Brazil, the volume
of intensive care units (ICUs) available in the country would not be sufficient to meet
demand from the week of April 21. This projection is based on a mathematical model
created by a group of six researchers in the fields of Physics and Medicine linked to the
federal universities of Alagoas and Rio Grande do Norte, to Santa Casa de Maceió, to the
HIV / AIDS Testing and Reception Center Itaberaba (BA) and the School of Health
Sciences, in Brasília.
The study, published on April 3, was submitted for international publication and is
preliminary, that is, it has not yet been evaluated by peers - but it showed adherence to
the real data until at least the last April 15: the evolution of the numbers of deaths reported
by the Ministry of Health (an indicator with less underreporting than the total volume of
cases and, therefore, more reliable) has been consistent with the forecasts pointed out by
the team and used as a basis for calculating the use of ICU beds in hospitals. The work
also takes into account the social distancing measures currently in force - the so-called
"voluntary quarantine" -, its impact on reducing the transmission of the disease and the
average percentage of infected people who need to be hospitalized in intensive care units
for presenting more severe conditions of infection in the lungs.
The projections of the model developed by the group of researchers point to a total
number of infected people of 3.15 million, with 393 thousand deaths in a period that is
not predetermined, but that, according to the researcher, would concentrate in a few
months. He points out, however, that this is the "inertia" scenario, if the current measures
are not tightened up. The researchers also made projections for alternative scenarios to
assess the effectiveness of the measures taken so far. If there were no movement

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restrictions, for example, the total number of infected people would be 30.47 million, with
1.45 million dead. In a scenario of vertical isolation such as that advocated by President
Jair Bolsonaro, with social distancing only from those over 60 years old, there would be
about 26 million infected and 723 thousand dead.
Text by Rafael Garcia under the title Veja em gráfico os países estão conseguindo frear o
coronavírus (See in graph the countries are managing to curb the coronavirus), available
on the website <https://extra.globo.com/noticias/coronavirus/veja-em-grafico-os-paises-
estao-conseguindo-frear-coronavirus-24317040.html>, informs that the superior
performance of Japan and Singapore draws attention by avoiding a high rate of growth of
the epidemic because they reacted quickly to isolate cases by conducting tests and
adopting social distance and maintaining strict policies since then. China and South Korea
stand out for having managed to block their growth curves after suffering an explosive
increase in cases. The Chinese adopted a policy of curfew and blocking transport from
the 24th day of the epidemic. Koreans have been successful with measures of social
detachment and extensive testing of suspected cases and tracking / isolating people
contacted as sick. In Italy and Iran, where the number of cases started to explode in
February 2020, the epidemic's growth curve is beginning to show signs of subsiding. Both
increased their containment measures throughout March, as did the extension of the
curfew. Countries that took a long time to employ similar measures like Brazil, the United
States and the United Kingdom, are still seeing a brutal increase in the number of
registered cases, exceeding 30% per day.
From the above, it is demonstrated the imminent collapse of the health system in Brazil
and the imperative need to adopt measures that are being successful in the countries
mentioned above, including the “lockdown”. In order to avoid the collapse of the health
system, it is urgent that governments at all levels (federal, state and municipal) converge
towards the same objective of facing together the health and economic crises resulting
from the new Coronavirus. Brazil's failure to achieve full social distancing to prevent the
virus from spreading is fundamentally due to the fact that the President of the Republic
encourages the return of people to work in opposition to the work of governors and
mayors and the ineffectiveness of the Ministry of Health that it had two ministers fired
for opposing Bolsonaro's wishes. In addition, the Bolsonaro government contributes
people to take to the streets in search of their survival and micro, small and medium-sized
companies operate during the pandemic to avoid bankruptcy, because it makes it difficult
for the population to release basic income and help with loans to micro, small and medium
entrepreneurs. Despite the approval of the resources by the National Congress for the
vulnerable population and for the needy entrepreneurs in March of this year, the resources
remain dammed by the Bolsonaro government. Without the collaboration of the federal
government in overcoming health and economic crises, Brazil will inevitably move
towards the collapse of the health system and the consequent collective murder of the
Brazilian population by the new Coronavirus with the death of 500 thousand to 1 million
Brazilians whose main responsible will be the Bolsonaro government.
* Fernando Alcoforado, 80, awarded the medal of Engineering Merit of the CONFEA / CREA System,
member of the Bahia Academy of Education, engineer and doctor in Territorial Planning and Regional
Development by the University of Barcelona, university professor and consultant in the areas of
strategic planning, business planning, regional planning and planning of energy systems, is author of the
books Globalização (Editora Nobel, São Paulo, 1997), De Collor a FHC- O Brasil e a Nova (Des)ordem
Mundial (Editora Nobel, São Paulo, 1998), Um Projeto para o Brasil (Editora Nobel, São Paulo, 2000), Os
condicionantes do desenvolvimento do Estado da Bahia (Tese de doutorado. Universidade de
Barcelona,http://www.tesisenred.net/handle/10803/1944, 2003), Globalização e Desenvolvimento (Editora

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Nobel, São Paulo, 2006), Bahia- Desenvolvimento do Século XVI ao Século XX e Objetivos Estratégicos
na Era Contemporânea (EGBA, Salvador, 2008), The Necessary Conditions of the Economic and Social
Development- The Case of the State of Bahia (VDM Verlag Dr. Müller Aktiengesellschaft & Co. KG,
Saarbrücken, Germany, 2010), Aquecimento Global e Catástrofe Planetária (Viena- Editora e Gráfica,
Santa Cruz do Rio Pardo, São Paulo, 2010), Amazônia Sustentável- Para o progresso do Brasil e combate
ao aquecimento global (Viena- Editora e Gráfica, Santa Cruz do Rio Pardo, São Paulo, 2011), Os Fatores
Condicionantes do Desenvolvimento Econômico e Social (Editora CRV, Curitiba, 2012), Energia no
Mundo e no Brasil- Energia e Mudança Climática Catastrófica no Século XXI (Editora CRV, Curitiba,
2015), As Grandes Revoluções Científicas, Econômicas e Sociais que Mudaram o Mundo (Editora CRV,
Curitiba, 2016), A Invenção de um novo Brasil (Editora CRV, Curitiba, 2017), Esquerda x Direita e a sua
convergência (Associação Baiana de Imprensa, Salvador, 2018, em co-autoria) and Como inventar o futuro
para mudar o mundo (Editora CRV, Curitiba, 2019).