The increase in cases and hospitalizations for Covid-19 in several states that has been registered with an upward trend since the beginning of November is finding a healthcare system less prepared to meet the demand for beds in wards and ICUs, not only in the metropolitan regions, but mainly in smaller towns inland. The possibility of a breakdown of care for new cases is real and could happen in the coming weeks, aggravated by the advent of holidays and vacations.

The technical note The end of the inland expansion cycle, the synchronization of the epidemic and the difficulties of care in hospitals, developed by the research team of MonitoraCovid-19, warns that at the end of the year the greatest movement of people “without proper care and without maintenance of social isolation” will aggravate a picture composed of “demobilization of extra beds of field hospitals; the occupation of beds by other health problems that were dammed during the advance of the Covid-19 epidemic; the greater circulation of people; difficulties in identifying cases and their contacts due to low testing; and relaxation of care for social distance, wearing masks, and hygiene”.

“At the beginning of the epidemic in Brazil, we had a great demand in the metropolitan regions, and only then the inland expansion come, at a time when the incidence of Covid-19 already showed signs of stability in larger cities. Now Covid-19 is strongly present in both metropolitan regions and inland cities. And the epidemic is synchronized; it no longer starts in the metropolises and then goes to inland. A further increase in cases will put pressure on the health care capacity of metropolitan regions, while also reducing their resources to assist patients coming from inland. In most places, health care must be unable to meet demand,” warns epidemiologist Diego Xavier, from the Institute of Scientific and Technological Communication and Information in Health (Icict / Fiocruz) and one of the authors of the trial.

According to the technical note, the metropolitan regions (MRs) comprise only 177 of the total of 5,570 cities in Brazil. However, its total population is about 70 million, representing 33% of the national population. By the end of May, about 67% of Covid-19 deaths in Brazil were registered in metropolitan regions. With the inland expansion of the disease, on the last day of October this proportion was reversed: “MRs now represent only 33% of the total deaths registered in the country, demonstrating what can be considered as the end of the inland expansion process”, says the technical note.