As of March 2020, health systems around the world have been affected by the avalanche of cases of Covid-19. Brazil was not immune to this problem. Thousands of Brazilians developed severe cases of the disease and needed treatment in Intensive Care Units (ICU).
Intensive care is a recent hospital setting and medical specialty. Coincidentally, the emergence of modern ICUs is credited with being related to another infection. In 1952, the polio epidemic that devastated Copenhagen, Denmark, caused medical students and other healthcare professionals to take turns artificially breathing patients.
These were gathered and treated in specific hospital sectors where they were monitored, which became the embryos of the current ICU. As it is recent and often associated by the lay public with a place where patients go “to die”, there is a lot of ignorance about the ICU and its professionals. The pandemic served to show the population the importance of these specialists, who work restoring life, welcoming and comforting critically ill patients and their families.
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According to data from the Brazilian Intensive Medicine Association (AMIB), before the pandemic, Brazil had about 45,000 ICU beds. It is one of the countries with the highest number of beds in the world.
Unfortunately, this number is unevenly distributed across the country. In most states, SUS users find it difficult to access an ICU bed, especially compared to health insurance holders.
This inequality was even more accentuated during the pandemic due to the large number of cases in need of ICU at the same time. To meet demand, the public and private systems opened about 10,000 new ICU beds during this period.
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But an intensive care bed is much more than just a bed, a ventilator, and a heart rate and oxygenation monitor. Behind the care of a critically ill patient, there is a team of highly qualified professionals to carry out an adequate treatment. The lack of these trained professionals is one of the main problems in national intensive care.
AMIB data show that Brazil has about 8,000 doctors certified by the entity. The country would need to have twice as much.
If the pandemic opened up the problems in Brazilian ICUs, it also demonstrated the ability of well-trained professionals to provide quality care in well-equipped places . The best public and private Brazilian ICUs have Covid-19 mortality rates similar to those of the first world.
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Anyway, here’s the lesson for future pandemics. Brazil can and should have quality intensive care assistance, but this involves training more and better professionals today. We cannot be surprised by the next pandemic, which will come at some point.
*Luciano César Azevedo is a professor of Clinical Emergencies at USP, author of the book Practical Intensive Medicine Approach (Ed. Manole) and intensive care physician at Hospital Sírio-Libanês