Vigilância em saúde no enfrentamento da COVID-19 no Brasil: uma revisão de escopo

The management of the COVID-19 pandemic in Brazil was marked by contradictory statements and controversial decisions by the head of the executive branch and the Ministry of Health, creating uncertainty about the effective implementation of federal actions to control the disease. This study aims to describe the main health surveillance strategies adopted by the federal government to combat COVID-19, with a focus on actions aimed at preventing SARS-CoV-2 infection. This is a scoping review conducted between November 2019 and January 2021, using DECS and MeSH descriptors in four databases, in addition to consulting 85 legislative documents available on the Brazilian government's legislation portal. The analysis included ten scientific articles and identified federal actions related to non-pharmacological and pharmacological measures, decisions on international borders, procurement of supplies, and essential services. The results point to the presence of sporadic strategies for pandemic containment but reveal insufficient surveillance in the face of the number of cases and deaths recorded. The study highlights the lack of robust federal support, which hindered the coordination and planning.

Faced with the criticism of the biopolitical control exercised in the COVID-19 pandemic, we defend the importance of a re-examination of the foucauldian reflections so that the critical diagnoses of the present is accompanied by a careful analysis of the fields of force and knowledges in which such controls occur. Bearing in mind the correlation between security mechanisms and the management of insecurities, we argue that in the management of the pandemic by the brazilian executive government, the excesses of power took place more due to the lack of imposing restrictive health measures and obstacles to the control of contagion than through restrictive actions of classical individual freedoms.

This paper analyzes the political and institutional management of the COVID-19 pandemic in Brazil, with a focus on the initial response, the role of federal leadership, and the consequences of fragmented governance. It explores how the country’s public health structures, initially mobilized through surveillance and emergency protocols, were gradually undermined by political interference, especially from the Federal Executive. The study highlights the use of Epidemiological Bulletins not only as technical tools but also as instruments of political rhetoric, reshaped to align with the government’s interests. The frequent changes in the Ministry of Health’s leadership and the conflicting public narratives weakened coordinated action, generating confusion among local authorities and the population. In addition, institutional actors and scientific organizations responded in polarized ways, further reflecting the broader social and political divisions. The analysis underscores how Brazil’s pandemic management became a stage for ideological disputes, compromising evidence-based strategies and the integrity of public health communication. Finally, the paper discusses the post-pandemic institutional landscape, emphasizing the need for transparent leadership, restoration of scientific credibility, and reinforcement of the Unified Health System as central to future emergency preparedness.

This article explores the management of the COVID-19 pandemic in Brazil radicalizing Foucault’s notion of governmentality. While dominant scholarship has been interpreting the human tragedy of the outbreak in Brazil in terms of necropolitics and Bolsonaro’s populist rhetoric, the present work highlights other dimensions. It shows that the management of the pandemic was deployed to govern the conduct of the Brazilian population. This article detects novel economies of medical truth, obedience, and salvation. It also examines the struggles and (bio)political resistance of Brazil’s vulnerable communities. While academic debates interpreted those movements in terms of care and compassion, this article highlights their radical political aspects. Extending Foucault’s notion of “counter-conducts,” this article reveals how those collectives shaped new forms of medical dissent. More concretely, they brought forward political practices of hope, solidarity, and resilience.

In the COVID-19 pandemic in Brazil, do brown lives matter?

INTRODUCTION: This study investigated the role of early public research funding regarding the COVID-19 pandemic in Brazil. METHODS: We examined the budget for research projects relating to the number of cases and deaths and the relationship between each federal unit, gross domestic product (GDP) per capita, and the national GDP per capita. RESULTS: Using data from the websites of official funding agencies and the Brazilian government, we found that, in the first four months since the first case in Wuhan, China (December 31, 2019), around US$ 38.3 million were directed to public funding for scientific investigations against the COVID-19 pandemic. However, only 11 out of 27 federal units provided funding during the initial stages of the outbreak, and those that did provide financing were not necessarily the units having the most inhabitants, highest GDP, or the greatest number of cases. The areas of research interest were also identified in the funding documents; the most common topic was “diagnosis” and the least common was “equipment for treatment.”CONCLUSIONS: Brazilian researchers had access to funding opportunities for projects against COVID-19. However, strategies to minimize the economic impacts of COVID-19 are crucial in mitigating or avoiding substantial financial and social shortcomings, particularly in terms of an emerging market such as Brazil.

The efficacy of pre-exposure prophylaxis (PrEP) in HIV will diminish with poor adherence; pharmacologic measures of drug exposure have proven critical to PrEP trial interpretation. We assessed drug exposure in hair against other pharmacologic and more routinely used measures to assess pill-taking. Participants were randomized to placebo, daily PrEP, or intermittent PrEP to evaluate safety and tolerability of daily versus intermittent tenofovir/emtricitabine (TFV/FTC) in 2 phase II PrEP clinical trials conducted in Africa. Different measures of drug exposure, including self-report, medication event monitoring system (MEMS)-caps openings, and TFV/FTC levels in hair and other biomatrices were compared. At weeks 8 and 16, self-reported pill-taking, MEMS-caps openings, and TFV/FTC levels in hair, plasma, and peripheral blood mononuclear cells (PBMCs) were measured. Regression models evaluated predictors of TFV/FTC concentrations in the 3 biomatrices; correlation coefficients between pharmacologic and nonpharmacologic measures were calculated. Both trials were registered on ClinicalTrials.gov (NCT00931346/NCT00971230). Hair collection was highly feasible and acceptable (100% in week 8; 96% in week 16). In multivariate analysis, strong associations were seen between pharmacologic measures and MEMS-caps openings (all P < 0.001); self-report was only weakly associated with pharmacologic measures. TFV/FTC hair concentrations were significantly correlated with levels in plasma and PBMCs (correlation coefficients, 0.41-0.86, all P < 0.001). Measuring TFV/FTC exposure in small hair samples in African PrEP trials was feasible and acceptable. Hair levels correlated strongly with PBMC, plasma concentrations, and MEMS-caps openings. As in other PrEP trials, self-report was the weakest measure of exposure. Further study of hair TFV/FTC levels in PrEP trials and demonstration projects to assess adherence/exposure is warranted.

Skilled nursing facilities (SNFs) experienced high mortality during the COVID-19 pandemic, leading them to adopt preventive measures to counteract viral spread. A critical appraisal of these measures is essential to support SNFs in managing future infectious disease outbreaks. To perform a scoping review of data and evidence on the use and effectiveness of preventive measures implemented from 2020 to 2024 to prevent COVID-19 infection in SNFs in the US. Two analyses were performed. First, an analysis of the federal COVID-19 SNF Database was conducted to describe time trends in COVID-19 incidence, deaths, testing, vaccination, and treatment among SNF residents and staff, as well as shortages in staff and personal protective equipment (PPE). Then, a comprehensive literature search was conducted from May 2023 to April 2024 to identify high-quality evidence on the use and effectiveness of modifiable preventive measures used among SNF residents. Both nonpharmacologic (facility characteristics, PPE, cohorting, and isolation, visitation, staffing, testing) and pharmacologic (vaccination, treatment) measures were reviewed. Nationwide data indicated early shortages of PPE, infrequent testing, and persistent staff shortages in SNFs. Other nonpharmacologic measures, such as visitor restrictions or ventilation modifications, were widely adopted but there were no available national data to quantify their effectiveness. These nonpharmacologic measures lacked high-quality studies to verify effectiveness. In contrast, the effectiveness of vaccination and antiviral treatment was shown in multiple studies. Evidence also showed associations between COVID-19 outcomes in residents and crowding, staff size, hours per residents and networks, and surveillance testing of residents and staff. Despite high initial uptake, up-to-date vaccination status was suboptimal in residents and staff from 2022 to 2024. Only a minority of infected residents received antiviral treatment. This scoping review found that although many preventive measures were implemented in SNFs in the US throughout the COVID-19 pandemic, few were based on clear evidence of their effectiveness. Pharmacologic measures, such as vaccination and antiviral treatment, had more robust evidence supporting their efficacy than nonpharmacologic interventions. Using the scarce resources and staff of SNFs on measures of questionable effectiveness could distract from known effective ones such as vaccination and antiviral treatment. When possible, implementation efforts should be commensurate with the demonstrated effectiveness of available preventive measures.

Although it is generally recognized that poor sleep is common in the intensive care unit (ICU), it is still unclear which interventions can effectively improve sleep in this setting. In this review, we critically analyze the various pharmacological and non-pharmacological measures that have been proposed to tackle this problem. A search of MEDLINE/PubMed, SciELO, and the Brazilian Virtual Library in Health (LILACS and BNDEF) databases was performed. Results were reviewed and 41 articles on pharmacological and non-pharmacological interventions to promote sleep in ICU were analyzed. Non-pharmacological interventions including eye mask and earplugs, bundles to reduce noise and lighting, and organization of patient care were shown to improve subjective and objective sleep quality, although the level of evidence was considered low. Assist-control ventilation was associated with a greater objective sleep quality than spontaneous modes, such as pressure support ventilation and proportional assist ventilation. Among pharmacological interventions, a moderate level of evidence was found for oral melatonin, with increases in both objective and subjective sleep quality. Continuous nocturnal infusion of dexmedetomidine was reported to increase sleep efficiency and favorably modify the sleep pattern, although evidence level was moderate to low. Several non-pharmacological and pharmacological measures can be helpful to improve sleep in critical patients. Further high-quality studies are needed to strengthen the evidence base.

Whole–of–society approach for influenza pandemic epicenter Containment exercise in Indonesia

Access to and coverage of renal replacement therapy in minorities and ethnic groups in Venezuela

A pesar de las evidencias sobre los asesores informales de los presidentes en América Latina, la literatura sobre el tema aún es incipiente. Esteartículo investiga el escenario informativo que rodeó al presidente brasileño,Jair Bolsonaro, de enero a abril de 2020, un período de toma de decisionespresidenciales sobre las medidas para combatir la pandemia de Covid-19. Paraeso, se realiza un estudio de caso de las interacciones establecidas por el presidente brasileño basado en los registros de la Agenda del Presidente. Se utilizanherramientas de análisis de redes sociales (SNA) para examinar las evidencias.Los resultados indican que el Ministerio de Salud no fue el principal canal deinformación del presidente al principio de la pandemia a pesar de su papel central en la estructura de gobernanza nacional de emergencia en salud pública.Además, revelan la elección del presidente de utilizar la presidencia como suprincipal soporte informativo, incluso fortaleciéndolo a través de sus poderes. &#x0D;

Until 2005 some developing countries with pharmaceutical manufacturing capacities especially India used the transitional period allowing local manufacturers to produce and sell generic versions of first-generation ART drugs patented in industrialized countries and originally produced and sold at high prices by Western pharmaceutical companies. Thanks to international competition between generic manufacturers and these companies significant price reductions were achieved for the large majority of these drugs. This was a key factor in the implementation and strengthening of access to AIDS treatment in developing countries and a strategic element in the World Health Organization (WHO) 3by5 plan. However with the end of the extended deadline for TRIPS compliance the scenario is likely to change radically. Considering the end of the transitional period which effectively will prohibit the free manufacture of newer and innovative antiretroviral generations to mark a key episode in the history of the fight against AIDS in developing countries this review will provide an overview of the meaning and consequences of this turning point and to present some of the new challenges of the post-2005 period. (excerpt)

It is a study of Financial Impact Analysis, where the financial consequences arising from the possibility of inclusion of the dentist in the Intensive Care Units (ICU), within the reality of the Unified Health System (SUS), were evaluated in Brazil. It was based on a quick review of the literature and economic evaluation with reference to the year 2018. Information on costs and hospitalizations were collected from the official databases of the Ministry of Health, the Federal Council of Medicine and the Union of Dentists of the State of São Paulo. Only the direct medical costs related to the hospitalizations were calculated. Scenarios were simulated for a time horizon of 1 year (2018) and a sensitivity analysis was made for a more optimistic scenario (values 20% lower) and another less optimistic (values 20% higher). On average, the presence of a dentist in the ICU reduces the development of pneumonia cases by 56% and 8.18 days, which represents a savings of 34.92% in hospitalization costs in the evaluated scenario. In Brazil, when hiring dentists in all ICUs, each avoided case would contribute to savings of R$ 7,949.45 (1US$ = R$ 4,02 in 30/10/2019), ranging from R$ 6,359.56 to R$ 9,539.35 in the optimistic and pessimistic scenarios, respectively, where each case avoided is higher than the dentist's monthly salary. It would be necessary to spend R$ 142,060,140.00 on hiring the dentist to cover the ICUs, making the final savings more than 865 million reais. It is concluded that the inclusion of the Dental Surgeon (DS) in ICU teams would have a positive economic impact, with savings in hospitalization costs from the perspective of SUS. The COVID-19 pandemic in Brazil, depending on the State's action in containment strategies, could require 2.17 times more in the bests of scenarios where the action of total suppression would be used. Such a situation requires emergency measures, and the role of the dentist is a strategy that can support the health system.Key messages Dental care in the ICU is an important and cost-effectiveness strategy for the control of microorganisms that act in the evolution of the pneumonia nosocomial.Such a situation requires emergency measures, and the role of the dentist is a strategy that can support the health system.

Currently, the fast spread of COVID-19 is the cause of a sanitary emergency in Brazil. This situation is largely due to President Bolsonaro’s denial and the uncoordinated actions between the federal and local governments. In addition, the Brazilian government has reported that it would change its method of sharing information about the pandemic. On June 6, 2020, the presentation of accumulated cases and deaths was stopped, and the Supreme Court of Brazil determined that the federal government should continue to consolidate and disseminate the accumulated figures of cases and deaths. However, doubt about the transparency of the data remained. We used data reported by the government from Situation Reports 38–209 of the World Health Organization to assess the Benford’s law fulfillment as an indicator of data quality. This rapid evaluation of data quality during the ongoing COVID-19 pandemic in Brazil suggests that the Brazilian public health surveillance system had an acceptable performance at the beginning of the epidemic. Since the end of June, the quality of cumulative death data began to decrease and remains in that condition as of August 2020. A similar situation has existed since August, with the data of accumulated new cases.