Bolsonaro fires health minister, calls to reopen economy
reuters.com
reuters.com
As a friend who’s a standup comedian said in response to reading that: “Brilliant, why didn’t our government think of this? We wouldn’t have all these problems.”
[1] https://www.npr.org/sections/coronavirus-live-updates/2020/0...
https://www.theguardian.com/commentisfree/2017/aug/08/trump-...
https://www.thedailybeast.com/cheats/2015/03/09/florida-bans...
There are other factors involved in producing a higher mortality, like comorbidity and demographics.
[1] https://www.scmp.com/news/china/science/article/3079831/coro...
The paper you link to discusses attenuation of influenza A at 39.5 ºC, which is pretty far above useful environmental temperatures (you'd just trade off viral deaths with heatwave-associated deaths), not to mention it's an entirely different virus.
It became a ego dispute in the last days, but original rumors that the role would be occupied by someone without health expertise that would follow Bolsonaro orders to the letter were wrong. The new minister is also a doctor who hinted that lockdown is necessary before.
I believe Bolsonaro leadership is a disaster and more people will die because of his actions and speeches. I just don't think today's announcement will change much. It will not get worse.
The governors here don't have that much autonomy as in the US, but they have enough to define what will indeed happen in the streets. This won't change with the new minister.
Wish I was kidding.
We sure can act like irrational animals and play the natural selection card (and leave people to die an excruciating death), but I personally prefer to slow down the almost inevitable [3], so our health system has more time to cope with the situation as well as they can.
[1] https://www.npr.org/sections/health-shots/2020/04/07/8280914...
[2] https://www.nytimes.com/interactive/2020/03/11/science/how-c...
[3] https://www.bloomberg.com/news/articles/2020-02-13/coronavir...
Also being athletic doesn’t really confer a magic boost to your immune system that overcomes age. It’s better than being obese and out of shape, but it isn’t going to magically restore your immune system to that of a 20 year old.
Also, having seen videos of Bolsonaro doing “push-ups”, I’d say that formerly athletic is closer to the mark.
Perhaps Boris Johnson's attitude will change a little bit now, for example.
One of the running twitter jokes, started by a famous comedian over there, is asking for the health minister, now that he was fired, to release the real result for the president's covid19 test.
https://en.wikipedia.org/wiki/2020_coronavirus_pandemic_in_C...
https://en.m.wikipedia.org/wiki/2020_coronavirus_pandemic_in...
https://www.thelocal.se/20200414/understanding-swedens-figur...
The way to prevent a lot of deaths is simply to prevent people from catching it at all.
Anecdotal word from family members working in ERs is that none of them have been on a shift with a successful code run on a covid patient. CPR is low single digits 30-day survival based on Chinese numbers released this week. It was something like (1) patient survived out of 37 attempts.
The question of if the 10-30% of vent survivors would have survived without a vent is fair, but that's a maximum efficacy at this point.
Vents are definitely not the answer everyone thought they would be.
Doctors seem to be doing a better job of informing patients (or families) of those issues before intubating, especially if they have multiple risk factors, and a surprising number of cases have opted not to vent.
But also:
1) There are quite a few really sad stories of patients getting dropped at the ED curb by a spouse as if they'll get checked out and be right back out to go home, only to be immediately intubated and sedated, and ultimately dying without family by their side and no chance to say goodbyes.
They now make a lot of effort to make phone calls or video chats to family before intubating anyone, but it's still rough without anyone being able to be there, and then not being able to speak either. And it just adds to the weight of what the nurses have to deal with, emotionally.
2)There's also the murky topic of straining hospital resources. You obviously don't know ahead of time who the 10-30% of survivors will be and you want to save whoever you can, and hopefully we never get to the point of true rationing. But...
It's hard to be blind to the fact that it's a huge amount of risk, resources, and physical & emotional effort that are seeing relatively little success. I don't have an answer. Hopefully we get better at it.
Germany is seeing better results by ventilating earlier, FYI.
But I don't know, severe permanent lung damage guaranteed, delirium and dementia likely, and the misery of the treatment itself, all for a 1-in-5 chance of surviving (where survival is measured only at 30 days)?
I'm not saying nobody should be allowed to make that choice -- they should -- but I don't know that I would.
For example, my country's CDC has the official number of confirmed cases in the low hundreds with a dozen deaths, but anyone wise enough knows that between the ridiculously low number of samples tested (less than ten thousand in a population of a couple hundred million), the poor public health infrastructure, the anaemic government response and general public health illiteracy, the real number of cases is easily an order of magnitude or two higher.
Are you suggesting that as long as your hospitals aren't overrun, inflection rates aren't worth knowing ?
If by "strategy" you mean herd immunity, Sweden isn't doing that. No one is publicly claiming to be trying that anymore.
I have to say, as someone usually loathes my generally scientifically-blinkered federal government (Aus), it's relaxing and pleasant to be able to think quite well of them for once. Australia at this stage seems almost like a case study in how to handle a pandemic like this intelligently. Time will tell, of course.
Sweden is at 118 deaths per million vs 53 per million in Denmark or 94.5 in the US
Australia is at 2.52 per million
Sweden has a population of something like 10 million while the greater Sydney area alone has a population of 5.98 million so population density isn't the reason why Sweden has so many more deaths.
Voluntary lockdown means that some people still stand too close at the supermarkets, still plenty of people socialising around my area as normal & different companies apparently have different ideas when it comes to work from home policies
To be fair many countries are locked down as much as Australia and are also doing worse so I'm not sure what it is that is working so well there.
https://www.statista.com/statistics/1104709/coronavirus-deat...
Their numbers aren't reflective of reality.
Same as the US and Canada I suppose.
It looks like it was estimated to have arrived in Sweden two days earlier.
SF itself is more densely populated than Sweden’s most densely populated city which appears to be Stockholm (7700/km^2 vs 5000/km^2). Stockholm has a population around 20% larger than SF.
According to Wikipedia, California is smaller than Sweden.
So there may be some dense pockets in Sweden but it certainly isn’t more densely populated than California and it doesn’t appear that there are large cities that approach the density of NYC/SF.
https://covid19.quersive.com/chart?c=M&e=SE&e=US-CA&e=US-NY&...
https://www.cbc.ca/news/world/covid-19-russia-spike-cases-1....
... In an interview with CBC News on Monday, Dr. Rimma Kamalova, who heads the hospital's rheumatology department and is quarantined in the facility, said when the outbreak started, regional health authorities refused to test patients for coronavirus.
"According to our policies ... we could not do testing on coronavirus," she said.
"We had orders, at that time, not to give this diagnosis and take the relevant [mitigation] measures." ...
If you are getting less than that, you aren't testing enough people. ALso if your number is far higher you might be only testing dire cases.
That looks like a lot of things, but it sure as heck doesn't look like a lockdown, certainly doesn't look like one that is going to be anywhere near as effective as the lockdowns in other jurisdictions. Crowding like that is absurd.
Add to that the fact that they share a large border with China and were pretending to have no cases for at least a solid month or so. As the article I linked to stated, they have even given up on the propaganda effort at this point. Even the authorities in Russia whose specialty is self-deception know which way this is headed now!
Won't that just be a sequel to the first cycle, where things seemed under control, it was downplayed, and then it got going outside of China. Why should anyone expect other than a fractal replay?
What worries me is that now Brazil is in a stand off, the military that surround him, vice-president included, have cutted him off power and congress is starting to look into an impeachment. But even if they do, and do away with Bolsonaro, then the military that ran with him will have the power, will finally declare the lockdown and anything can happen next, they'll be lucky if they have elections after that. Police abuse during lockdown grew a lot in other latin countries, i expect at least the same to happen there, who knows to which level.
Mandetta, the previous health minister, had no flexibility in his views, he wanted to follow the WHO blindly, without weighing anything else.
Maybe the new guy has the flexibility and the brains to find a better balance of views, and to create a strategy on top of it.
It’s the job of the executive to balance between the different paths recommended by different advisors, and chart a path that has the correct balance of trade offs.
I don't know much about this guy but if he was as bad at balancing the variables he had to consider as the GP suggests then I can see why he was removed.
On the other hand, the president wants a "vertical" isolation without a plan, he simply wants to "reopen the economy" (whatever it means). Remembering that he has largely underplayed the issue, calling it "just a little flu" (probably it would be better translated to: "just a cold").
Brazil doesn't have enough tests to make good decisions about which areas should be in a horizontal isolation or to be instead in a vertical one.
The former health minister was clear that all the information coming from his office should be backed by science (and this alone was bugging the president a lot for some reason). This also meant that he, as the health minister, couldn't go public and say that a specific medication was effective to treat the covid-19 just because some tests worked in vitro (any doctor or scientist knows that this alone doesn't mean that it'll work efficiently in vivo).
The president behaviour was the opposite, many times he went public to say that a drug tested in vitro was enough to have the horizontal isolation lifted out. And as a consequence or his irresponsible pronouncements, many of his followers ran to the drug stores to buy certain medications, leaving people that really need them for other diseases without medication.
So the main issue turned out to be the fact that the former health minister was becoming popular because of his common sense, and everyone knows that in the eyes of a populist, "there can be only one".
Edit: And here goes my karma. I will need to do some PR to catch up with this :)
It's the same in the US. Article here:
https://www.washingtonpost.com/outlook/2020/04/16/coronaviru...
https://lh3.googleusercontent.com/-nq9Tcrho5QQ/XpjnH7DgeRI/A...
The CDC claims[1] influenza caused 61,000 and 34,157 in 2017-18 and 2018-19 respectively, in the USA.
My guess is, without social / travel restrictions COVID-19 could potentially kill a lot more?
I don't envy politicians right now. Proposing politicians act based on how many would have died anyway must be a bit uncomfortable for them.
Mess situation.
About the only country significantly under normal is Ireland, which has a youngish population and a fairly effective lockdown.
The good news is that it seems to be starting to fall in most countries.
https://www.rivm.nl/documenten/epidemiologische-situatie-cov...
You can see that there are approximately 1500 more deaths per week and there is no peak visible.
https://www.lavocedinewyork.com/en/news/2020/03/26/coronavir...
It's important to look at the numbers by region and not the total numbers. And if you consider the overall mortality you have to take in mind that other incidents where people usually die went down (e.g. traffic accidents. But all these countries have now strict lockdown measures in place.
I'm sure that the death toll im Brazil will skyrocket.