ABC | Volume 114, Nº6, June 2020

Editorial Covid-19 in Brazil: Learning How to Walk in the Dark Without Leaving Anything Behind  Juliano Lara Fernandes 1, 2 Radiologia Clínica de Campinas, 1 Campinas, SP - Brazil Instituto de Ensino e Pesquisa Jose Michel Kalaf, 2 Campinas, SP – Brazil Mailing Address: Juliano Lara Fernandes • Radiologia Clínica de Campinas – Av. José de Souza Campos, 840. Postal Code 13092123, Campinas, SP - Brazil E-mail: jlaraf@terra.com.br Keywords Coronavirus; COVID-19; Pandemics; Catastrófica Illness/ mortality; Hospitalization/economics; Equity in Access to Health Services; Diagnostic Tests/methds; Personal Protective Equipment; Masks; Ventilators Mechanical. “If you have ups and downs, celebrate it because it means you’re alive!” The SARS-CoV-2 pandemic had its first case in Brazil on February 4, 2020 in the state of São Paulo. Like a real meteor, it practically paralyzed the planet without a more effective therapeutic approach to fight the virus, in addition to practices adopted worldwide only decades or even hundreds of years ago, with a very low level of robust modern evidence. 1 Brazil had the advantage of previewing the pandemic as it was a few weeks behind its Asian and European peers, so it was able to identify the hits and failures of these countries in their preparation to face the problem. We have then found out by chance that we have the world’s third biggest number of ICU beds, second only to the USA and Germany, 2 but we are also faced with an enormous heterogeneity between states, limitations and bureaucracy for the purchase of personal protective equipment and testing kits. This has prevented some pandemic approaches taken by other countries from being adopted here, either due to the impossibility of a lockdown in a continental country, or due to the speed and costs to identify the cases of transmission. Besides, limitations on the number of tests to be done has left us without a precise guide as to the spread of the pandemic, making it difficult to plan the timely, orderly and efficient allocation of scarce resources. The solution to that was to adopt our own strategies, which would allow us to walk in the dark while at least having a better idea of how far along the path we were. This information is essential for important decisions impacting not only the economic scenario of Brazil, but also the entire healthcare chain of a population that has been deprived of access to outpatient services and elective treatments due to the pandemic. Theoretical epidemiological mathematical models proved to be little capable of predicting our real figures, either because they overestimate the lethality of the disease that seems to stand closer to 0.2–0.5%, 3 or because they are based on data from past pandemics with other transmission dynamics. Interestingly, the models that were most suitable for modeling at what point in the pandemic we are resulted from curve adjustment strategies or Baysean models using data from other countries or based on the preliminary data that we already had on our curves. 4,5 These models appeared relatively spontaneously and outside traditional research groups, but proved to be more assertive in determining different moments of the pandemic. 6 In a simpler way, but also using data on how the pandemic has previously progressed in other countries, we analyzed the charts of new cases per day from 30 countries with the highest number of covid-19 cases according to the following criteria: countries had reached a peak and presented at least 5 days of decline or stabilization of new daily cases. 7 China was excluded as it concentrated thousands of previous cases on a later day; Brazil was excluded because it was subject to the application of the result. Five countries that did not have mandatory isolation were included. Of the 30 countries, 18 were considered to have completed the full pandemic cycle, with a number of new daily cases <70% of the peak of new cases per day. Using the date of the 1 st , 100 th and 200 th case or 10 th death, the times between these dates and the peak of new cases/day were determined. From these results, it was found that 95% of the countries studied had their peaks 55±8 days from the 1 st case, 31±5 days from the 100 th case, 27±5 days from the 200 th case and 19±4 days from the 10 th death. With this data, it would have been possible to establish the peaks of new cases, deaths and use of the hospital system in different states and cities in Brazil, even without being sure of the exact number of cases due to underreporting, based on the behavior of the pandemic in countries with different healthcare systems and mitigation measures. Death peak dates were established after 14 days of peak of cases and use of the hospital system after 26 days of peak of cases, considering incubation times, manifestation of symptoms, hospitalization and potential clinical worsening. 8 With these criteria, we estimated the different peaks in each of the Brazilian states with the highest number of cases, as shown in Table 1 (limited only to the forecast from the 100 th case to exemplify the model). What cannot be predicted with any of these models is the descending portion of the curve, faster in some places and much slower, showing a plateau in others, requiring hospital beds for longer times, a potential virulence effect that is different from the virus after many mutations. 9 DOI: https://doi.org/10.36660/abc.20200445 988