Cenários brasileiros da Saúde Mental em tempos de Covid-19: uma reflexão

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Abstract

O artigo visa apontar e refletir sobre alguns efeitos da pandemia da Covid-19 na saúde mental dos brasileiros. Se por um lado a materialidade do corpo posta em risco por um organismo invisível afeta psiquicamente todos os sujeitos do mundo, por outro, as experiências subjetivas diante do vírus no Brasil são marcadas pela distribuição desigual das vulnerabilidades e pela condição singular de elaborar os vividos. O artigo tratará da temática da Saúde Mental no Brasil considerando os atravessamentos dos contextos sociocultural e político na produção do sofrimento psíquico e valendo-se de reflexões construídas pelas produções bibliográficas já existentes sobre Covid-19, sobre sofrimento psíquico, e também pela escuta de experiências individuais e sociais advindas do atendimento clínico de brasileiros vivendo no país durante a pandemia.

Translated abstract

El objetivo del artículo es señalar algunos de los efectos de la pandemia de Covid-19 en la salud mental de los brasileños y reflexionar sobre ello. Si por un lado la materialidad del cuerpo puesta en riesgo por un organismo invisible afectó psíquicamente a todos los sujetos del mundo, por el otro, las experiencias subjetivas ante el virus en Brasil están señaladas por la distribución desigual de las vulnerabilidades y por la condición singular de elaborar lo vivido. El artículo tratará de la temática de la Salud Mental en Brasil considerando las conexiones del contexto sociocultural y político en la producción del sufrimiento psíquico y valiéndose de reflexiones construidas a partir de las producciones bibliográficas ya existentes sobre Covid-19, sobre sufrimiento psíquico y también a partir de escuchar experiencias individuales y sociales provenientes de la atención clínica de brasileños que viven en el país durante la pandemia.

Translated abstract

The article aims to point out and reflect on some effects of the Covid-19 pandemic on Brazilians’ mental health. If, on the one hand, the materiality of the body endangered by an invisible organism has psychically affected all subjects in the world, on the other hand, the subjective experiences facing the virus in Brazil are marked by the unequal distribution of vulnerabilities and the unique condition of elaborating the lived. This work will address Mental Health in Brazil considering the crossings of the sociocultural and political context in the production of psychological distress and drawing on reflections built from the available bibliographic productions on Covid-19, psychological suffering and from listening to individual and social experiences from the clinical care of Brazilians living in Brazil during the pandemic.

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COVID-19 in Brazil: “So what?”

The Lancet (2020)

The coronavirus disease 2019 (COVID-19) pandemic reached Latin America later than other continents. The first case recorded in Brazil was on Feb 25, 2020. But now, Brazil has the most cases and deaths in Latin America (105 222 cases and 7288 deaths as of May 4), and these are probably substantial underestimates. Even more worryingly, the doubling of the rate of deaths is estimated at only 5 days and a recent study by Imperial College (London, UK), which analysed the active transmission rate of COVID-19 in 48 countries, showed that Brazil is the country with the highest rate of transmission (R0 of 2·81). Large cities such as São Paulo and Rio de Janeiro are the main hotspots now but there are concerns and early signs that infections are moving inland into smaller cities with inadequate provisions of intensive care beds and ventilators. Yet, perhaps the biggest threat to Brazil's COVID-19 response is its president, Jair Bolsonaro. When asked by journalists last week about the rapidly increasing numbers of COVID-19 cases, he responded: “So what? What do you want me to do?” He not only continues to sow confusion by openly flouting and discouraging the sensible measures of physical distancing and lockdown brought in by state governors and city mayors but has also lost two important and influential ministers in the past 3 weeks. First, on April 16, Luiz Henrique Mandetta, the respected and well liked Health Minister, was sacked after a television interview, in which he strongly criticised Bolsonaro's actions and called for unity, or else risk leaving the 210 million Brazilians utterly confused. Then on April 24, following the removal of the head of Brazil's federal police by Bolsonaro, Justice Minister Sérgio Moro, one of the most powerful figures of the right-wing government and appointed by Bolsonaro to combat corruption, announced his resignation. Such disarray at the heart of the administration is a deadly distraction in the middle of a public health emergency and is also a stark sign that Brazil's leadership has lost its moral compass, if it ever had one. Even without the vacuum of political actions at federal level, Brazil would have a difficult time to combat COVID-19. About 13 million Brazilians live in favelas, often with more than three people per room and little access to clean water. Physical distancing and hygiene recommendations are near impossible to follow in these environments—many favelas have organised themselves to implement measures as best as possible. Brazil has a large informal employment sector with many sources of income no longer an option. The Indigenous population has been under severe threat even before the COVID-19 outbreak because the government has been ignoring or even encouraging illegal mining and logging in the Amazon rainforest. These loggers and miners now risk bringing COVID-19 to remote populations. An open letter on May 3 by a global coalition of artists, celebrities, scientists, and intellectuals, organised by the Brazilian photojournalist Sebastião Salgado, warns of an impending genocide. What are the health and science community and civil society doing in a country known for its activism and outspoken opposition to injustice and inequity and with health as a constitutional right? Many scientific organisations, such as the Brazilian Academy of Sciences and ABRASCO, have long-opposed Bolsonaro because of severe cuts in the science budget and a more general demolition of social security and public services. In the context of COVID-19, many organisations have launched manifestos aimed at the public—such as Pact for Life and Brazil—and written statements and pleas to government officials calling for unity and joined up solutions. Pot-banging from balconies as protest during presidential announcements happens frequently. There is much research going on, from basic science to epidemiology, and there is rapid production of personal protective equipment, respirators, and testing kits. These are hopeful actions. Yet, leadership at the highest level of government is crucial in quickly averting the worst outcome of this pandemic, as is evident from other countries. In our 2009 Brazil Series, the authors concluded: “The challenge is ultimately political, requiring continuous engagement by Brazilian society as a whole to secure the right to health for all Brazilian people.” Brazil as a country must come together to give a clear answer to the “So what?” by its President. He needs to drastically change course or must be the next to go. © 2020 Bruna Prado/Getty Images 2020 Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

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COVID-19: faecal–oral transmission?

Jordan Hindson (2020)

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, which causes coronavirus disease 2019 (COVID-19), first emerged in China in December 2019 and has now spread worldwide, with a reported 351,731 confirmed cases and 15,374 deaths as of 23 March 2020 according to John Hopkins University. The infection is typically characterized by respiratory symptoms, which indicates droplet transmission. However, several case studies have reported gastrointestinal symptoms and/or evidence that some patients with SARS-CoV-2 infection have viral RNA or live infectious virus present in faeces, which suggests that another possible route might be faecal–oral transmission. In a clinical characterization of ten paediatric patients with SARS-CoV-2 infection in China, none of whom required respiratory support or intensive care and all of whom lacked signs of pneumonia, eight tested positive on rectal swabs, even after nasopharyngeal testing was negative. The details were published as a Brief Communication in Nature Medicine. The patients, whose ages ranged from 2 months to 15 years, initially tested positive after being screened by nasopharyngeal swab real-time reverse transcription PCR (RT–PCR). Next, the researchers conducted a series of nasopharyngeal and rectal swabs to investigate the pattern of viral excretion. Eight patients had real-time RT–PCR-positive rectal swabs. In addition, these eight patients had persistently positive rectal swabs even after their nasopharyngeal tests were negative. Four patients were discharged after two consecutive negative rectal swabs, but the rectal swabs of two of these patients later became positive again, despite nasopharyngeal tests remaining negative. Finally, the researchers used the viral RNA measurements to determine that viral shedding from the digestive system might be longer-lasting than that from the respiratory tract. The findings suggest that we also need to use rectal swabs to confirm diagnosis of COVID-19, says Kang Zhang, a corresponding author of the study. PeopleImages/Getty There had been earlier reports, particularly in adults, of gastrointestinal symptoms and of the possibility of a faecal–oral route of transmission. In a cohort of 1,099 patients with COVID-19 from 552 hospitals in China, published in the New England Journal of Medicine, 5.0% of patients presented with nausea or vomiting and 3.8% presented with diarrhoea. Also, preliminary findings published in the American Journal of Gastroenterology found that of 204 patients with COVID-19 (mean age 54.9 years) who presented to three hospitals in China, 99 (48.5%) patients presented with digestive symptoms as their chief complaint. 60% of patients without digestive symptoms were cured and discharged, compared with 34.3% of patients with digestive symptoms. In a short Research Letter published in the Journal of the American Medical Association, different tissues of patients with COVID-19 (n = 1,070 specimens from 205 patients of mean age 44 years) were tested by RT–PCR. 32% of pharyngeal swabs (126 of 398) and 29% of faecal samples (44 of 153) tested positive. Electron microscopy of four SARS-CoV-2-positive faecal specimens detected live virus in stool samples from two patients who did not have diarrhoea. The precise mechanisms by which SARS-CoV-2 interacts with the gastrointestinal tract remain unknown. SARS-CoV-2 is thought to use ACE2 as a viral receptor, and ACE2 mRNA is highly expressed in the gastrointestinal system. In preliminary findings published in Gastroenterology, researchers examined clinical specimens from 73 hospitalized patients with SARS-CoV-2 infection. 39 patients tested positive for SARS-CoV-2 RNA in stool samples. In addition, 17 patients remained positive for SARS-CoV-2 in stool after becoming negative in respiratory samples. Viral host receptor ACE2 stained positive mostly in gastrointestinal epithelial cells. eight patients had persistently positive rectal swabs even after their nasopharyngeal tests were negative Together, these findings have implications for our understanding of SARS-CoV-2 transmission. “Asymptomatic children and adults may be shedding infectious virus and they could transmit it. This is another reason to emphasize good personal hygiene,” says Mary Estes at Baylor College of Medicine, Texas, who was not involved in these studies. “Physicians and caretakers of potentially-infected children need to be aware that stools might be infectious,” adds Estes. The results are preliminary and further research is needed. “We are now assembling a much larger cohort to confirm our results and will test more patients to confirm faecal–oral transmission,” says Zhang.

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Necropolítica

Achille Mbembe, A. MBEMBE, A. Mbembe (2018)

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Journal

Journal ID (publisher-id): icse

Title: Interface - Comunicação, Saúde, Educação

Abbreviated Title: Interface (Botucatu)

Publisher: UNESP (Botucatu, SP, Brazil )

ISSN (Print): 1414-3283

ISSN (Electronic): 1807-5762

Publication date (Print and electronic): 2021

Volume: 25

Issue: suppl 1

Electronic Location Identifier: e200330

Affiliations

[01] Rio de Janeiro RJ orgnameInstituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira orgdiv1Fundação Oswaldo Cruz Brasil

Article

Publisher ID: S1414-32832021000200204 Publisher ID: S1414-3283(21)02500000204

DOI: 10.1590/interface.200330

SO-VID: a8e77c25-dae5-4a66-911f-ec5f161f30c3

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This work is licensed under a Creative Commons Attribution 4.0 International License.

History

Date accepted : 01 December 2020

Date received : 27 May 2020

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Cenários brasileiros da Saúde Mental em tempos de Covid-19: uma reflexão Translated title: Escenarios brasileños de la Salud Mental en tiempos de Covid-19: una reflexión Translated title: Brazilian Mental Health settings in Covid-19 times: a reflection

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COVID-19 in Brazil: “So what?”

COVID-19: faecal–oral transmission?

Necropolítica

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