In an interview to the Fiocruz News Agency (AFN), Nísia Trindade Lima comments on the context of the Covid-19 pandemics and the challenges of its arrival in Brazil. The Fiocruz president also lists some of the actions taken by the institution as a response to this public health crisis, from the production of tests to health care to those infected. All departments and units of the Foundation are mobilized to face the epidemics. “Fiocruz turns 120 year next May, and our anniversary will be marked by our response to this pandemics, just like the beginning of the institution was a public health response to epidemics in Rio de Janeiro”, highlights Nísia.
AFN: How do you see the context of the Covid-19 pandemics in the world today?
Nísia Trindade Lima: On the one hand, I look at my institutional role, and on the other, from the perspective of someone who has worked for a long time and continues to work with a social-historical reflection on health and the relationship between epidemics/endemics and society. This is a unique situation in the world, although the world has seen other pandemics, of course. This one adds a huge layer of complexity, because we are right into the 21st century. The world in which we live today is extremely connected from the point of view of population, people and goods. We also have a great capacity for information, analysis and intense production of knowledge in various scientific domains, such as molecular biology, immunology and epidemiology, which is very important at this moment.
We have a new context going on, with much more intense virus dissemination, of reemergence of old diseases and emergence of new ones. This is something we must think about. We will have many more cases of virus diseases in the upcoming years, especially involving the respiratory system. This is a trend indicated by many studies and is related to our development model, with environmental variables and the relationship between humans and non-humans, as is the case of this virus, that came originally from an animal. That is, there is a large amount of complexity and plenty of questions.
In addition, our everyday lives are completely altered, with many insecurities, concerns and even fear, as is normal when a new and unknown disease arises. On the other hand, today we have resources, information and communication technology that help face such a dire situation, and perhaps allow us to live through this isolation as something that is not social distance, but physical distance only.
We also need to look at demographic and social realities of different countries, of each territory swept by the disease, because it does not come to everyone at the same time, and contention strategies will also play a role in this. So we are dealing with human, political and scientific interference, all at once. I believe this means a huge responsibility for public authorities in all national states and to the society as a whole. This is a great challenge, unthinkable up to not long ago.
AFN: What are the specificities of the pandemic once it gets to Brazil?
Nísia Trindade Lima: I am a sociologist, so I will be speaking of the social impact of this pandemic. It is crucial to think of the social-spatial dimension of this, something essential in the middle of an epidemic outbreak. Each epidemic must be examined in its specificities. The Covid-19 is intensifying in Brazil in two largest cities first, which is natural, as it has arrived to us by air traffic. It have arrived in business class, but it meets a reality of high populational density and very vulnerable living conditions, as is the case of many of our peripheral neighborhoods and slums in all urban centers in the country. We also have a very complex and difficult urban mobility, crowded buses and trains, a series of issues that will certainly interfere in the course of the epidemic. This also applies to specific groups that are of huge concern to us, such as the situation in Brazilian prisons. We need to focus on all this and also on the elderly. All these factors must be observed, and research and government policies must examine this complex reality that can be summed in a single word: inequality. We need to keep an eye on this factor when we think of social solidarity strategies.
AFN: How has Fiocruz been acting in different fronts to respond to this emergency?
Nísia Trindade Lima: Since the beginning, when it had not yet been defined as a pandemic and when the cases of new coronavirus in China began to appear and severe forms of pneumonia were identified, we have been following the evolution of the disease, together with the surveillance department of the Ministry of Health, as well as from the point of view of research and development of actions. It is very clear to us that the priority now must be to save lives.
This is why one of our main lines of action, since the beginning, has been the issue of diagnosis, including production and analysis. A second priority, also defined with the Ministry of Health, is the specialized assistance in infectious diseases for severe patients. A third line of action includes clinical trials to define elective therapies. We are also developing research in various areas of knowledge to help advance knowledge on the virus and its disease, and on the fight against the epidemic. It is also important to highlight our role in the training of professionals and on information platforms, which are fundamental today and will continue to be throughout this pandemic, so that not only Fiocruz but also the Ministry of Health and the Brazilian society as a whole can be provided with figures and evidences that can be translated into institutional policies. Last but not leasat, we also have our communication actions.
Fiocruz turns 120 next May, and our anniversary will be marked by our responde to this pandemic, just like the beginning of the institution was a public health response to epidemics in Rio de Janeiro. The pandemic is being observed by all our institutes nad units, in all states in which Fiocruz is present. All together joining their forces with health secretaries of its states so we can respond to this challenge.
AFN: What are the main actions taken regarding diagnosis?
Nísia Trindade Lima: We have a tradition in the production of diagnostic tools. The entire Brazilian blood network relies on diagnostic tests produced by Fiocruz. Our capacity associates technological development and production. We are fully dedicated to it right now.
We began with the work of the Respiratory Virus and Measles Laboratory of the Oswaldo Cruz Institute (IOC), a reference in the country, and we have been working very hard. This laboratory has developed a crucial work of training for other laboratories, working in a network. We initially offered this training to the Adolfo Lutz and Evandro Chagas laboratories, in the states of São Paulo and Pará, respectively, and also to the Lacen (Central Laboratory) of the state of Goiás, which was where the Brazilians who had been in China first arrived. Following this work, we offered training, in a partnership with the Pan-American Health Organization (PAHO), to the countries of Latin America, and we have been constantly developing training for all Central Laboratories in the country so that all Brazilian states are capable of processing the tests.
In addition to that, we also have Bio-Manguinhos, our Institute of Technology in Immunobiological Products, in charge of producing diagnostic kits. We now have been commissioned by the Ministry of Health to intensify the production of these tests, to increase production to our maximum capacity. We are working very hard to fulfill this demand. This work is being done in a very integrated way. Bio-Manguinhos has been tirelessly increasing its production rate.
And lastly, there is the fundamental role of test quality analysis, played by the National Institute for Quality Control in Health (INCQS).
AFN: How about assistance?
Nísia Trindade Lima: The National Institut of Infectology Evandro Chagas (INI) is already Fiocruz’s reference unit in the field of clinical research and specialized assistance to infectious diseases, working as reference center for the treatment of Covid-19 severe patients, but there is still a very small healthcare structure focused on this emergency. We are therefore mobilizing our entire team in a great effort to provide care to severe patients, increasing the number of beds, with the Fiocruz Hospital Center for the Covid-19 Pandemic, in our headquarters in Manguinhos.
We are talking about 200 beds for intensive and semi-intensive care, which will be assembled in a soccer field in Manguinhos. We have created a committee to monitor all Fiocruz actions at this moment, a group dedicated to this so we can have these beds available in good quality conditions, with safety for the patients, something that can only be achieved thanks to the excellence of our INI team and to the bold character of our institution. This boldness derives from its committment to public health.
We also have the National Institute of Women, Children and Adolescents Health Fernandes Figueira (IFF), which has been following pregnant women and newborns on the novel coronavirus in Brazil. This is something I consider crucial, as there are still many doubts regarding the transmission of the disease and its possible effects.
AFN: What other lines of research are being developed at Fiocruz? How has this area been structured?
Nísia Trindade Lima: Mathematical models are being made, as well as studies on the impact of the disease on the public health system and their social and economic impact. My proposal is to establish a Researcher Forum for the covid-19 and use the Technical Chamber of Research as an element of contribution to this. With this, we would have elements to structure an induction by our Inova program to elucidate this current dramatic situation, all the while contributing to prepare our institution and the country as a whole to face possible new emergencies, just like we faced the zika virus public health emergency. I believe at this moment we are facing a significant research challenge, in all fields.
AFN: How has Fiocruz been acting regarding clinical trials and possible treatments?
Nísia Trindade Lima: Together with the Department of Science and Technology, with the Ministry of Health and with the World Health Organization (WHO) we have been working to be part of a multicentric research of clinical trials focused on defining the best therapeutic strategies. This work is coordinated by our Vice President of Production and Innovation in Health (VPPIS) and will also involve INI, regarding clinical research, and the Technological Development Center for Health (CDTS), which has expertise in the analysis of these therapies in laboratory conditions.
This is, without a doubt, a very sensitive point, in which we can give a very important contribution, I believe. I have been very careful when it comes to the issue of treatment, because a lot of stuff has been released out there. It is possible to say there are promissing drugs being studied, but we will only issue statements after the Ministry of Health and the necessary institutions validate these drugs for patient use. One of the problems the country has been facing is the unavailability of some drugs for those who truly need them, who use them contiuously. The population is insecure and it is our job to ensure the efficacy and the safety of all drugs involved, so they have no counterindications. We are contributing to this goal.
AFN: How about communication actions?
Nísia Trindade Lima: I think communication has been one of the emphasis of our work and it has played a crucial role, as can be seen in the presence of our specialists who have been clarifying things in the media. Today, we have a network coordinated by the Presidency’s regular communication office, which plays a fundamental role, in addition to Fiocruz’s own vehicles, our Website; our social network profiles; Radis; our Canal Saúde [broadcast TV channel] etc. Fiocruz’s communication is also a system, and this work is acknowledged by all.
I think we need to think in terms of language and of target public. We need to offer communication to young people, this must be done together with the population, it is not just a message we direct, it is a joint contruction of messages. How do we create communication that reaches everyone, and not just the middle layers of the population? It is very important that we can review our strategies at any given moment, our emphasis, because communication tends to be directed to a middle-class public, even some social isolation measures, such as stay in your bedroom, avoid agglomerations, use hand sanitizer and things like that. But we know these measures are not possible for everyone in Brazil. I think this is a challenge for us.
An interesting initiative in this matter is our health communication campaign “Se liga no corona” [“Watch out for coronavirus”], created together with social organizations, to prevent the spreading of the new coronavirus among the population that inhabits slums and peripheral neighborhoods. All pieces are created based on doubts expressed by locals, collected by our partner community organizations.
AFN: What has been done in terms of education and professional training?
Nísia Trindade Lima: Fiocruz normally provides education at all levels, but at this moment we have been focusing particularly on training employees of laboratories that process the tests, and on healthcare professionals, such as the training of health agents with the Joaquim Venâncio Polytechnic Health School (EPSJV).
These early weeks will be very tough for all of us and for all these activities, because we are watching the models, the estimates, and we will be getting ourselves ready. As for education, we have taught an online inaugural class on the new coronavirus. The subject was not supposed to be this - originally, the class was going to be about sustainable development, with Professor Jeffrey Sachs, but it would be very alienating to talk about any subject other than the pandemic that has been moving and having impact all over the world, especially at an institution such as ours. We are also preparing online courses for health professionals, focusing on how to fight the covid-19. These courses are very important for the strategy of assistance. Post-grad programs are adapting and preparing virtual activities and some thesis are already being presented in this manner. This applies to education and to all activities in this format.
AFN: What can you say about the impact of the virus on the everyday work of the institution’s employees?
Nísia Trindade Lima: I think this impact is huge. This is why we have established a Contingency Plan to protect our workers and our essential activities, as Fiocruz is part of the solution for this problem we are facing. We are also focusing our attention to the discussion of the matter of hospital bonus (APH) for healthcare professionals, a fundamental issue to ensure we can take better care of people. Right now, healthcare professionals are under the strong impact of the pandemic, work is hard and with a very intense psychological strain. These professionals must be able to face very difficult, very dramatic situations. So our very special attention is focused on all Fiocruz workers, and, at this moment in particular, on all those who will be working with healthcare.
It is not our intention to de-mobilize our institution. On the contrary, we want to give our workers and students safe conditions, within the rules defined by public health authorities. We intend to protect our workers in the best possible way, all the while attempting to keep on doing our Fiocruz activities. Because this is what will give us stamina, will keep us from getting sick, will give a sense to this difficult social isolation time during which many remain home: remaining connected to one of the most important things, namely the ‘proud of being Fiocruz’ and being able to respond to such a serious public health emergency. A crisis that does not only affect the percentage of people who will develop the most serious form of the disease, but the entire health system. A universal and public system in which we believe, to whose construction we contribute, and which I believe is one of the strengths of Brazil right now.