New Coronavirus News from 26 Mar 2022

Brazil's COVID-19 guidelines: political hijack of public health [The Lanvet, 26 Mar 2022]

Authored by Luis C L Correia, Cristina Sette, Marisa Santos, Carlos A S Magliano and Fotini S Toscas

On Jan 20, 2022, in an unprecedented move, the Brazilian Secretary for Science, Technology, and Innovation overrode the Brazilian guideline for COVID-19 outpatient treatment. The guideline was originally demanded by the Ministry of Health, developed by a team of academics, specialists, and health technology analysts, according to GRADE-ADOLOPMENT methodology.1

The guideline, which recommended against the use of drugs without scientific proof of efficacy, such as hydroxychloroquine and ivermectin,2 was finally approved by the National Committee for Health Technology Incorporation (CONITEC) in December, 2021. In the Brazilian public health system, CONITEC has a central role in evaluating and recommending technology implementation on the basis of the scientific paradigms of efficacy, effectiveness, and cost-effectiveness.

Since the beginning of the COVID-19 pandemic, there has been endless and polarised debate regarding the use of unproven therapies for COVID-19 in Brazil, which, combined, are known as COVID Kit. COVID Kit was popularised by a populist federal government and, unfortunately, was adopted by some members of the medical community who failed to recognise the principles of scientific reasoning in medical decision making.3

Paradoxically, the anti-scientific decision against the guideline was taken by a secretary of science. The decision was accompanied by a long note of justification, which made use of epidemiological jargon to define a logic that clearly violated basic scientific principles. First, it suggested that statistical significance should not be a necessary condition for establishing drug efficacy; second, it proposed Bradford Hill criteria as a means to claim drug efficacy in the absence of controlled empirical observations, such as large and low risk of bias clinical trials; and finally, it concluded in favour of the effectiveness of hydroxychloroquine, while claiming that vaccination has no demonstrated effectiveness.4

It is natural for humans to suffer from intrinsic bias in the process of judgement. However, the present situation seems to be the result of a strongly polarised environment that led to this unfortunate conspiracy to replace scientific criteria with political interests.
Brazil has been an example of two opposite phenomena: the tendency of a populist government to undermine science, and the resistance of scientists under a strong democratic regimen that supports freedom of speech. We believe that with the support of the international scientific community, the latter will prevail.

References
1. Schünemann HJ, Wiercioch W, Brozek J et al.
GRADE Evidence to Decision (EtD) frameworks for adoption, adaptation, and de novo development of trustworthy recommendations: GRADE-ADOLOPMENT.
J Clin Epidemiol. 2017; 81: 101-110
2. Ministry of Health
Diretrizes Brasileiras para tratamento medicamentoso ambulatorial do paciente com COVID-19.
http://conitec.gov.br/images/Consultas/Relatorios/2021/20211112_Diretrizes_Brasileiras_para_Tratamento_Medicamentoso_Ambulatorial_do_Paciente_com_Covid-19.pdf
3. Correia LC, Lopes JRP, Garcez FB, Campion EL, Barcellos G and Barreto-Filho JA
Physicians' preference towards the non-evidence based hydroxychloroquine treatment for COVID-19: the pandemic effect.
Evidence. 2020; 2: 10-15
4. National Commission for Health Technology Incorporation
Fundamentação e decisão acerca das diretrizes terapêuticas para o tratamento farmacológica do COVID-19.
http://conitec.gov.br/images/Audiencias_Publicas/Nota_tecnica_n2_2022_SCTIE-MS.pdf

Shanghai rules out full lockdown despite sharp rise in Covid cases [The Guardian, 26 Mar 2022]

Concern about economy leads city to try targeted approach with rolling restrictions of individual neighbourhoods

Shanghai has recorded a sharp rise in Covid-19 cases, but officials have ruled out a full lockdown over the damage it would do to the economy.

Millions of Chinese in affected areas have been subjected to city-wide lockdowns by an Omicron-led outbreak that has sent daily case counts creeping ever-higher, though they remain insignificant compared with other countries.

Shanghai, however, has aimed to ease disruption with a more targeted approach marked by rolling 48-hour lockdowns of individual neighbourhoods and large-scale testing while largely keeping the metropolis of 25 million people running.

At a daily Shanghai press conference on Saturday, officials alluded to the importance of avoiding a full lockdown of the huge port city.

“If Shanghai, this city of ours, came to a complete halt, there would be many international cargo ships floating in the East China Sea,” said Wu Fan, a medical expert with the city’s pandemic taskforce.

“This would impact the entire national economy and the global economy.”

Wu made the comments as city officials also announced that they would begin handing out self-testing kits to Shanghai residents, in the latest sign that the government was expanding its pandemic response.

The north-eastern province of Jilin also said that it had begun distributing 500,000 rapid-antigen kits.

Shanghai and Jilin have been the areas hardest hit by the outbreak, which took off in early March.

China had largely kept the coronavirus – which first emerged in the city of Wuhan in late 2019 – under control through its strict zero-tolerance measures.

But that top-down approach is increasingly being questioned amid concerns over the economic impact and public “pandemic fatigue”, especially considering Omicron’s less severe symptoms.

The National Health Commission announced two weeks ago that it would introduce the sale in China of rapid antigen self-test kits for the first time, and they have begun to appear on pharmacy shelves.

But Saturday’s announcements appeared to mark their first wide-scale use as part of official pandemic control measures.

China on Saturday reported 5,600 new confirmed domestic transmissions, most of them asymptomatic.

Chinese authorities had watched nervously as a deadly Hong Kong Omicron surge sparked panic buying and claimed a high toll of unvaccinated elderly in the southern Chinese city.

Its subsequent spread in mainland China has posed a dilemma for authorities wrestling with how forcefully they should respond.

On Wednesday, Shanghai infectious disease expert Zhang Wenhong, a top doctor in the city’s pandemic fight, called for balancing antivirus measures with maintenance of “normal life”.
The comments in his widely followed blog indicated growing official tolerance for voices who question the lockdown approach.

Frustration with Covid response grows in China as daily cases near 5,000

Shanghai’s softer strategy has so far failed to stop cases from rising, and the localised lockdowns have provoked grumbling online and a run on groceries in some districts.
Shanghai reported another steep rise in new local transmissions to 2,269 – about 40% of the national total.