By NewsDesk  @infectiousdiseasenews

Case counts

The number of confirmed coronavirus cases in Brazil rose to 12,345, including 581 deaths.

São Paulo has reported the most cases and deaths of all Brazilian states. Only the states of Acre and Tocantins do not have confirmed deaths from COVID-19.

Indigenous territories

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The BBC reports infections have now spread across the country, including to indigenous territories in the Amazon basin that are the size of France and Spain combined. The first case among indigenous peoples was recorded in Amazonas state.

“There is an incredible risk of the virus spreading across the native communities and wiping them out,” says Dr Sofia Mendonça, a researcher at the Federal University of São Paulo (Unifesp).

Social distancing criteria

On Monday, April 13, the municipalities and states of the country that have not exceeded the percentage of 50% occupancy of health services, after the coronavirus pandemic, can start a transition to a format where only a few groups stay in isolation. The measure is recommended as long as there is an offer of beds and respirators, Personal Protective Equipment (PPE) for the work of health professionals and diagnostic tests.

The recommendation is in the Special Epidemiological Bulletin on Coronavirus , published on Monday, April 6 by the Ministry of Health.

The document guides the adoption of differentiated actions in relation to social distancing by states and municipalities, based on different scenarios of virus circulation. The objective is to promote a gradual return to the movement of people, including labor activities, with safety, avoiding a possible explosion of cases without the local health system having time to absorb them and guarantee adequate assistance to the population.

However, in places that present an incidence coefficient 50% higher than the national estimate, these measures of social distance from all sectors of society must be maintained until the health materials and supplies are sufficient, considering the possibility of increasing the transmission of the virus. The initiative considers the diversity of the Brazilian territory, from North to South, from the perspective of 5,570 municipalities.

The executive secretary of the Ministry of Health, João Gabbardo, explains that measures must be proportional to the reality presented in each municipality, each region and each capital. “We discussed better with the states and municipalities so that identical measures were not taken for completely different situations”, pointed out João Gabbardo.

“We created virus circulation parameters and bed usage parameters that can enable the manager to take these quarantine measures more safely. To take this attitude, we need to be safe from the point of view of PPE, rear beds, ICU, and human resources ”, highlighted the executive secretary of the Ministry of Health, João Gabbardo.

So far, only the states of São Paulo (10.5), Rio de Janeiro (8.4), Ceará (11.0), Amazonas (12.6) and the Federal District (15.5) have an incidence coefficient higher than the national average, which is 5.7 per 100 thousand inhabitants. Brazil, in general, is at the stage of localized epidemics. The duration and severity of each phase of the pandemic may vary depending on the local public health response.

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Currently, the measure used by most regions of the country is the Extended Social Distancing (DAS), when all sectors of society need to remain in the residence for the duration of the decree of the measure by the local managers. The method should be used in places where the number of confirmed cases has impacted more than 50% of the installed capacity of the local health system. This is until the supply of equipment (beds, PPE, respirators and laboratory tests), in addition to health teams, are available in sufficient quantities to safely promote the transition to the Selective Social Distancing (DSS) strategy.

In places where confirmed cases have not impacted more than 50% of the capacity of the health system, the Ministry of Health indicates the transition to Selective Social Distancing. In these cases, only a few groups are isolated, with attention to those at higher risk of worsening the disease, such as the elderly and people with chronic diseases, such as diabetes and hypertension, or risk conditions, such as obesity and risk pregnancy. In these cases, people under 60 can move freely if they are asymptomatic.

In summary, in places where there is low circulation of the coronavirus and, consequently, low need to use the structures of health services, if conditions are guaranteed, the resumption of work and economic activity is possible.