Bauru tem leitos suficientes para lidar com a covid-19?

Segundo o sistema de dados do SUS, são 1228 leitos de internação e 196 leitos complementares na cidade, entenda a classificação

Publicado em 25 de março de 2020

Número na cidade atende previsão da OMS quando somados os leitos públicos e particulares; contando somente do SUS, não (Arte: Bibiana Garrido/JornalDois)
Por Vinícius Nascimento e Bibiana Garrido

Bauru tem 1424 leitos hospitalares conforme números divulgados pelo DataSus em fevereiro de 2020. Na classificação do SUS – Sistema Único de Saúde, esses leitos se dividem entre leitos de internação e leitos complementares. Do total disponível na cidade, 1228 são de internação e 196 são complementares.

Os números contam leitos em hospitais públicos e privados.

Leitos de internação ficam “em ambientes hospitalares, na categoria leitos cirúrgicos, clínicos, obstétricos, pediátricos, hospital dia e outras especialidades”, define o SUS. São as camas destinadas à internação de um paciente no hospital. Já os leitos complementares, são “leitos em ambientes hospitalares, nas categorias de leitos complementares (UTI e Unidade Intermediária)”.

Se considerarmos somente a estrutura do SUS em Bauru, estão disponíveis 636 leitos de internação e 99 leitos complementares – totalizando 735 leitos hospitalares.

Os leitos complementares, utilizados nas Unidades de Terapia Intensiva (UTI), são os que podem receber um aparelho respirador em caso de necessidade do paciente.

Não se sabe quantos desses leitos estão sendo destinados ao tratamento da covid-19, doença causada pelo coronavírus. A equipe do J2 solicitou a informação atualizada à Prefeitura Municipal, mas não obteve resposta até a publicação da reportagem – veja, ao final da matéria, os questionamentos enviados à administração.

Queda no SUS, mas não em Bauru

Desde dezembro de 2007 houve perda de 49 mil leitos do SUS  no Brasil, o que corresponde a 14,3% dos leitos da saúde pública. No mesmo período o setor de saúde privada teve aumento de 8,2%. Quando considerado o número total – leitos SUS e Não SUS – as perdas são de 6,2%, conforme dados disponibilizados pelo Cadastro Nacional de Estabelecimentos de Saúde (CNES).

Segundo Ederlon Rezende que é membro do Conselho Consultivo da Associação de Medicina Intensiva Brasileira (AMIB) e coordenador do Projeto UTIs Brasileiras, 95% de ocupação dos leitos durante a pandemia do coronavírus será pelo SUS.

Isso porque 157,7 milhões de pessoas no país dependem exclusivamente do sistema público de saúde – o que dá 75% da população. 

(Dados: CNES | Arte: Vinícius Nascimento/JornalDois)
No SUS, 1,9 leitos para cada mil bauruenses 

Em 2009 o número de leitos para internação em Bauru era de 1.046, sendo 465 do SUS, dados disponibilizados pelo Instituto Brasileiro de Geografia e Estatística (IBGE). Ao contrário do cenário nacional, a estrutura dos leitos de internação cresceu aproximadamente 15% na última década.

A Organização Mundial da Saúde (OMS) recomenda de 3 a 5 leitos para cada mil habitantes. Bauru tem uma população estimada em 377 mil habitantes, conforme dados do IBGE de 2019. Fizemos a conta: ao todo são 3,7 leitos para cada mil bauruenses – dentro da margem, considerando o setor público e hospitais particulares.

Se contarmos somente no SUS são 1,9 leitos para cada mil habitantes.

A pandemia e o colapso na saúde

Com o atual surto de coronavírus o número de casos confirmados no Brasil chegou a 1891 com 47 mortes. São 40 mortes só no estado de São Paulo, que concentra 810 casos confirmados.

A capacidade do sistema de saúde brasileiro suportar a crescente demanda passou a ser questionada. Segundo Luiz Henrique Mandetta, ministro da Saúde, o SUS pode entrar em colapso em abril “se não fizermos nada”. O Ministério da Saúde afirma que a situação começará a se normalizar a partir de setembro.

No cenário nacional, a previsão calcula cerca de 7 mil casos no Brasil até o fim de março. A estimativa foi publicada pelo Observatório Covid-19 BR, grupo de iniciativa independente que reúne pesquisadores das universidades brasileiras UFABC, UNESP, USP e Unicamp; das universidades estadunidenses University of Chicago e UC Berkeley; e a alemã UNI Oldenburg.

Previsão da Agência Brasileira de Inteligência (ABIN) é que o Brasil pode chegar a 200 mil casos com 5,5 mil mortos até o dia 6 de abril – se seguir na mesma velocidade de contágio que foi observada na China, Itália e Irã.

O cálculo entre o número de novos casos em relação ao tempo e a capacidade de atendimento das ocorrências se chama curva de transmissão. As medidas tomadas pelo poder público até agora visam desacelerar o aumento dos casos num curto espaço de tempo. Essa estratégia ficou conhecida pela expressão  “achatamento da curva”, para evitar que o sistema de saúde sofra uma sobrecarga.

O Brasil está na fase de transmissão localizada da doença, quando não há como saber a origem de de quem transmitiu o vírus. O investimento federal destinado para combater a pandemia é de 1,2 bilhão, com os esforços voltados para a atenção primária para o combate ao coronavírus no país.

Em 20 de março foi aprovado decreto para o estado de calamidade pública no país. A medida autoriza o descumprimento da meta fiscal do ano, ou seja, em 2020 o governo poderá gastar mais do que o inicialmente previsto. O decreto não livra o governo de cumprir o teto de gastos (a proibição de investimentos crescerem acima da inflação durante 20 anos).

A construção de novos leitos é considerada essencial para melhor eficiência no tratamento das pessoas com covid-19, principalmente das que apresentarem casos graves.

Previsão para Bauru

São 60 casos suspeitos e 2 mortes invesigadas para covid-19 em Bauru. O último boletim informativo, divulgado pela prefeitura na noite de segunda-feira (23), registra 7 casos descartados e nenhum confirmado para doença.

O município pode chegar a 80 mil pessoas com coronavírus e 180 mortes,  se aplicarmos previsões a partir de modelos matemáticos que calculam o crescimento dos casos, como informou o  secretário de saúde de Bauru Sérgio Henrique Antônio, “muitos casos assintomáticos ou com sintomas leves”.

Do total de casos previstos para a cidade, o órgão afirma que apenas 1800 teriam condições de serem diagnosticados e confirmados.

A prefeitura decretou situação de emergência em saúde pública e lançou medidas para a prevenção. As indicações visam a redução e paralisação de serviços, com diminuição da circulação de pessoas – as principais ações foram relatadas nessa matéria do Jornal Dois.

Como parte do plano de contingência, o prefeito Clodoaldo Gazzetta disse que nos próximos dias deverá ser anunciada pelo governo estadual a criação de 222 novos leitos no Hospital das Clínicas da Universidade de São Paulo (USP) em Bauru. De Bauru, Gazzetta (PSDB) reforça importância da medida como forma de prevenção: “uma retaguarda importante” para a cidade e região.

No dia 19 de março o prefeito anunciou a aquisição de 30 novos respiradores, equipamentos necessários para tratar casos mais graves de covid-19, e a liberação de R$2,5 milhões para a compra de equipamentos de tomógrafo, que podem fazer o diagnóstico da doença. Como pode haver demora no processo de compra, a saída indicada pela prefeitura é alugar aparelhos ou usar o dinheiro para compra de exames, seja em clínicas particulares, seja na Universidade Estadual Paulista (Unesp) de Botucatu – que vende os exames por R$75 cada. 

Demora nos resultados da covid-19

Do jeito que está funcionando hoje, sem análise de exames na cidade, os testes de coronavírus são enviados ao laboratório de virologia do Instituto Adolfo Lutz em São Paulo. O laboratório na capital é um dos quatro centros de referência no país para detecção da Covid-19, os outros são Fundação Oswaldo Cruz (RJ), Instituto Evandro Chagas (PA) e Laboratório Central (GO).

A Prefeitura de Bauru estuda a possibilidade de transferir as análises do Instituto Adolfo Lutz para a unidade regional do mesmo órgão em Bauru, na tentativa de acelerar os diagnósticos. O governo estadual precisa aprovar a mudança.

Iniciativas municipais buscam acelerar os diagnósticos na cidade, parados há duas semanas por conta da demanda no laboratório da capital. O prazo, que era 72 horas para resultados, passou para 15 dias no Instituto Adolfo Lutz.

A Faculdade de Odontologia de Bauru, da USP, indicou que poderia realizar os testes – para começar, também precisa de aprovação.

Sem respostas

A Prefeitura de Bauru foi questionada sobre o número de leitos do município, sobre o número de leitos destinados ao tratamento de pessoas com covid-19 e as etapas para atendimento de pacientes suspeitos, e não respondeu até a publicação dessa reportagem.

Sobre assentamentos e populações vulneráveis, o prefeito Gazzetta afirma que serão intensificados os cuidados de consultórios nas ruas da cidade, oferecendo cestas básicas para famílias mais pobres e acolhendo as “pessoas mais necessitadas na cidade”. 

Baixe o aplicativo do SUS

O Ministério da Saúde desenvolveu o aplicativo “Coronavírus-SUS” para Android e iOS para facilitar o acesso a informações oficiais sobre o coronavírus, além de oferecer orientações preventivas ao usuário.

No aplicativo é possível realizar uma “triagem virtual”, onde o usuário responde um questionário prévio à consulta na Unidade Básica de Saúde (UBS). O Ministério da Saúde solicitou que as operadoras de telefonia não descontem do plano de internet do usuário a utilização do app – Claro, Vivo e Oi se manifestaram a favor da recomendação.

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