Coronavírus: impacto da pandemia causará mais mortes por Aids, tuberculose e malária, indica estudo
Países de baixa e média renda podem ver, nos próximos anos, um aumento no número de mortes por Aids, tuberculose e malária em decorrência de medidas tomadas para conter uma outra e nova doença, a covid-19.
Mais precisamente, no pior cenário simulado por pesquisadores em modelos matemáticos, pode haver, nos próximos cinco anos, um aumento em número de óbitos de 10% pela Aids; 20% por tuberculose; e 36% por malária.
O tratamento destas doenças está sendo afetado pelos distúrbios e o esgotamento dos sistemas de saúde “já frágeis” com a covid-19 nestes países, e também por medidas de isolamento que acabam afetando rotinas de cuidado.
Em linhas gerais, os resultados indica que o impacto da pandemia nestas outras doenças varia de acordo com a extensão em que as intervenções contra a covid-19 precisam durar, causando longas interrupções nas atividades; e com o êxito dessas medidas na redução da transmissão do SARS-CoV-2, evitando que o sistema de saúde seja sobrecarregado por muito tempo.
O estudo foi publicado no periódico Lancet Global Health e é assinado por pesquisadores do Conselho de Pesquisa Médica do Centro para Análise de Doenças Infecciosas Globais, do Instituto Abdul Latif Jameel e do Imperial College de Londres, todos no Reino Unido. Os países considerados na pesquisa não foram revelados.

Além de simular o impacto das mortes adicionais, os pesquisadores também fizeram modelos considerando anos de vida perdidos — a expectativa de vida de uma pessoa subtraída por uma causa de mortalidade particular.
Em ambos critérios, a perspectiva de mortes e anos de vida perdidos por Aids, tuberculose e malária nos próximos cinco anos é menor que a da covid-19, mas de “magnitude similar”.
Os próprios autores alertam, porém, que prever o futuro, ainda mais considerando uma pandemia em andamento, é algo espinhoso.

Isso porque ainda há muito a ser conhecido sobre o novo vírus, e os desdobramentos dele para outras doenças ainda são muito imprevisíveis. A pesquisa, porém, visa quantificar o potencial da covid-19 de afetar estas doenças infecciosas e também oferecer informações para que esta perspectiva preocupante possa ser evitada ou minimizada hoje.
Por exemplo, os autores reforçam a importância da manutenção dos principais serviços referentes à Aids, tuberculose e malária.
Especificamente em relação à Aids, os autores preveem que o maior impacto se dê em problemas no fornecimento do coquetel antirretroviral. Por isso, o trabalho sugere prescrições de medicamentos com maior duração e entregas em domicílio.
Já para a tuberculose, o maior risco pode estar no diagnóstico e tratamento deixarem de ser feitos no tempo adequado; e, para a malária, em problemas nas medidas de combate aos mosquitos.

Desde 2000, mortes por malária e Aids foram significativamente reduzidas no mundo, destaca o artigo — mas o mesmo não pode ser dito sobre a tuberculose. A perspectiva que a covid-19 trouxe para todas elas é altamente preocupante.
“A pandemia de covid-19 e as ações tomadas em resposta podem desfazer alguns dos avanços mais importantes contra estas doenças nas últimas duas décadas, reproduzindo o ônus causado pela própria pandemia diretamente”, disse em comunicado à imprensa o professor Timothy Hallett, do Imperial College Londres.
“Em países com alto índice de malária e grandes epidemias de Aids e tuberculose, até mesmo interrupções de curto prazo podem ter consequências devastadoras para milhões de pessoas que dependem de programas para controlar e tratar essas doenças. Entretanto, este impacto indireto da pandemia pode ser amplamente evitado pela manutenção dos serviços principais e pela continuidade de medidas preventivas.”
Em um comentário à parte da pesquisa, Peter Sands, diretor executivo do Fundo Global para a Luta contra Aids, Tuberculose e Malária, sediado na Suíça, afirmou: “O impacto indireto (da pandemia) na Aids, tuberculose e malária pode ser potencialmente ainda pior do que este estudo sugere e, em alguns países, pode ser ainda pior do que o impacto direto da covid-19.”
“O Fundo Global realiza uma pesquisa qualitativa quinzenal nos mais de 100 países em que investe; os últimos resultados publicados sugerem que 85% dos programas contra o HIV, 78% contra a tuberculose e 73% contra a malária estão passando por interrupções. E 18% dos programas de HIV, 17% dos programas de tuberculose e 19% dos programas de malária estão passando especificamente por uma interrupção de alto ou muito alto impacto. “
O estudo publicado no Lancet foi financiado pela Fundação Bill & Melinda Gates, pelo instituto de apoio à pesquisa britânico Wellcome Trust, pelo Departamento de Desenvolvimento Internacional do Reino Unido e do Conselho de Pesquisa Médica.
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Apresentado com vários gráficos e metodologia detalhada, o trabalho considerou um número reprodutivo básico (R0; o número médio de pessoas que cada indivíduo com o vírus provavelmente infectaria) do novo coronavírus de 3.
A partir daí, com modelos matemáticos, os cientistas simularam quatro cenários, de acordo com respostas políticas diferentes à pandemia: nenhuma ação; mitigação; supressão aumentada; e supressão (algo como um lockdown mais rigoroso).
Em seguida, estes dados foram combinados com modelos de transmissão do HIV, tuberculose e malária.
As piores perspectivas para a Aids foram observadas no cenário de nenhuma ação ou supressão aumentada; para tuberculose, no cenário de supressão; e para a malária, em todos cenário com exceção da supressão.
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