O que aconteceu nos países que acabaram com as restrições contra a covid

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Alemanha, Áustria, Reino Unido, China, Coreia do Sul… Foram vários os países da Europa e da Ásia que tiveram um aumento no número de casos de covid-19 nos últimos dias.

A nova subida acontece após uma queda vertiginosa nas infecções pelo coronavírus, registrada entre o final de janeiro e o início de março, momento em que a onda provocada pela variante ômicron arrefeceu em boa parte do globo.

Esse período também foi marcado pelo fim da maioria das medidas preventivas, como o uso de máscaras em lugares fechados, especialmente nas nações europeias.

Alguns governos chegaram até a decretar o fim da pandemia e anunciaram que a covid passaria a ser encarada como uma endemia.

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Mas como explicar esse repique nos casos? O alívio das restrições é suficiente para justificar a retomada das curvas? E será que o Brasil, que passa por um momento de queda nas estatísticas da pandemia, passará por uma piora daqui a algumas semanas? A BBC News Brasil ouviu especialistas para entender esse cenário e encontrar possíveis respostas para todos esses questionamentos.

Variante ômicron, versão 2.0

O aumento de casos em alguns países europeus e asiáticos acontece em um momento em que a BA.2, uma variante “prima-irmã” da ômicron (a BA.1) começa a se tornar dominante em muitos territórios.

Para se ter uma ideia, a BA.2 apareceu em 68,6% das amostras que foram sequenciadas no Reino Unido entre os dias 27 de fevereiro e 6 de março. A ômicron “original” representou 31,1% dos casos no mesmo período.

Esse mesmo padrão de crescimento da linhagem BA.2, que substitui aos poucos a BA.1, pode ser observado em outros países, como Áustria, Coreia do Sul e Alemanha.

Há poucas semanas, a BA.1 reinava absoluta em muitos desses locais. Mas a variante perdeu a dianteira, de acordo com o Instituto Sorológico da Dinamarca, porque a BA.2 tem uma capacidade de transmissão 1,5 vez maior em comparação com a BA.1. E a BA.1 já era um dos vírus mais contagiosos que surgiram no último século.

“Todas as ondas que vimos nesta pandemia tiveram um componente em comum: o surgimento de uma nova variante do vírus”, interpreta o médico Marcio Sommer Bittencourt, professor associado da Universidade de Pittsburgh, nos Estados Unidos.

A boa notícia é que a BA.2 não parece estar relacionada a um quadro mais grave do que o observado até agora com a BA.1.

“As análises preliminares não encontraram evidências de um risco maior de hospitalização após a infecção com a BA.2, em comparação com a BA.1”, escreve a Agência de Segurança em Saúde do Reino Unido num relatório publicado no dia 11 de março de 2022.

Vale lembrar que probabilidade de sofrer complicações da covid também está relacionada à quantidade de vacinas que um indivíduo tomou ou às infecções prévias.

Ou seja: quem tem pouca ou nenhuma imunidade contra o coronavírus pode experimentar consequências muito piores do que alguém que está com as doses em dia, especialmente se considerarmos os grupos de risco (como idosos e portadores de doenças crônicas).

Outro aspecto que traz uma perspectiva otimista para esse novo aumento de casos é que ele tende a subir e cair rapidamente, a exemplo do que ocorreu com a BA.1: em países onde a BA.2 virou dominante há algumas semanas, como Dinamarca e Holanda, o registro diário de infecções já está em queda novamente, como é possível observar no gráfico a seguir.

Países como Holanda (linha verde) e Dinamarca (linha laranja) tiveram uma primeira onda causada pela variante BA.1 seguida por uma segunda onda relacionada à BA.2. Nos dois lugares, o aumento e a queda aconteceram de forma rápida

No entanto, uma elevação de casos também pode suscitar um aumento de hospitalizações e óbitos, ainda mais nos lugares com uma grande parcela da população suscetível pela baixa cobertura vacinal ou pela ausência de ondas maiores até então.

Ainda não se sabe se esse novo aumento de casos na Europa e na Ásia está acometendo apenas quem não teve covid recentemente e não foi vacinado, ou se também inclui uma proporção de indivíduos que se infectaram com a ômicron “original” recentemente.

Até o momento, a Organização Mundial da Saúde (OMS) aponta que “os estudos que avaliaram a taxa de reinfecção em algumas populações sugerem que a infecção com a BA.1 proporciona uma forte proteção contra a BA.2, ao menos pelo curto período em que os dados estão disponíveis”.

“Isso é algo que ainda precisa ser estudado, mas vemos que esse aumento de casos é mais intenso nos países que não têm uma taxa de vacinação adequada ou não tiveram grandes ondas anteriormente, como a Alemanha”, observa Bittencourt.

“Já Portugal, que está com uma alta cobertura vacinal e teve mais casos de infecção prévia, parece possuir uma ‘bagagem imunológica’ maior e não experimenta um aumento de casos agora”, compara o médico.

Portugal (linha laranja) não parece estar sofrendo com um aumento grande de casos mais recentemente, enquanto a curva sobe de forma acelerada na Alemanha. Diferença pode ser taxa de vacinação e o tamanho das ondas anteriores

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Embora a alta transmissibilidade da BA.2 seja a principal explicação para o cenário europeu atual, existe um segundo elemento que precisa ser considerado: o fim de quase todas as medidas restritivas que marcaram os últimos dois anos.

Em alguns países, o uso de máscaras deixou de ser obrigatório em lugares abertos e fechados, não há mais políticas de testagem em massa, nem a recomendação de que pacientes infectados com o coronavírus fiquem em isolamento.

A mudança nas políticas públicas estimulou mais encontros e aglomerações, contextos onde o vírus consegue se espalhar em escala geométrica e criar novas cadeias de transmissão. E isso, junto com a maior taxa de contágio da BA.2, ajuda a explicar essa nova subida de casos em algumas partes do mundo.

Passados dois anos desde o início da pandemia, a política de “covid zero”, seguida à risca em lugares como Coreia do Sul, Vietnã, Taiwan, Austrália e Nova Zelândia, foi abandonada na maioria dos países. O único local que continua apostando nessa estratégia é a China.

Mesmo entre os pesquisadores da área, soa quase como uma utopia a ideia de eliminar completamente a covid-19 de uma região através de medidas como o lockdown no atual contexto.

China registrou recorde de mais de 5 mil casos, a maioria na província de Jilin

“Do ponto de vista da saúde pública, o fechamento total das atividades pode até fazer sentido. Mas o custo de parar tudo também traz custos sociais e econômicos muito grandes”, pondera Bittencourt.

“No início da pandemia, com o risco da doença muito alto, o fechamento era necessário, por mais caro e custoso que isso fosse”, diferencia o médico. “Atualmente temos vacinas e muitas pessoas foram infectadas, então o risco é menor, logo as medidas podem ser calibradas para essa situação.”

Isso não significa que o extremo oposto dessa postura, a liberação completa de todas as restrições, faça sentido.

Para explicar esse ponto de vista, a médica Lucia Pellanda, professora de epidemiologia da Universidade Federal de Ciências da Saúde de Porto Alegre, faz um paralelo entre a covid-19 e o futebol.

“Às vezes, sinto que a pandemia se assemelha a uma partida, em que estamos ganhando de 1 a 0 e simplesmente abandonamos o campo antes de o juiz dar o apito final”, compra.

“Quando as coisas começam a melhorar um pouco, há uma pressa para dizer que a covid não é mais um problema e podemos acabar com todas as medidas preventivas.”

“E o que a experiência nos mostra é que não existe uma solução simples para dar um fim de verdade à pandemia. Precisamos insistir com as vacinas, as máscaras e o cuidado com as aglomerações até o final desta partida”, conclui a especialista.

A médica e epidemiologista Eleonora D’Orsi, professora do Departamento de Saúde Pública da Universidade Federal de Santa Catarina, concorda. “Em muitos lugares, houve uma estagnação na cobertura vacinal com duas ou três doses e, para piorar, todos os cuidados preventivos foram deixados para trás.”

“E estamos lidando com uma doença sobre a qual não conhecemos todos os efeitos de longo e médio prazo. Vários estudos nos indicam que a covid não é simples e afeta outras partes do corpo além do sistema respiratório”, alerta.

Já o bioinformata Marcel Ribeiro-Dantas, pesquisador na área de saúde do Instituto Curie, na França, entende que muitos desses países fizeram tudo o que podiam e o relaxamento das medidas era um passo natural e razoável.

“Houve um esforço grande do governo e da população de muitos países europeus para conter a pandemia. Os primeiros lockdowns aqui na França foram drásticos e todo mundo ficou trancado em casa”, lembra o pesquisador.

“Com a estafa natural após dois anos de restrições e a ampla disponibilidade de vacinas e tratamentos efetivos, parece inevitável que alguns países diminuam as restrições.”

“A questão é conseguir transformar obrigações da lei em recomendações que as pessoas sigam no dia a dia. Quando você consegue conscientizar a população sobre a necessidade do uso de máscaras em alguns ambientes, por exemplo, isso passa a fazer parte de uma nova cultura daquele local”, completa o especialista.

Vacinação continua a proteger contra formas mais graves da covid, que levam à hospitalização e morte

Essa onda vai chegar ao Brasil?

Enquanto os casos sobem em partes da Ásia e da Europa, o Brasil se encontra numa situação oposta: as médias móveis de casos e mortes por covid seguem em queda desde janeiro, quando o país registrou o pico da variante ômicron.

Os especialistas ouvidos pela BBC News Brasil entendem que não dá pra dizer que esse mesmo cenário de agravamento em curso no exterior também se repetirá no país.

Em outros momentos da pandemia, coisas que impactaram profundamente o Brasil — como a variante gama — não tiveram o mesmo efeito no cenário internacional.

E o inverso também aconteceu: embora tenha sido avassaladora na Índia e nos Estados Unidos, a variante delta não foi tão desastrosa do ponto de vista da mortalidade nas cidades brasileiras.

Até fevereiro, a BA.2 representava apenas 0,4% das amostras sequenciadas no Brasil, segundo a Rede Genômica da Fundação Oswaldo Cruz (FioCruz). A BA.1, a ômicron original, está presente em praticamente 99% de todo o material analisado em laboratório nesse período.

Bittencourt entende que, diante de uma situação mais estável da pandemia, “é hora de discutir algumas medidas e ajustar a intensidade delas”.

“É claro que isso não significa abandonar completamente o uso de máscaras. Elas são necessárias no transporte público, mas não precisam ser usadas em lugares abertos.”

“Mas precisamos ter em mente também que o Brasil flexibilizou a maior parte das medidas há tempos. Shoppings, restaurantes e casas noturnas estão funcionando normalmente”, completa.

Pellanda acredita que o desafio é fazer essa comunicação sobre o manejo e a prevenção da covid de forma adequada e contextualizada. “As pessoas precisam avaliar o risco individual e de cada local em que elas estiverem”, diz.

“É errado encarar as máscaras como algo ruim e limitador. Elas precisam ser incorporadas em algumas situações, da mesma maneira que fizemos com o uso do cinto de segurança nos carros e com a proibição de fumar em estabelecimentos fechados”, argumenta.

Entre o fim da pandemia e uma nova piora no número de casos relacionada à BA.2 e ao relaxamento das medidas de prevenção, o caminho mais adequado e seguro em qualquer país do mundo continua bem parecido: acompanhar o que está acontecendo e adequar os cuidados à situação de momento.

BSB Revista com BBC de Londres.


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