Decifra-me ou te devoro: enigmas da Vigilância em Saúde na pandemia Covid-19

Abstract

Resumo Desde janeiro de 2020, o mundo vive uma crise sanitária sem precedentes, após declarada, pela Organização Mundial da Saúde, a Emergência de Saúde Pública de Importância Internacional, como estratégia de vigilância e resposta imediata à pandemia da Covid-19. No Brasil, o caos econômico e político resultante do golpe de Estado de 2016 aprofundou a crise pandêmica, expondo o fosso das desigualdades sociais e, em particular, das desigualdades em saúde, e o descaso pela vida em todas suas dimensões. Essa reflexão traz à cena elementos conjunturais (econômico-políticos e socioambientais) necessários à compreensão das intervenções técnicas de vigilância, com destaque à quarentena e ao isolamento social, como estratégias emergenciais normatizadoras da vida individual e coletiva, usadas para o controle de corpos e lugares. Nesse cenário catastrófico, territórios vulneráveis são penalizados duplamente, por sua condição periférica no espaço das cidades e por sua exclusão sistemática aos direitos de cidadania, exigindo, dos governos, intervenções que considerem a dimensão continental e a heterogeneidade econômica-cultural do país; as desigualdades sociais e em saúde; e a capacidade de resposta oportuna de cada esfera de gestão de responsabilidade exclusiva do Estado, nos âmbitos das ações de Vigilância em Saúde, Assistência Especializada e Atenção Primária à Saúde no Sistema Único de Saúde.

The inequality pandemic and its impact on public health

“…For the first time, the world has realized the fragile balance in which we are immersed and the value of universal health systems and public policies supported by the State, to ensure health security and social well-being. [11] Uncertainties, vulnerabilities and ambiguities are current challenges that demand responses from governments and short, medium and long-term interventions that take into account the urgency of radical changes in the ways of producing and reproducing life in the different essential areas of human activities (water, ha ¬habitation, transport, health, education, agriculture, among others), to preserve life. [11] The epidemiological, economic and humanitarian scenario, which is triple threatening, demanded, from international health authorities and national governments, protective actions of surveillance and control, with a central focus on the practice of social isolation / removal that it recommends to all people to remain.…”

“…These measures aim to reduce the spread of the disease and prevent the immediate collapse of the hospital network (public and private), unable to respond, in time, to the geometric increase in the number of infected and to safely care for patients. [11] Brazil adds, to the multiple faces of the current global health situation, other epidemic ailments and serious socioenvironmental vulnerability that perverse exposes a significant portion of the population living in precarious and exceptional territories. These 'invisible' subjects to the world of neoliberal capital and policies live in inadequate housing conditions and urban infrastructure and survive on informal-unprotected work to meet basic human needs.…”

“…They are vulnerable people, families and social groups, with a greater chance of exposure to risks in intra and peridomestic spaces; subjected to social isolation and quarantine and under multiple threats, they suffer the uncertainty of the disease and the imminent loss of family income. [11] The Ministry of Health's Contingency Plan for Public Health Emergency of National Importance (ESPIN-Covid-19) indicates different strategies and technologies that should be incorporated into Health Surveillance actions in the Containment and Mitigation phases. However, the fragmentation between surveillance actions, specialized care and primary health care remains, and the precariousness in the integration of the three spheres of management of the system.…”

“…However, the fragmentation between surveillance actions, specialized care and primary health care remains, and the precariousness in the integration of the three spheres of management of the system. [11] The gap between recommendations, interventions and real needs of the territories for protection, risk control and solutions to vulnerabilities is evident, given the speed of infection / response and the homogeneity of diagnoses, which reveal numbers (infected, cases and death), without the corresponding accuracy to the different contexts of life of the populations, in the regional, state and municipal scales. [11] Furthermore, they forget that the institutional actors who carry out most of the disease surveillance and control actions are medium-level technical workers, with great capillarity in the territories, but without experience in emergency situations, being exposed to uncertainties and pressures of all kinds: lack of guidance and training to face the problem; joblessness; and the absence of adequate technologies to develop your work safely and resolutely.…”

“…[11] The gap between recommendations, interventions and real needs of the territories for protection, risk control and solutions to vulnerabilities is evident, given the speed of infection / response and the homogeneity of diagnoses, which reveal numbers (infected, cases and death), without the corresponding accuracy to the different contexts of life of the populations, in the regional, state and municipal scales. [11] Furthermore, they forget that the institutional actors who carry out most of the disease surveillance and control actions are medium-level technical workers, with great capillarity in the territories, but without experience in emergency situations, being exposed to uncertainties and pressures of all kinds: lack of guidance and training to face the problem; joblessness; and the absence of adequate technologies to develop your work safely and resolutely. [11] Social isolation / removal and quarantine as health surveillance devices and protective measures to contain the spread of the SARS-CoV2 virus require translation of knowledge to be incorporated into the daily lives of the population.…”