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Interview

Sergio Machado Rezende: Together against COVID-19

The physicist is one of the coordinators of the Scientific Committee for the Fight against Coronavirus in the Northeast, which advises the region's governors

Rezende at home: one of his tasks is to write the bulletin with the scientific committee recommendations

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Isolated in his Recife home since March, in the state of Pernambuco, the physicist Sergio Machado Rezende—a professor emeritus at the Federal University of Pernambuco (UFPE)—had as his sole urgent task during the COVID-19 pandemic to review evidence for his textbook Fundamentals of magnonics. Written in English, the book is about a little-known area of quantum physics and should be released by the science publisher Springer in mid-2020. However, on Sunday, March 29, Rezende received a phone call that would change his isolation routine in the weeks that followed: he was asked to become—alongside neuroscientist Miguel Nicolelis from Duke University in the United States—one of the coordinators of the Scientific Committee for the Fight against Coronavirus, an initiative by the Northeast Consortium, established in March 2019 by government representatives from the nine states in the Northeast region of Brazil. At 79, the former Minister of Science and Technology (Rezende held the position from July 2005 to December 2010) accepted the challenge. Rezende put off reviewing his textbook for a while and began working instead on recruiting researchers for the committee who could help come up with technical recommendations for governors on how to manage the escalation of COVID-19 cases. In this interview, the physicist expands on the committee’s work and the status of COVID-19 in the Northeast, which has one third of all official cases in Brazil and nearly 30% of all deaths.

How did you first become involved with the scientific committee?
I am a physicist, and I work with a very alienating subject: nanotechnology. During crises, like the one we are currently living through, I am often cut off from the world. I am currently not involved at all with governments or politics. On Sunday, March 29, the Pernambuco representative for the Northeast Consortium, Antônio Figueira, former Secretary of Health and current special advisor to the governor [Paulo Câmara, PSB], called to inform me that the consortium would establish a scientific committee. He then asked me to be one of the committee coordinators. I replied that I knew nothing about healthcare. Then, Carlos Gabas, executive secretary of the consortium, called me to reiterate the invitation. They clarified that I would be a kind of management coordinator for the committee, while Miguel Nicolelis, a doctor and neuroscientist, would be the healthcare coordinator. So, I ended up saying yes. I thought I would be there just to help and would not have much to do. But I was wrong—it is a monstrous amount of work. The committee is currently made up of 15 members, including the two coordinators and representatives from each state [the committee is now made up of 14 members, as the representative from the state of Rio Grande do Norte left on May 20]. On April 1, we met with the governors, who had many questions and suggestions regarding COVID-19. The committee then began having daily online meetings to discuss what should be done.

Would it be correct to state that the main goal of the committee is to encourage joint action by the northeastern states against the pandemic?
The main goal is to exchange information and experience and to promote government action through the consortium. State and city governments usually act individually. Because the northeastern states have so much in common, the idea is to combine efforts. We have created nine subcommittees focusing on areas such as epidemiology, virology and vaccines, hospital equipment, and simulations. Each is coordinated by a member of the committee and includes people from the Northeast appointed by the consortium representatives. There are currently about 100 people on these subcommittees, all experts in their areas, and they come up with proposals and recommendations. The subcommittees then forward these proposals to the committee. Every week or so we produce a bulletin with recommendations.

Who has access to the bulletin?
It goes directly to governors and state representatives through our WhatsApp groups. The bulletin is also made available on our website almost immediately. There is no set schedule; we just need to gather a certain amount of information before putting together an issue. So far, we have released seven issues—nearly one every week.

The pandemic is getting worse in the outskirts of the northeastern metropolitan regions and in less urban areas

Does the status of the pandemic in the Northeast vary greatly from other parts of Brazil?
I don’t believe so. The situation in the Northeast is like that of São Paulo, Rio de Janeiro, and other areas. Much like what we are seeing in other major cities in the country, the pandemic is getting worse in the outskirts of the northeastern metropolitan regions and in less urban areas. All bulletin issues begin by reinforcing the importance of social distancing. The first issue was very generic; it mentioned the importance of social distancing, of supporting those in need, and of collaboration between research foundations. As the subcommittees came up with recommendations, based on their own experience and on the scientific articles coming out every day, the bulletin became more specific. Each subcommittee has its own WhatsApp and email groups. They share a lot of information and papers. The second issue explained how the subcommittees worked. We also released a statement defending the use of masks when leaving the home—there had been some controversy as to whether masks were helpful in this case.

Did the committee take a stand on the use of hydroxychloroquine?
Yes. The third issue included our recommendation that it not be used to treat COVID-19 patients, regardless of the severity of the symptoms. Although there were doctors in our group who were in favor of its use, we made this recommendation based on scientific papers that showed no significant improvement and also pointed to an increased risk of heart problems and death when this medication was used. In the fourth issue, we covered what we call the emergency healthcare brigade. One of the issues faced by rural municipalities in the Northeast is a lack of doctors. Some towns only had doctors from the Mais Médicos (More Doctors) program, which was shut down at the start of the Bolsonaro administration, meaning they currently have no health professionals available. The healthcare brigades can be established by medical students who would have graduated this June, if not for the pandemic. They are not doctors yet, but they can be hired under whatever job title is most appropriate—such as healthcare technician—to work under the supervision of a more experienced doctor. This could even be done remotely, with the help of internet tools. Another proposal of ours, which caused some controversy, is to find some way to revalidate the diplomas of doctors trained abroad. For this, doctors must pass an exam called Revalida. However, due to federal government issues, Revalida has not been offered since 2017 [on May 14, the Ministry of Education announced that it will run Revalida in two phases, in October and December 2020]. We suggested that state universities with a medical program take responsibility for the revalidation of these diplomas.

But is there any legal basis for that?
Apparently not. The proposal provoked a huge reaction from corporate medical councils. We were heavily criticized for it; they argued that it could mean hiring unqualified doctors. This reaction occurred before any action was taken from state governments in response to the proposal. Then, the president of the consortium—the governor of Bahia, Rui Costa (PT)—made a formal inquiry regarding this eventuality with the Ministries of Education and Health. There was no answer. Even without their endorsement, the Maranhão government took concrete action. On May 8, the State University of Maranhão released an emergency call to start the revalidation process for up to 45 doctors trained abroad.

How many health professionals have joined these brigades so far?
The initiative is still small, as it began a few weeks ago. We are only just getting started. I do not know about numbers yet.

Does the committee suggest enforcing a lockdown in the northeastern states to contain the spread of the novel coronavirus?
In early May, we asserted the need for stricter social isolation measures. We suggested a set of quantitative criteria for governments to enforce a lockdown: states should adopt this measure when hospital bed capacity exceeds 80% while, at the same time, the curve of COVID-19 cases and deaths continues to rise. Our current situation is already worse than that. We know that, throughout most of Brazil, self-isolation is being followed by less than 50% of the population. We have a group that uses sophisticated tools to simulate the evolution of the pandemic, which includes physicist José Soares, from the Federal University of Ceará (UFC), astrophysicist José Dias do Nascimento Júnior, from the Federal University of Rio Grande do Norte (UFRN), physicist Roberto Andrade, from the Federal University of Bahia (UFBA), among others. They have always worked with simulations, but not in the healthcare field. Based on the percentage of people in self-isolation, this group simulates the behavior of the COVID-19 curve—whether it rises or flattens. This type of data is essential for decision-making politicians. About a month ago, the governor of Ceará, Camilo Santana (PT), wanted to reduce self-isolation measures. But, during a meeting, Soares showed the governor that the low self-isolation levels did not allow for a reduction. The governor was moved and went on TV to explain the situation to the population and even showed a picture of the evolution of the curve. Ideally, more than 70% of the population should be in self-isolation. When this is maintained, the spread of the virus will begin slowing down within two weeks. In Brazil, only Fernando de Noronha managed to achieve this. They closed their airport and self-isolated for three weeks. As a result, there are no more COVID-19 cases there.

In Brazil, we are facing two issues during the pandemic. One is a lack of discipline. The other is our political situation

A 70% self-isolation rate is difficult to achieve and maintain.
But there is a country with a population of 96 million that achieved this and did not have even one COVID-19 death: Vietnam [up until May 21, only 324 cases of the disease and no deaths had been officially recorded in the country]. I visited there five years ago, and I was very impressed; it was the fastest-growing country in Asia at the time. As soon as the new coronavirus emerged in China and started to spread to Korea, Vietnam closed its borders and imposed a strict lockdown. The Vietnamese people have an advantage: they have already experienced lockdown conditions during the war against the United States [from 1954 to 1975]. In certain regions of Vietnam, families would spend years hiding underground in caves. They are very disciplined and obedient. In Brazil, we face two issues. One is a lack of discipline. In Europe, especially in Germany, when their governments tell them that self-isolation is necessary, people obey them. We are—for various reasons—a disobedient people.

But in some Latin countries in Europe, such as Italy and Spain, many were slow to self-isolate.
Brazil has more COVID-19 cases than all of South America, which is also of Latin origin. But Brazil has an additional challenge: our political situation, that is, the poor example set by the President of the Republic. Since the start of the pandemic, there has not been a single week when he does not set a bad example. He has said in the past that the disease was no worse than a cold or the flu, that it would not reach Brazil. He has also both attended and promoted large gatherings.

What are your daily responsibilities involving the scientific committee?
I am part of two subcommittees. One is the research subcommittee, established by leaders from the nine research foundations in the Northeast. Fortunately, they are all in operation, although some have limited resources. We hold video meetings and share information via WhatsApp. I am also part of the simulations group. But my key role is to help with management. There is a lot of information being shared. I always remind them that we need to focus projections on a certain date and produce a unified set of analyses. All of our projections show that the peak of the disease in the Northeast will not be reached before June 15. But we have not widely disclosed this projection, as it is not 100% certain and depends on several variables. In addition, this piece of information could discourage the population since it means a very long period of self-isolation. Another role of mine is writing the first draft of the bulletin. Then, other group members make suggestions or add more details. Nicolelis, who is self-isolating in São Paulo, has a fundamental role. He is directly involved with several areas and managed to attract volunteers from São Paulo and other states. We are also using projections from the Institute of Mathematics and Statistics of the University of São Paulo (IME-USP). We created a page for Project Mandacaru on our website, open to volunteers who want to help. We are producing dynamic maps of the pandemic. Some are not up on our website, but on what we call the virtual situation room. Nicolelis and I can access this virtual room and ask for a certain simulation to be built.

According to official data, the three most concerning states in the Northeast are Ceará, Pernambuco, and Maranhão. Is this how you see it as well?
Yes. The pandemic is now leaving the urban areas. This is why, in the issue before last, we asked the governors to close roads in the Northeast. But that has not been done yet. There should be police on the highways to fine and prevent people from traveling without a valid reason. The number of cars on the roads is lower than before the pandemic, but it is still high. The virus is carried by people. The only vehicles allowed to pass freely should be trucks carrying essential items and buses whose passengers are social distancing, wearing masks, and have been tested. A month ago, the state of Paraíba blocked the roads into the state. On May 11, the state of Pernambuco enforced a lockdown until the end of this month. The state of Ceará is also in lockdown. Maranhão was in a lockdown, but just lifted it.

Do the state governments follow most of the scientific committee’s recommendations?
Some are implemented by all states, though at different times. In late April, the governor of Sergipe signed a decree that reduced social isolation measures. We released a statement criticizing it; Nicolelis gave a television interview where he also criticized the governor’s actions. The next day, Governor Belivaldo Chagas (PSD) backpedaled and changed his decree. The governors have been following our recommendations, which is very gratifying and motivates us to continue our work.

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