_{^{Published May 11, 2021}}

For valiant service selflessly rendered on the frontlines of the fight against COVID-19, the American Roentgen Ray Society symbolically awarded each and every one of our members the 2021 ARRS Gold Medal. The ARRS Gold Medal Story Series shares perspectives of imaging professionals who conquered the day-to-day challenges of battling COVID-19.

One of the countries most severely hit by the coronavirus disease (COVID-19) pandemic, cases and deaths are spreading in Brazil.

The Brazilian health care system, “Sistema Único de Saúde,” is a universal, comprehensive, and free-of-charge public service assisting more than 120 million people. During previous public health emergencies, like the HIV pandemic of the 1990s, the system worked efficiently. Therefore, it was expected our system would place the country in an excellent position to mitigate the COVID-19 pandemic.

That was not the case.

Public and private hospitals had been reorganized to treat COVID-19 patients, but the country began to see a rapid uptick in new cases. Each region of the country—a country of continental dimensions—had peaked at different times, and several cities had their health care systems exhausted at different times.  

The limited number of reverse transcriptase polymerase chain reaction tests available in many centers, and the prolonged time to process their results, have led to the early use of CT as an auxiliary method for screening suspected cases. This use of CT in suspected cases had been described in many countries experiencing similar scenarios and was mentioned in the guidelines of several international radiological societies.

At our hospital, a public university hospital in São Paulo State with more than 1,000 beds, the scenario was no different. To help cope with the adaptations required to overcome the myriad challenges imposed by this pandemic, a Crisis Committee was created, gathering the major players engaging with COVID-19: medical specialists like radiologists, nursing and physical therapy staff, as well as other professionals providing all kinds of goods and services in a hospital. Since March 2020, our crisis counselors have convened every day (except from September to November), including weekends and holidays. Their daily briefings offer quick, practical solutions to dynamic problems.

In treating COVID-19-positive patients, our radiological services have experienced a significant increase in chest CTs and a marked reduction in imaging tests performed for other indications. To help limit the spread of infection, many departments had to turn their focus toward fighting COVID-19.

In September, due to general improvement of the overall situation in Brazil, some health services began returning appointments for care that had been postponed, particularly resuming treatment for chronic diseases and cancer.

This scenario lasted for a short time, until January 2021, when the pandemic’s second wave hit Brazil even more severely with the more virulent variant, P1, accounting for more than 80% of new cases. At this time, the scene is even more stark, quickly draining the resources of both public and private systems. Even centers that offered adequate assistance in the first wave had their capacities depleted during this second wave. Currently, the major issues are lack of ICU beds dedicated to COVID-19 patients and a shortage of specific medical supplies, such as medications for intubation and sedation. Some parts of the country are experiencing an even worse scenario: limited oxygen supplies, for instance.

Brazil’s national vaccination program against COVID-19 began in February 2021. The elderly and health professionals remain priorities. Although more than 25 million people have been vaccinated, that is merely 12% of our population.

We are still facing an overloaded health system and a high number of cases and deaths, but we’re starting to see a significant reduction in the number of new COVID-19 cases. And as the vaccination campaign moves forward, we are hoping for better days soon.