Reorganization of primary health care for universal surveillance and containment of COVID-19.

Abstract

The COVID-19 pandemic has established an extremely serious epidemiological situation, owing to the high transmissibility of its etiological agent, SARS-CoV-2, and the severity of part of the cases, which require high complexity health care. In the face of this scenario, health authorities have turned to expanding the hospital network, including intensive therapy units (ITU), which has indeed been necessary; but without ensuring universal surveillance for new case detection and, above all, maximization of control actions aimed at reducing transmission of the virus. One of the crucial mechanisms for containing any epidemic is the setting up of special surveillance strategies with the objective of detecting the largest possible number of cases and contacts, followed by actions that reduce the risk of the disease spreading, particularly when the agent is transmitted through respiratory droplets, as in the case of SARS-CoV-2. COVID-19 is a community disease which spreads very rapidly, manifests itself similarly to other flu-like syndromes (FLS) and is difficult to contain. As highlighted by Sarti et al. (2020), Brazil’s vast Primary Health Care (PHC) network has been contributing to the achievement of important results in improving the population’s health conditions and can be one of the mainstays of the actions needed to contain the problem. Moving in this direction indicated by those authors, it is our understanding that it is fundamental to develop specific strategies for articulating PHC with Epidemiological Surveillance (ES) teams in the municipalities, because we consider that this is the route capable of promoting universal case and contact detection and control that the COVID-19 pandemic is demanding. Although it has some limitations, the Brazilian communicable diseases surveillance system is well structured, works in a capillary manner in all the country’s municipalities, alongside the National Health System (SUS) network of services, developing systematically and, generally, timely surveillance and control actions appropriate for each of the communicable diseases of Public Health concern. In addition, the surveillance system investigates and initiates actions when unprecedented events occur, such as the case of the microcephaly/ congenital Zika virus syndrome epidemic. As part of their work routine, PHC teams undertake certain ES actions. However, integration between PHC teams and ES teams is incipient with regard to in-field epidemiological investigations in the territories where they provide care, identify and control contacts, such as happens with tuberculosis and leprosy surveillance. In the vast majority of municipalities, these activities are strictly the responsibility of ES. One of the large and recognized