Amazonas leads the list of worst performance in the fight against coronavirus among the 27 units of the federation, shows the Covid-19 Ranking of States, prepared by the Center for Public Leadership (CLP) and obtained exclusively by Estadão. Not only is Amazonas at the top of the list today, it is in that position since the beginning of the monitoring of the CLP, on April 1st, seven weeks ago.

With a score of 71.72, Amazonas also appears quite distant from the second and third place, Pará and Amapá, with scores of 46.66 and 43.23. In this ranking, the higher the number, the worse the evaluation in the fight against the disease. “Amazonas has always been in the 1st position, due to the evolution of cases and deaths and low transparency and isolation”, explains CLP’s Head of Competitiveness, José Henrique Nascimento.

According to the survey, Amazonas has a coronavirus mortality rate of 7.02%, above the national average (4.58%), and the highest proportion of infected people per million inhabitants (pmh), around 4,630. The occupancy of ICU beds in the State is 87%, according to the Health Secretariat. According to the most updated figures from the Ministry of Health, Amazonas is the fourth in number of Covid-19 cases in the country, with 25,367, and the sixth in fatal victims (1,620).

The northern state also leads the way, showing a rate of 34.09%, mortality due to Severe Acute Respiratory Syndrome (SARS), one of the most serious symptoms of Covid-19 and an indication of underreporting of the disease, with 138 cases per million. population.

Pará and Amapá, in turn, have opposite realities. Pará has the second highest coronavirus mortality rate in the country (9.31%), although the number of cases per million inhabitants (pmh) is relatively in line with the national average (1,355). Amapá, on the other hand, has a low percentage of fatal victims, of 3.01%, but is vice-leader in cases per million inhabitants (4,422).

Closing the Top 5 States with the most unfavorable performance against the coronavirus, Rio de Janeiro appears, which has the highest mortality rate for Covid-19 in the country (11.50%), and Pernambuco, with the third highest mortality rate. high (8.16%). With three States at the top of the ranking, the North has the worst score among the regions, followed by the Southeast, Northeast, Midwest and South. The Southeast, however, pulled by Rio and São Paulo, raises the national average of mortality, with 6.74%.

The ranking has a weekly update (the last one was made on 05/20) and uses the same methodology as the Competitiveness Ranking of the States, also prepared by the CLP and going to its ninth edition this year. For the analysis of the performance in the face of the pandemic, nine indicators are used: the proportion of confirmed cases, the evolution of cases (on a logarithmic scale) and the percentage of Covid-19 mortality, according to SUS numbers, as well as the same indicators for SRAG , provided by Fiocruz, in addition to the Covid-19 Transparency Index, from Open Knowledge Brasil, and social isolation data, from Google.

The use of SRAG numbers and the transparency index help to alleviate the lack of information about the coronavirus due to the underreporting of cases due to the lack of tests, according to Nascimento, the CLP’s Head of Competitiveness. “The ranking goes beyond the official data and gives a more correct perspective of what is happening in the States”, says the Head of Technical Intelligence at the CLP, Daniel Duque.

The combination of information, such as the isolation rate and the evolution of cases, also makes it possible to anticipate the official data and can give indications of the situation of the States in the coming days, even if the authorities lack transparency, point out Nascimento and Duque.

This is the case, for example, of Pará, which, five weeks ago, appeared in the 11th position and, today, occupies the second place in the ranking. Recently, the State adopted stricter social isolation measures and appears in a more intermediate position in relation to the evolution of cases, but, according to the Department of Health, the occupancy rate of the ICU for adults in hospitals under State management is 84 , 56%.

On the other hand, Nascimento argues that Rio Grande do Sul, with differentiated actions in each region and an effort to account for cases, has managed to stabilize the number of infected and deaths and has been gradually easing the quarantine successfully, maintaining itself in the last places. Today, it ranks 20th, with a mortality rate below the national average of 3.79%, and a low number of infected people per million (about 306). In addition, the occupancy rate of adult ICU beds is 72.90%, according to information from the Department of Health.

Nascimento also highlights that the ranking suggests that some federative entities may have had a premature relaxation of social isolation, such as the Federal District (DF). With the adoption of strict measures early on, the DF three weeks ago was in 22nd place. Now, it has moved up to 15th position.

Created to identify the places in greatest need of protection in the midst of the pandemic, the Covid-19 Ranking of States soon also proved to be a useful tool to better plan actions to combat the virus in the coming days, using data and evidence. Thus, the CLP says that it is possible to contribute, through partnerships, with the states that have the greatest difficulty. This year, the edition of the Competitiveness Ranking will use data related to the coronavirus, to assess how the pandemic affected the various state indicators.

“These are states (in a worse situation) for which we need to take a closer look to understand how to support them with public policies and actions that can mitigate the effects of the coronavirus”, stresses Nascimento, emphasizing that the effort aims to avoid an abrupt worsening social indicators. “It is possible to make a strategic direction”, he adds, on the ranking’s capacity to anticipate the situation in the near future.

CLP is a non-partisan and non-profit organization focused on developing public leaders who can promote change through effective management and improving the quality of public policies.

What the States say

According to a note from the government of Amazonas, a study by the Federal University of Amazonas (Ufam) indicates that there are currently, in Manaus, about 85,000 active cases of Covid-19, which implies that the lethality rate may be much lower than the one currently presented. The State also said that it has been working to expand the health care network, which was one of the first to adopt social isolation and is trying to increase testing capacity, but which faces difficulties and has already requested support from the federal government. Regarding the SRAG numbers, he stated that they are influenced by the seasonality of the Amazonian winter and aggravated by the cases of Covid-19. In relation to transparency, he said it was ranked as the 10th best state in Brazil in a study released this Thursday (21st) by Transparency International.

The Health Department of the Federal District informed, by means of a note, that all measures are adopted in a coordinated manner with other agencies to combat the coronavirus. The secretariat also said that it is disseminating information to the population, aiming to maintain social distance, with the recommendation that people who are not involved in essential activities and not included in the professional activities that were released remain at home. The DF secretariat also stated that rapid tests are being carried out and that the number of ICU beds is gradually increasing.

The Government of the State of Rio de Janeiro stated, by means of a note, that it implemented a series of measures and actions to improve transparency and control of emergency expenditures during the pandemic period, in addition to keeping the bulletin with information on the disease in the territory of Rio de Janeiro.

Questioned, the governments of Pará and Pernambuco did not respond until the publication of this report.

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