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Resumo O artigo explora a complexidade e as incertezas atuais sobre a covid longa, uma entidade nosológica emergente pós-covid-19, com contornos imprecisos e caracterizada por sintomas imprevisíveis e persistentes. Baseado em relatos de pessoas afetadas e equilibrando a revisão da literatura médica e jornalística sobre o tema, a história da ciência e a etnografia em saúde, o trabalho descreve e analisa as políticas de reconhecimento e de cuidado da doença em um contexto de injustiça epistêmica. O artigo contesta as representações da covid longa como uma condição meramente transitória, argumentando que, diferentemente das promessas de plena recuperação, o que tem ganhado forma é emergência de uma nova pessoa cuja biografia passa a ser reescrita com a covid longa. Para essas pessoas, o reconhecimento pleno da covid longa como uma entidade patológica distinta, aliado à validação de seu conhecimento experimental, significa mais do que simplesmente abrir possibilidades concretas para alívio do sofrimento físico e mental. Isso também representa justiça, reparação e um passo adiante na reconstrução de suas vidas.

COVID-19, a disease induced by SARS-CoV-2, became a worldwide pandemic while SARS, a disease induced by a closely related virus, SARS-CoV, was successfully contained. This is because COVID-19, unlike SARS, can be spread by people who do not display any symptoms of disease, either because they are in the early stages of the infection or because their infection remains clinically silent. This research article traces the complex history of the diagnosis of symptom-free (or asymptomatic) carriers of pathogens, a term inseparably linked to the rise of the laboratory diagnosis of pathogens. Only such a diagnosis can reveal that an apparently healthy individual harbours dangerous bacteria, parasites, or viruses. The article begins with the iconic story of ‘Typhoid Mary’, a New York cook found to be an asymptomatic carrier of typhoid fever microbes. It then discusses divergent approaches to the treatment of symptom-free carriers of hookworm and controversies around the screening of HIV carriers, especially before the development of anti-retroviral treatments. It concludes with a presentation of the debates on the role of asymptomatic carriers in the spread of COVID-19 and of the differences between the approaches of countries seeking to eliminate this disease, a goal that itself entails tracing and isolation of all asymptomatic carriers of coronavirus, and those trying to contain it, an approach that tolerates the presence of a limited number of ‘invisible’ virus carriers.

This article follows the introduction of COVID-19 polymerase chain reaction (PCR) diagnostic tests in France. It shows how, at the intersection of science, medicine, politics, and policy-making, the test, trace, and isolate (TTI) strategy played out during the first months of the pandemic against a backcloth of multiple shortages. In so doing, the authors move beyond trite explanations (such as ‘French public health’s backwardness’) to highlight how successive policy inflections affected the national response to the pandemic. The piece analyses the shifting French political discourse surrounding (scarce) COVID-19 tests while exploring ad-hoc regulations and guidelines as well as the intense ‘bricolage’ that they triggered in the field of clinical medicine. The authors contend that the limitations of the testing infrastructure in France during the first half of 2020 shaped the decision to resort to lockdown. The research article sheds light on two coexisting registers of professional uses of reverse transcription-polymerase chain reaction (RT-PCR) assays—a ‘public health use’ and a ‘clinical use’—and highlights the changing political and social relevance of these two registers, with scarcity as a major determinant of these changes. One of the striking aspects of the introduction of COVID-19 tests in France therefore lies in the enduring gap between the dynamics of the epidemic and the dynamics of testing. In this respect, the French situation is neither extreme nor unique, which makes this case study a relevant basis for the international comparison of testing practices in different phases of the COVID-19 pandemic.

Abstract: Since the first recorded case of COVID-19 on February 26, 2020, Brazil has seen an exponential growth in the number of cases and deaths. The national testing approach has been insufficient to correctly use this tool in the support of containing the epidemic in the country. In this communication, we discuss efforts and challenges to scale-up COVID-19 testing at the Brazilian Unified National Health System (SUS). This communication presents the initial results of the research project created to investigate the political, industrial, technological, and regulatory aspects that may affect the diagnostic and testing capacity for COVID-19 in Brazil. The paper draws on the review of academic literature, media publication, and collection of public data on tests purchase and regulation. It enlists initiatives to enhance PCR testing, national production and development of technologies, as well as regulatory measures to fast-track new tests. Our analysis indicates some points of reflection. Firstly, the lack of a consistent national strategy to fight COVID-19 exarcebated supply problems of diagnostic components. If the country was eventually able to circumvent this situation, it still faces a more structural dependency on the importation of diagnostic components. Secondly, the discontinued funding and distribution of tests may have implied health policy fragmentation and the growing importance of local governments and non-state actors to fighting the epidemics within SUS. Finally, initiatives established since the second semester of 2020 have expanded the testing capacity at SUS. However, it has not been sufficient to control the progress of the epidemic in the country.

This compilation is based on the original report on a clinical survey conducted in Brussels (1905-1906) by Josephine Joteyko and Varia Kipiani with 43 vegetarians. Having advanced expertise in physiology and experimentalism, Joteyko (with Lithuanian and Polish origins) and Kipiani (with Georgian origins) discussed their findings at the Congress of the Belgian Society for Vegetarianism in 1906. For both children and adults, females and males, regardless of age, the findings demonstrated vegetarian dietary habits to be beneficiary for human development, the subjects’ physical and mental health, welfare, and physical and intellectual efficiency. Surprisingly, Joteyko and Kipiani confirmed C. Darwin’s observation across various nutritional cultures that vegetarian food would increase the energetic balance of the human body. Additionally, their focus on the moteur humain shows affinities with Taylorism, the modernist utopias of labor, the enhancement of human faculties, the protection of workers and their rights from automation, and applied social science represented by Joteyko and Kipiani as multidisciplinary investigators. The compilation was made on: J. Joteyko & V. Kipiani, Enquête scientifique sur les Végétariens de Bruxelles, Conférence donnée à la Société végétarienne de Belgique, le 4 décembre 1906, pp. 1–77, with no further correction.

Background: In their landmark report on the “Principles and Practice of Screening for Disease” (1968), Wilson and Jungner noted that the practice of screening is just as important for securing beneficial outcomes and avoiding harms as the formulation of principles. Many jurisdictions have since established various kinds of “screening governance organizations” to provide oversight of screening practice. Yet to date there has been relatively little reflection on the nature and organization of screening governance itself, or on how different governance arrangements affect the way screening is implemented and perceived and the balance of benefits and harms it delivers. Methods: An international expert policy workshop convened by Sturdy, Miller and Hogarth. Results: While effective governance is essential to promote beneficial screening practices and avoid attendant harms, screening governance organizations face enduring challenges. These challenges are social and ethical as much as technical. Evidence-based adjudication of the benefits and harms of population screening must take account of factors that inform the production and interpretation of evidence, including the divergent professional, financial and personal commitments of stakeholders. Similarly, when planning and overseeing organized screening programs, screening governance organizations must persuade or compel multiple stakeholders to work together to a common end. Screening governance organizations in different jurisdictions vary widely in how they are constituted, how they relate to other interested organizations and actors, and what powers and authority they wield. Yet we know little about how these differences affect the way screening is implemented, and with what consequences. Conclusions: Systematic research into how screening governance is organized in different jurisdictions would facilitate policy learning to address enduring challenges. Even without such research, informal exchange and sharing of experiences between screening governance organizations can deliver invaluable insights into the social as well as the technical aspects of governance.

Ludwik Fleck is known today primarily as pioneer in the social study of scientific knowledge. However, during World War II he was a prisoner in Buchenwald, where he and other prisoners produced a typhus vaccine for the Nazis, and where he witnessed murderous experiments on human beings. After WW2, Fleck was accused by one of the prisoners who had participated in the vaccine production at Buchenwald of collaborating, either deliberately or due to lack of imagination, with the Nazi experiments. This article critically examines this accusation and its well-documented rebuttal by Fleck. It argues that while sometimes, especially when dealing with emotionally fraught issues, it may be difficult to establish what precisely took place at a given time and site, it is important to restore the original complexity and messiness of past events – in order to open spaces for understanding, reflexivity and compassion.

Este artigo tem como objetivo analisar os fatores que moldam as culturas materiais da biomedicina contemporânea. Trata do desenvolvimento histórico das técnicas diagnósticas e de como elas definem a "norma" e influenciam a evolução dos comportamentos dos profissionais e dos familiares. Pretende-se esclarecer esses processos a partir de uma reconstrução da evolução histórica do diagnóstico pré-natal, seguida de uma análise detalhada do caso de uma anomalia particular: as ACS, ou seja, as aneuploidias dos cromossomas sexuais. Embora alguns casos de ACS impliquem graves problemas de saúde, que chegam a comprometer a própria sobrevivência do indivíduo, a grande maioria das crianças que possui um número anormal de cromossomas sexuais é afetada por uma deficiência que pode ser qualifi cada como "menor" (em numerosos casos o diagnóstico definitivo das ACS só se coloca na adolescência). Assim, especialmente nos contextos em que existe o aborto legalizado, o diagnóstico pré-natal visibiliza a construção do "feto anormal" e o "risco de ter uma criança anormal" como fenômeno técnico-social, construído ao longo do tempo, de maneira indissociável, pelas técnicas da biomedicina, pela organização do trabalho médico, pelas limitações legais e pelas considerações socioculturaisThis article aims at analyzing the factors that mold the material cultures of contemporary biomedicine. It considers the historical development of diagnostic techniques, how they define the "norm", and influence the evolution of conducts of professionals as well as those of concerned members of the family. Following a brief reconstruction of the historical evolution of pre-natal diagnostics, we present a detailed case analysis of a particular anomaly: aneuploidy of the sexual chromosomes (ACS). Although some cases of ACS may represent grave and even life-threatening deficiencies, the great majority of children who possess an abnormal number of sexual chromosomes experience relatively minor problems. In many cases, the very diagnostic of ACS only surfaces during the person's adolescence. Thus, especially in contexts that permit legal abortion, the prenatal diagnosis of these syndromes renders visible the construction of the "abnormal fetus" and the "risk of having an abnormal child", as a techno-social phenomenon that emerges over time through the interaction of biomedical techniques, the organization of medical work, legal limitations, and sociocultural considerations

Cytological screening for cervical cancer (the Pap smear), the first attempt at mass screening for a human malignancy, is often presented as a non-problematic demonstration of the feasibility of such screening. Screening for this tumor became a model for screening for other malignancies: breast, colon and prostate. My text follows the early history of the Pap smear and the conditions that led to its transformation into a routine screening test, despite persistent problems in stabilizing the readings of microscopic slides. It then analyzes the consequences of diffusion of the Pap smear, controversies surrounding this test, the mutual shaping of diagnostic tests and the disease cervical cancer, and the problematic extension of the lessons learned in screening for cervical tumors to other malignancies.O exame citológico para verificação do câncer cervical (teste de Papanicolau), primeira tentativa de investigação em massa de um câncer humano maligno, é com frequência apresentado como demonstração não problemática da exequibilidade do exame. Ele se tornou um modelo para outros tumores malignos: seio, cólon, próstata. O presente artigo analisa a história inicial do teste de Papanicolau e as condições de sua transformação num exame de rotina, apesar de dificuldades de estabilizar as leituras das lâminas microscópicas. Analisa as consequências da difusão da técnica, as controvérsias a esse respeito, a modelagem articulada do teste diagnóstico e da doença câncer cervical e a problemática aplicação a outros cânceres das lições aprendidas com o exame de tumores cervicais.

As tentativas feitas pelos especialistas da Fundação Rockefeller de erradicar a febre amarela no Brasil foram prejudicadas pela baixa visibilidade desta patologia. Os casos eram, em sua maioria, atípicos e se confundiam facilmente com outras febres. Na década de 1920, os especialistas dependiam de observações clínicas para avaliar a incidência da febre amarela. Na década seguinte, porém, conceberam métodos indiretos para visualizar a presença de seu agente. A viscerotomia revelava a presença de casos agudos e o teste de proteção em camundongos, contatos passados com o vírus da doença. Conjuntamente, estes testes permitiram aos especialistas da Rockefeller confeccionar mapas indicando a presença de zonas de endemicidade da doença. Puderam, então, direcionar campanhas específicas contra a febre amarela baseadas na eliminação seletiva de seu vetor, o mosquito Aedes aegypti. Na saúde pública, tal como nas ciências, as práticas de representação modelam a intervenção.

A imunologia sempre recorreu a uma linguagem metafórica. Logo de início, ela oscilou entre imagens bélicas e outras que insistem na interação dos macanismos da imunidade ao conjunto das funções fisiológicas do organismo. No final do século XIX, os glóbulos brancos eram comparados com uma 'polícia de fronteiras' encarregada de rechaçar os intrusos, com um exército formado para combater os invasores, mas também com um mecanismo fisiológico de eliminação das células envelhecidas e mortas, ocasionalmente exterminador de corpos estranhos, os anticorpos eram descritos como sendo armas muito poderosas e mortíferas, mas também como fazendo parte integrante dos mecanismos que permitem a assimilação dos alimentos pelas células. Esta dualidade das imagens próprias da imunidade permanece ainda em nosso dias. O artigo analisa a emergência e o desenvolvimento dessas imagens, relacionando-as com a redefinição da imunologia como ciência do self e do não-self, dissecando-as enfim à luz dos recentes acontecimentos, tais como a epidemia de Aids.

O médico e epistemologista Ludwik Fleck desenvolveu, nas décadas de 1920-30, uma abordagem bastante original para o estudo das ciências. Ele apoiou sua epistemologia em duas bases: por um lado, em sua própria experiência profissional de bacteriologista e imunologista; por outro, na reflexão da Escola Polonesa de Filosofia da Medicina sobre as práticas dos médicos. Tal escola julga que os 'fatos científicos' são construídos por comunidades de pesquisadores - segundo os termos de Fleck, "coletivos de pensamento". Cada coletivo de pensamento elabora um "estilo de pensamento" único, composto pelo conjunto de normas, saberes e práticas partilhados por tal coletivo. Os recém-chegados são socializados em seu estilo de pensamento particular e adotam, portanto, seu olhar específico sobre o mundo. Os fatos científicos produzidos pelos membros de um dado coletivo de pensamento trazem sempre a marca de seu estilo de pensamento. Graças a isso, eles são incomensuráveis com os 'fatos' produzidos por outros coletivos de pensamento. A incomensurabilidade dos fatos científicos, aumentadas pela necessidade de 'traduzi-los' em outro estilo de pensamento para sua utilização pelas outras comunidades profissionais é, aos olhos de Fleck, uma fonte importante de inovação nas ciências e na sociedade. Por muito tempo esquecidas, as idéias de Fleck foram redescobertas nas décadas de 1960-70, em primeiro lugar por Thomas Kuhn (que, na introdução de The structure of scientific revolutions presta uma homenagem explícita à sua obra), depois pelos sociólogos das ciências. Além de sua influência diretamente perceptível, a epistemologia de Fleck mostra profundas afinidades com as novas tendências que se afirmam no estudo das ciências: a consideração das práticas dos pesquisadores e o interesse por suas técnicas materiais, discursivas e sociais.In the 1920's and 30's the physician and epistemologist Ludwik Fleck developed a highly original ideas on science. These ideas were rooted in Fleck's own experience as bacteriologist and immunologist and, on the other hand, in the practice-based thought of the Polish School of Philosophy of Medicine. Fleck affirmed that 'scientific facts' are constructed by groups of scientists, in his terms, by "thought collectives". Each thougth collective elaborates a "thought style" which contains norms, concepts and practices of that collective. Newcomers to a professional community are socialized into its specific thought style and develop an unique way of viewing the world. Scientific facts produced by a given thought collective are therefore shaped by that collective's thought style, and are incommensurable with facts produced by other thought collectives. The incommensurability of scientific facts and its consequence, the need to 'translate' these facts into the style of different thought collectives in an inter-community use are, Fleck proposed, an important source of innovations in science and in society. Fleck ideas were rediscovered in the 1960's and 70's, first by Thomas Kuhn, who in the introduction to his book, The structure of scientific revolutions, acknowledges his ties with Fleck's thought, then by sociologists of science. Beyond their direct influence, Fleck's epistemology has many affinities with new trends in science studies, focused on the scientists' practices, and interested in their material, discursive and social techniques.

Abstract Within the context of the creation of birthing houses around the world and different models of care for childbirth, the author proposes an analysis that contributes to the discussion about the place for birth, especially in urban Brazil.

Resumo: A infecção por zika teve grande impacto não somente nas grávidas e nos recém-nascidos, mas também na saúde pública, nas ideias populares sobre o Aedes aegypti e no respeito dos direitos sociais das mulheres. O objetivo deste texto é identificar esse impacto e as mudanças históricas, sociais e sanitárias da doença e o legado do vírus zika. As intervenções de pesquisadores de diferentes disciplinas propiciam condições para investigações mais abrangentes sobre futuras ameaças epidêmicas no Brasil e na América Latina. Este diálogo ocorreu após o seminário “Aedes aegypti: antigas e novas emergências sanitárias”, organizado pela Casa de Oswaldo Cruz, quando conversamos com alguns palestrantes e outros destacados pesquisadores sobre a história e os desafios do Aedes aegypti e do zika.