Nosso Desafio no Coração do Brasil

Faced with the major health crisis of the century – Coronavirus Disease (COVID19) Pandemic, we could see two waves installing in society: incredulity and fear. This issue was politicized several times and the vast amount of scientific publications made the discussion very controversial and consequently society became more and more confused and insecure. Brasilia - the Capital of Brazil, is the heart of the country, it is centrally located and therefore politically strategic. It was one of the first places in Brazil to spread, under public decree, radical measures of social isolation (such as closing schools, colleges, commerce, and other public places) in mid March / 2020. Only the so-called “essential activities” continued working. When such measures were adopted, the city had just over 50 confirmed cases of COVID19. Concerns about the pandemic moved the entire local health care assistance, with homeric financial investments by hospitals with massive testing for Coronavirus and a reduction in the number of elective surgeries (important profit providers). The Bone Marrow Transplant (BMT) Unit, traditionally considered to be a very vulnerable space, gained special focus and numerous efforts were designed to make it virtually a COVID19 free area. The view of doctors during this period was also very heterogeneous, and it varied between fearlessness and major worry. Finding a balance and offering a safe environment for carrying out the procedures proved to be a great challenge, whose building still occurs daily until today. Despite being a hard social, political and economic moment, it would not be appropriate to shoot all over the place like a war. The elaboration of new protocols, periodically reviewed and modified, was carried out based on intense involvement and collaborative works by the Hospital Coordination, the Infectious Diseases Specialists, doctors and multidisciplinary team. The Good Practices policies published periodically by the Medical Societies of Infectious Diseases and Bone Marrow Transplant guided our local protocols. Among the main measures adopted are the testing of patients and caregivers with PCR lab test to check the coronavirus infection before hospitalization, the prohibition of visitors and the use of reverse vestments (use of cloaks, gloves, caps and masks), which although controversial, was used to potentially reduce the risk of coronavirus transmission by asymptomatic health professionals. In addition, daily screening of respiratory symptoms was applied to all caregivers and employees of the unit, in order to identify suspected cases and keep them away before contact with patients. Such measures were crucial to the excellent results achieved and to strengthen the medical teams trust in the hospital logistic and support. According to data published by the Brazilian Organ Transplant Association - ABTO, in the first half of 2020, 31 transplants were performed in two institutions that predominantly receive public institutions patients (3 allogeneic and 28 autologous) and 23 transplants in the private services (18 autologous and 5 allogeneic) - represented by two private hospitals in Brasília1. The peak of the pandemic occurred in July and August 2020, with periods of significant overload in the hospital structure in the public and private sectors. The depletion of resources caused by the pandemic associated with previous institutional issues have compromised the care of adult patients who are candidates for BMT from public services. This fact generated an important patient demand for centers in other regions of the country associated with an increase in the obstacles of moving and welcoming these patients in the pandemic scenario. In private practice, there was a strong and well-structured work-ethic, which allowed the program to continue without impairing the quality of care or the expected outcomes. To date, we have had no cases of death by COVID19 in the scenario of bone marrow transplantation in Brasília, reflecting the efforts and protocols previously mentioned. At this moment, we are experiencing a significant reduction in the number of COVID19 cases in Brasilia, making it possible to observe an increase in the number of patients undergoing transplant procedures. This fact reflects the postponement of treatment of non-urgent cases in the previous three months. After six months of Pandemic, it is essential to recognize the strong presence of the spirit of cooperation, tolerance and patience that has been installed in all the scenarios that permeate the BMT, associated with the relevant growth of all involved. The “new normal” is uncomfortable because it is characterized by restrictions imposed by the pandemic and not by our choices and preferences, but above all it symbolizes our ability to adapt and to have resilience. We are important characters in this memorable historical period, and we carry the desire to continue pulsating in the heart of Brazil.