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      COVID-19: challenges for a new epoch

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          Dear Editor: The term “pan-epidemic Anthropocene” was proposed by Lucey et al. to refer to multifocal large infectious disease epidemics related to anthropogenic forces that have impacted and transformed the Earth System 1 . Smallpox was restricted to the Old World for thousands of years but became the first “pan-epidemic Anthropocene” when Europeans brought it to the Americas in the 16th century. The arrival of Europeans in America was considered as the first globalization event where the two civilizations met on unequal terms after 12,000 years of separation. Smallpox emerged in January 1519 and spread rapidly to the mainland of Central America. Native Americans had no immunity to the infections brought in by the Europeans. Smallpox, influenza, measles, typhus, pneumonia, scarlet fever, malaria, and yellow fever emerged subsequently and affected millions. Approximately 90% of the estimated 50-80 million Native American population died of these diseases, which suggests approximately 10% of mankind died during 1493-1650. This event initiated the globalization and homogenization of the world’s species and diseases 2 . In the 20th century, epidemics and pandemics continued to kill millions of people. The first pandemic of the 21st century was reported as influenza A (H1N1) in 2009-2010 that resulted in 100,000-400,000 deaths in the first year; however, for the first time, a vaccine was developed, produced, and distributed worldwide during the first year 3 . Globalization, the exchange of species, materials, energy, and culture, as well as urbanization and the increase in the world’s population and the global flow of people, had a clear, and probably irreversible, impact on the environment and the equilibrium of the Earth System that led to the proposal of a new geological Epoch, called Anthropocene 4 . The term “Anthropocene” was proposed by Crutzen and Stoermer in 2000, to emphasize the central role of mankind in geology and ecology 5 . The increasing impact of human actions on the environment was substantial, global, and long-lasting 2 . There is an increasing consensus on the formal recognition of Anthropocene as a geological Epoch, functionally and stratigraphically distinct from the Holocene 6 . New anthropogenic materials such as plastics, concrete, aluminum, and synthetic fibers; modification of sedimentary process; wastes from nuclear weapons testing; increase in atmospheric methane and CO2 concentrations; changes in carbon, nitrogen, and phosphorus cycles; climate and biotic changes are clear Earth System trends that confirm the transformations to be driven by human residents. Globalization, urbanization, transportation, increase in economic activities, and the flux of people, live species, and manufactured products are clear socioeconomic trends that characterize this new epoch, commonly referred to as “Human Epoch.” All these factors, in addition to political destabilization and civil and international wars, led to poverty, increase in maternal and child death, and spread of diseases. Hotez 7 reported that these changes have promoted the emergence of catastrophic neglected tropical diseases (NTDs), first being dengue fever in the 1980s in the American continent, chikungunya and Zika virus infections in Latin-American and Caribbean regions, and malaria in the Amazonian region of South America. NTDs along with other infections such as leishmaniasis, schistosomiasis, and Middle East Respiratory Syndrome (MERS) coronavirus infection, measles, and polio spread in the Middle East and North Africa. During 2014-2015, the Western African Ebola virus epidemic decimated numerous families and caused a socioeconomic disruption in Guinea, Liberia, and Sierra Leone. The outbreak of COVID-19 provides strong evidence that urbanization and globalization have changed the way people live in communities, and advances in transport and communications have led to a rapid spread of diseases, through both domestic and international transportation modes such as buses, trains, boats, and flights. Increased density of people in residences, public transportation, work environments, shopping centers, and cultural, political, sport, and religious events have increased the possibilities of virus transmission in the metros. Social inequalities lead to higher risks, particularly in middle- and low-income countries that generally have weaker health systems and a limited capacity to handle a rapid surge in cases. Poverty contributes to disseminating epidemics and pandemics, while simultaneously helping to perpetuate poverty through their longstanding negative effects. As no specific drugs or vaccines are available, the mitigation of the exponential spread of COVID-19 relies on community mitigation strategies 8 . There is a crescent consensus that social isolation to prevent the virus spread is the correct strategy from not only the human rights point of view but also the economic point of view. It seems clear that the collapse of the health care systems and millions of deaths would decimate countries financially, and as a society, thus saving human lives must be the governments’ first priority. Although the pandemic is a global phenomenon and the consequence of urbanization, transport, and interchange of people, live species, and manufactured products, its impact is greatly shaped by decisions taken by the individual governments. Many governments responded swiftly while others, after an initial slow response, acknowledged their error and adopted the World Health Organization’s (WHO) recommendations. Unfortunately for all, some are still ignoring WHO’s recommendations on avoiding mass gatherings. Recently, Croda et al. 9 reported on the progression of COVID-19 cases in Brazil and previous experiences with other health emergencies that constituted an important legacy in dealing with epidemics and demonstrated Brazil’s scientific capacity. They also discussed the initially implemented measures to reduce the virus spread and mortality. Despite the exceptional efforts by the state governors and city mayors, the response of the country’s President contributes to the growing uncertainty among the population about the health risks and economic impacts of the pandemic 10 . In uncertain times, positive leadership navigates through a crisis; leaders are required to make the right decisions based on science and to craft a good narrative to clarify the problems and unite the population to manage the situation. Global problems require global solutions and everybody’s efforts. In addition to all the negative impacts, the pandemic has opened new opportunities, displayed examples of solidarity in the local communities, and allowed sharing of resources, information, and expertise from countries further ahead in the pandemic or with better results and knowledge in controlling the spread. The scientific communities worldwide have joined hands and many universities have organized groups of researchers and students to help in the pandemic relief efforts in every possible manner. The pandemic is a strong reminder that to be prepared for the future, a fundamental change in our mindset, commitments, and values is necessary. It is necessary to create a change in our current way of living and a concentrated effort to establish conditions for humanity to manage itself in the Anthropocene, the “Age of Humans.” British economist Kate Raworth, from Oxford University, has rightly mentioned that humanity’s 21st-century challenge is to meet the needs of all within the means of the Planet 11 . Her model, known as “Doughnut Economics”, has recently been adopted to guide Amsterdam out of the economic impact left by the coronavirus pandemic 12 . Environmental repair, renewable energy, more investments in science, public health, and education are needed to reduce inequalities, climate changes, and the human impact on Earth’s equilibrium, else, humanity will never be prepared enough to confront the devastating challenges of a pandemic. Humans have the opportunity of saving their own lives and the life of all species in the Earth System through advanced technology and science. Preparedness is crucial to reduce the health, economic, and social impacts of a future epidemic, it is also the only way to avoid the spread of other diseases. Pandemics are not aleatory events but are the consequence of human interactions with the environment and could be avoided or reduced through science and investments in health, education and transportation and improved through better conditions of living. This is an opportunity for the global community to take advantage of the spirit of cooperation, embrace diversity and arrive at a necessary common global agreement to manage the future of Earth collectively.

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          COVID-19 in Brazil: “So what?”

           The Lancet (2020)
          The coronavirus disease 2019 (COVID-19) pandemic reached Latin America later than other continents. The first case recorded in Brazil was on Feb 25, 2020. But now, Brazil has the most cases and deaths in Latin America (105 222 cases and 7288 deaths as of May 4), and these are probably substantial underestimates. Even more worryingly, the doubling of the rate of deaths is estimated at only 5 days and a recent study by Imperial College (London, UK), which analysed the active transmission rate of COVID-19 in 48 countries, showed that Brazil is the country with the highest rate of transmission (R0 of 2·81). Large cities such as São Paulo and Rio de Janeiro are the main hotspots now but there are concerns and early signs that infections are moving inland into smaller cities with inadequate provisions of intensive care beds and ventilators. Yet, perhaps the biggest threat to Brazil's COVID-19 response is its president, Jair Bolsonaro. When asked by journalists last week about the rapidly increasing numbers of COVID-19 cases, he responded: “So what? What do you want me to do?” He not only continues to sow confusion by openly flouting and discouraging the sensible measures of physical distancing and lockdown brought in by state governors and city mayors but has also lost two important and influential ministers in the past 3 weeks. First, on April 16, Luiz Henrique Mandetta, the respected and well liked Health Minister, was sacked after a television interview, in which he strongly criticised Bolsonaro's actions and called for unity, or else risk leaving the 210 million Brazilians utterly confused. Then on April 24, following the removal of the head of Brazil's federal police by Bolsonaro, Justice Minister Sérgio Moro, one of the most powerful figures of the right-wing government and appointed by Bolsonaro to combat corruption, announced his resignation. Such disarray at the heart of the administration is a deadly distraction in the middle of a public health emergency and is also a stark sign that Brazil's leadership has lost its moral compass, if it ever had one. Even without the vacuum of political actions at federal level, Brazil would have a difficult time to combat COVID-19. About 13 million Brazilians live in favelas, often with more than three people per room and little access to clean water. Physical distancing and hygiene recommendations are near impossible to follow in these environments—many favelas have organised themselves to implement measures as best as possible. Brazil has a large informal employment sector with many sources of income no longer an option. The Indigenous population has been under severe threat even before the COVID-19 outbreak because the government has been ignoring or even encouraging illegal mining and logging in the Amazon rainforest. These loggers and miners now risk bringing COVID-19 to remote populations. An open letter on May 3 by a global coalition of artists, celebrities, scientists, and intellectuals, organised by the Brazilian photojournalist Sebastião Salgado, warns of an impending genocide. What are the health and science community and civil society doing in a country known for its activism and outspoken opposition to injustice and inequity and with health as a constitutional right? Many scientific organisations, such as the Brazilian Academy of Sciences and ABRASCO, have long-opposed Bolsonaro because of severe cuts in the science budget and a more general demolition of social security and public services. In the context of COVID-19, many organisations have launched manifestos aimed at the public—such as Pact for Life and Brazil—and written statements and pleas to government officials calling for unity and joined up solutions. Pot-banging from balconies as protest during presidential announcements happens frequently. There is much research going on, from basic science to epidemiology, and there is rapid production of personal protective equipment, respirators, and testing kits. These are hopeful actions. Yet, leadership at the highest level of government is crucial in quickly averting the worst outcome of this pandemic, as is evident from other countries. In our 2009 Brazil Series, the authors concluded: “The challenge is ultimately political, requiring continuous engagement by Brazilian society as a whole to secure the right to health for all Brazilian people.” Brazil as a country must come together to give a clear answer to the “So what?” by its President. He needs to drastically change course or must be the next to go. © 2020 Bruna Prado/Getty Images 2020 Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.
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            COVID-19 in Brazil: advantages of a socialized unified health system and preparation to contain cases

            Abstract The outbreak of new coronavirus disease 2019 (COVID-19) reported for the first time in Wuhan, China in late December 2019 have rapidly spread to other countries and it was declared on January 30, 2020 as a public health emergency of international concern (PHEIC) by the World Health Organization. Before the first COVID-19 cases were reported in Brazil, several measures have been implemented including the adjustment of legal framework to carry out isolation and quarantine. As the cases increased significantly, new measures, mainly to reduce mortality and severe cases, have also been implemented. Rapid and robust preparedness actions have been undertaken in Brazil while first cases have not yet been identified in Latin-American. The outcome of this early preparation should be analyzed in future studies.
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              The “Anthropocene”


                Author and article information

                Revista da Sociedade Brasileira de Medicina Tropical
                Rev. Soc. Bras. Med. Trop.
                Sociedade Brasileira de Medicina Tropical - SBMT (Uberaba, MG, Brazil )
                : 53
                Rio de Janeiro Rio de Janeiro orgnameUniversidade Veiga de Almeida Brazil
                Rio de Janeiro Rio de Janeiro orgnameUniversidade Federal do Rio de Janeiro orgdiv1Instituto de Química Brazil
                S0037-86822020000100913 S0037-8682(20)05300000913

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