Retired Maria Elisa Victorino Geraldo, 72, shares the house where she lives, on the east side of the city of São Paulo, with her mother, Dinah de Rossi Victorino, 94, her daughter and granddaughters. She is one of the approximately 340,000 elderly people in the city who live with school-age children and adolescents.
With the covid-19 pandemic and the discussion about returning to face-to-face classes in São Paulo, Maria Elisa fears that she will be more exposed to the new coronavirus when children return to school.
“We are very afraid of returning to school. I have diabetes and my mother has pulmonary emphysema. Here at home we have two children in school, Francesca, 14, and Antonella, 12. They must remain at home, in online classes, if this is optional until the end of the pandemic. Otherwise, my daughter, their mother, will see how this process can be done ”, admits the retiree.
“Our greatest fear, in addition to what we already know about the virus’s potency through reports, is that doctors always discover new symptoms and sequelae, that is, we are still unaware of what the virus really can cause in the short and long term, outside the danger of death, ”added Maria Elisa, who lives in Vila Prudente.
Retired couple Luís Pinheiro Silva, 69, and Miriam Cristina Borges Pinheiro, 67, also live with their grandchildren and fear the children’s return to school. For Luís, the return to school should only occur after the discovery of the vaccine against the new coronavirus and the immunization of all.
“If schools reopen, without any guarantee, because the vaccine was not made, who can say that the child will keep 1.5m away from each other if, on a daily basis, no one does this, not even in the supermarket or shopping mall ! The child can get infected and transmit it to his family, especially to his grandparents, so I don’t think it’s right to go back now. I think I should come back, after I have a vaccine for everyone, ”said the grandfather of Luiz Gustavo, 8, and Kethlyn Cristiana, 6, who live in Jardim Marília, also on the east side.
Up to this point, the city of São Paulo has, since October 7, released face-to-face classes for higher education students or for extracurricular activities for children, elementary and high schools ,.
The return to public and private schools has not yet been defined. The mayor said that the possibility of students returning from November 3 is being assessed.
According to the professor at the School of Public Health at the University of São Paulo (FSP-USP) Yeda Duarte, more than 20% of the elderly in the city of São Paulo live in homes with school-age youth. A fact that, according to her, needs to be taken into account when discussing the return of face-to-face classes.
The alert was made during the webinar “Covid-19, 60+: what is this epidemic?”, Promoted by Agência Fapesp (Research Support Foundation of the State of São Paulo) in partnership with Canal Butantan. The entire event can be viewed on YouTube.
“We are talking about approximately 340 thousand elderly people in close contact with children and adolescents who are going to return to normal life, they can be [portadores do SARS-CoV-2] asymptomatic and will bring this contamination into the home ”, said the researcher.
With the support of Fapesp, the professor has coordinated, since 2000, the Study on Health, Well-Being and Aging (SABE), which seeks to periodically assess the living conditions of residents of the city of São Paulo aged 60 or over. The data presented at the seminar was extracted from the most recent edition, conducted between 2015 and 2017 with 1,236 participants selected to represent the profile of the elderly population of the capital.
In recent months, in partnership with researchers from the Butantan Institute, the SABE team has investigated how Covid-19 has been affecting this group of volunteers. In addition to telephone interviews to assess the impact of the disease and social isolation, serological tests (to look for antibodies against the new coronavirus) were performed on 310 elderly people and on all people with whom they have frequent contact.
In the case of individuals who had suspicious symptoms in the 15 days prior to collection, the RT-PCR test (which detects the RNA of the virus and is the main diagnostic method for Covid-19) was also performed.
Preliminary data from SABE-Covid (80% of the tabulated results) point to a seroprevalence of 4.5% among the elderly evaluated. Among its main contacts, the percentage was more than double: 9.6%.
“The greatest number of reagents is among the contacts and this is an important issue when it comes to resuming normal activities. The elderly are in their homes and, most of the time, fulfilling social distance. But they are being contaminated by people who continue to circulate in the city and bring the virus from the outside in, ”said Yeda.
Most of the cases and the only two deaths recorded in the study group occurred in the south of the city, in neighborhoods such as Campo Limpo, Jardim Ângela and Jardim São Luís. Following are Pirituba, Freguesia do Ó (both in the north), Aricanduva and Artur Alvim (on the east side).
According to Yeda, the highest seroprevalence in peripheral neighborhoods is related to the living conditions in these places. “There are, for example, a greater number of people living in the same house. This aspect of social inequality needs to be considered when defining the flexibility of control measures and priority groups for vaccination, ”he said.
Infected at home
Data from SIVEP-Gripe (Influenza Epidemiological Surveillance Information System), presented at the event by doctor Paulo Rossi Menezes, member of the State Department of Health’s CCD (Disease Control Coordination), corroborate the assessment that most of the contamination among the elderly it occurred at home.
“After the mandatory use of masks was introduced, in May, there was a dramatic inflection in the hospitalization and mortality curves due to severe acute respiratory syndrome [SRAG] associated with covid-19 in the capital and Greater São Paulo. But that when looking at the population as a whole, ”he said.
“When looking only at the curves of people aged 60 or over, the pattern is totally different. Growth does not stop when the mask is introduced and remains until the end of June. This reinforces the idea that the elderly are being infected inside their homes. People who live with them take to the streets wearing a mask, but they take off their protection when they return, ”he explained.
According to Menezes, confirmed cases of covid-19 in the state of São Paulo are concentrated in the range of 30 to 50 years of age, to which most of the individuals who continued to work during the quarantine period belong.
However, the elderly account for three quarters of confirmed deaths. Of these, 83% had one or more chronic diseases, with the main heart diseases (52.4%), diabetes (36.5%) and neurological diseases (10.4%). Among people over 60 years of age who needed to be hospitalized after contracting the virus, 42% died.
In the search for genetic factors that may increase or decrease the risk of dying from infection with the new coronavirus, geneticist Mayana Zatz, coordinator of the Center for Studies on Human Genome and Stem Cells (CEGH-CEL) at USP, has already found seven centenarians who had contact with covid-19 and developed only mild symptoms or remained asymptomatic.
“To identify the risk and protection genes, we decided to focus on the extremes. We are collecting samples of people who died after contracting the disease and of resistant elderly people. Something that surprised us was the existence of discordant couples, that is, in which only one of the spouses had the disease. We thought it was rare, but we received over 800 emails with this type of report. We have already collected samples from 100 couples and we have seen that the majority of asymptomatic people have negative serology and 65% are female ”, she said.
The next step will be to sequence the genome of centenarians and nonagenarians resistant to covid-19, said the researcher. “We can reprogram these people’s blood cells to create lineages from different tissues, infect the cells in the laboratory and see how the virus behaves. This will allow us to understand the genetic mechanism of the infection. ”
Also participating in the webinar was the director of the Butantan Institute, Dimas Tadeu Covas, who presented partial results of the CoronaVac vaccine tests on volunteers over 60 years old. According to the researcher, the data indicate an “excellent safety profile” of the immunizer, developed by the Chinese company Sinovac Biotech.