What’s left in the Pandora’s Box? A short report about COVID-19 in Brazil

Written By: Leandro Iuamoto, MD (ISPRM WYF Country Ambassador of Brazil) and Marcelo Riberto, MD, PhD (President of Brazilian Association of Physical Medicine and Rehabilitation – ABMFR)

The population of Brazil is approximately 211 million and around July 28th 2020, nearly 2.5 million COVID-19 cases were confirmed and of which about 1.7 million cases have recovered. The COVID-19 pandemic caused just over 88,000 deaths so far. Currently, approximately 12 million tests (RT-PCR and Serology) have been performed for COVID-19. Unfortunately, Brazil is still on the upward curve for the number of infections. Although the current focus is on public health measures and acute hospital care of patients, eventually many of these patients will need rehabilitation. We are expecting many clinical, functional and psychological impairments in our patients during the post-COVID period. As patients are transferred to subacute care or discharged to the community, rehabilitation services must be prepared and trained to deal with these issues. Thus, rehabilitation doctors in Brazil are trying to assume their leadership role in the organization of care.

In Brazil, although there are reports of Physical Medicine being practiced in Rio de Janeiro in 1880s, it is only after the 1930s, that “Rehabilitation Medicine” became systematically practiced in Brazil, mainly with children with poliomyelitis. After the Second World War, Physical and Rehabilitation Medicine (PRM) became stronger and on September 9, 1954 the Brazilian Association of Physical Medicine and Rehabilitation (ABMFR) was founded in the city of Rio de Janeiro.

Nowadays, there are around 850 physiatrists spread across the country and 84 residents in-training in 17 Institutions. Brazilian’s residency program lasts 3 years (an extra 4th year usually involves sub-specialization in Clinical Neurophysiology or Pain Practice). Around 20 to 30 new physicians are board certified in PRM every year.

During COVID-19 pandemic, most of the residents are covering the acute medical care units of COVID-19 and some rehabilitation beds have been requested for those patients as well. This may lead to a delay in the end of residency training, although this has not yet been decided as a rule for every residency program. Because of this, the residents are having lesser exposure to the experiences of PRM outpatient services and interventional procedures.

Despite the difficulties, there are many opportunities to adapt to the new reality: studies in respiratory rehabilitation, inpatient care and adaptation of physiatric practices to the “new normal” have been well explored fields, together with innovative technologies to enhance the care provided by PMR doctors to patients, like remote monitoring and orientation of patients with telemedicine. It is up to national and global leaderships to encourage and prepare medical specialties to deal with the current and post-pandemic situation in rehabilitation.