COVID-19 Field Experiences of the Brazilian Field Epidemiology Training Program

In Brazil, the first case of COVID-19 was diagnosed in February 2020. Since the declaration of COVID-19 as a Public Health Emergency of International Concern by the World Health Organization (WHO) in January 2020, EpiSUS has been carrying out actions to prepare and respond to the situation. Through June 29, 2020, Brazil registered 1,368,195 confirmed cases of COVID-19, of which 58,314 (4.3 percent) died. Professionals in training at EpiSUS (at the advanced level) have participated in several fieldwork activities, conducting epidemiological investigations on COVID-19 in places with high rates of morbidity and mortality. Below are reports from teams that participated in three of these investigations.

Investigation of the therapeutic path and the reasons for lack of assistance related to deaths from COVID-19 in Pernambuco

"The arrival of the team in the field was challenging from beginning to end, starting with the difficulty of finding a place to sleep, since we arrived with the state in lockdown. A busy and touristic city, it was so empty: a shock. Interviews with the relatives of people who died recently was the biggest challenge, mainly due to reports about the lack of beds, supplies, doctors and other types of lack of assistance. After hearing the reports, the feeling of empathy affected us: anguish. We needed to collect care information on deaths, but we were faced with the quarantine of medical records by health institutions: barriers. The team had to plan again for the investigation to be carried out in time: resilience. During the investigation, the constant fear of falling ill due to COVID-19 was recurrent, even when wearing protective equipment, since we were exposed during the camp. But in the end, expectations were met and we managed to achieve the objectives by supporting the state in coping with COVID-19: overcoming."

–Ana Júlia, Ewerton, and Nathalie

Deaths due to ill-defined causes: dealing with the mourning of families during home visits in Amazonas

“It was a call in the midst of chaos; the number of deaths in Manaus had increased three times in that period! Our initial research question was: how many of those deaths can be attributed to COVID-19? Then, a new question: did these deaths result from the collapse of assistance in the municipality? To answer these questions quickly, we carried out 268 home visits in three weeks, an average of 15 families a day...15 stories of pain, loss, loss of mother, father, partner, son, brother, grandfather, from the grandson, from someone they loved...These families presented us with the opportunity to be useful within our craft and to bring a little warmth to those who lost a piece of their family. Throughout the fieldwork, we realized that doing field epidemiology is important, that being sensitive to the pain of others at these times is even more important because losing someone we love hurts; losing them from something unknown hurts us more and leaves us with a feeling of helplessness.”

–Dalva, Fernanda, and Ruanna

The intramural reality: challenges to controlling an outbreak of COVID-19 in a population deprived of liberty in the Federal District

“The investigation of the outbreak of COVID-19 in one of the largest prison complexes in Latin America was marked by many feelings, including fear. The instability that we could find in a system known to be unhealthy, overcrowded, and sometimes flawed in the resocialization process was the biggest challenge. The impacts we observed were many. When entering the jail and viewing a cell, with the capacity to hold nine inmates, being shared by 38 individuals who were huddled on top of each other, the prison overcrowding and the precarious sanitary conditions of that population were evident—something, at least, inhumane. There was a favorable environment for the spread of a highly transmissible virus, and with the first results of COVID-19 it was already possible to understand this effect. Although that scenario was fraught with adversity, the opportunity to accompany such a vulnerable population was a unique experience. Being able to study an outbreak and its precepts in that environment, and, thus, collaborate with public health in this important epidemiological moment, made us grow even more as people and professionals.”

–Camile, Patrícia, Danniely, Fernando, and Lairton

It is very difficult to describe, in a nutshell, all the feelings that arise during an investigation in the field, but even in the face of the unusual, our field epidemiologists proved to be true health professionals—but not only that. They also overflowed with courage, perseverance, empathy, love, fraternity, friendship, and respect. We in Brazil give all FETPs our deepest respect and admiration in responding to this pandemic! #TogetherWeAreStronger #IfYouCanStayAtHome