SciELO - Scientific Electronic Library Online

vol.31 número1Escala de Medo da COVID-19 - Validação e adaptação para o Período Perinatal índice de autoresíndice de materiabúsqueda de artículos
Home Pagelista alfabética de revistas  

Journal of Human Growth and Development

versión impresa ISSN 0104-1282versión On-line ISSN 2175-3598

J. Hum. Growth Dev. vol.31 no.1 Marília ene./abr. 2021 



The path of humanity in the pandemic of COVID-19: the choice of the realistic, optimist or pessimist scenario



Luiz Carlos de AbreuI, II

IProfessor. Department of Integrated Health Education. Postgraduate Program in Collective Health, Federal University of Espírito Santo, Brazil
IIAdjunct Professor. School of Medicine. University of Limerick, Ireland, Ie




Coronavirus Disease 2019 (COVID-19), characterized as a pandemic, has been causing a global recession in the economic and health systems1-3. Brazil faces the biggest health and hospital crisis in its history. On the night of 26/03/2021, 3,158 lives were lost in just twenty-four hours. The gloomy record reflects the country's lack of control of the pandemic, with almost 300,000 fatalities from Covid-19. Nineteen states and the Federal District are high in lethality and mortality indicators.

The moving average of deaths reached 2,349, with 12,136,615 confirmed cases of Brazilians who have had or have the coronavirus confirmed cases. Brazil currently accounts for about 35% of deaths from COVID-19 worldwide.

At the Covid-19 Observatory, of the Oswaldo Cruz Foundation, in Rio de Janeiro, Brazil, the researchers identified and detailed the severity of the pandemic situation and suggested/requested more rigorous non-pharmacological measures throughout Brazil and for 14 consecutive days, as unique pandemic curve decline strategy in Brazil.

And as a new concern, over a year of persistent circulation of SARS-CoV-2 in our environment, the genetic change of the virus is observed. In genomic epidemiology findings, the SARS-CoV-2 lineage was disseminated (The technical note also notes the detection of two replacement events for the main circulating lineages in Amazonas: B.1.195 to B.1.1.28 and then to P.1.).

The FIOCRUZ4 researchers point out that the first phase / first wave was of exponential growth and was mainly driven by the spread of the B.1.195 strain, which was gradually replaced by the B.1.1.28 strain. The second wave coincides with the emergence of the variant of concern (VOC) P.1, which evolved from a group of species with a unique common ancestor (with a technical name) B.1.1.28 local in late November and quickly replaced the lineage in less than two months4.

Successive lineage replacements in Amazonas were driven by a complex combination of varying levels of social distance measures and the emergence of a more transmissible VOC P.1 virus4. These data provide unique insights into the mechanisms behind the epidemic waves of COVID-19 and the risk of spreading SARS-CoV-2 VOC P.1 in Brazil and potentially worldwide4.

Thus, we are left with the immediate and unrestricted implementation of social distance and the use of easy masking as non-pharmacological measures to combat COVID-19. The lack of efficient social distance and other mitigation measures probably accelerated the early transmission of VOC P.1 At the same time,the high transmissibility of this VOC further fueled the rapid increase in SARS-CoV-2 cases and hospitalizations observed in Manaus after its emergence.

The weak adoption of non-pharmaceutical interventions, as occurred in Amazonas and other Brazilian states, represents a significant risk to the continued emergence and dissemination of new variants. The implementation of non-pharmacological measures is urgent. Valenti et al.,5 demonstrated that social distance is an effective measure to control the extensive dissemination of COVID-19.

On the other hand, there are epidemiological projections based on mathematical models, which make it possible to infer a future scenario of the pandemic's consequences. The group by Valenti et al.,5 provided the classification of the pandemic scenario of COVID-19 in three ways: realistic, optimistic, and pessimistic.

The realistic model estimates the potential for deaths that will occur at a given moment in the pandemic, based on the assumptions of efforts by society and governments to maintain social distance and reduce economic activities. The pessimistic model, on the other hand, considers the full opening of the economy and the potential immunity of the community's herd, with twice the deaths from COVID-19 in the same period. Finally, the optimistic model allows the association of non-pharmacological measures associated with vaccination (already present in our country, although quiescent) and allows to project the reduction of deaths due to COVID-19.

Furthermore, robust evidence has recently been obtained in the literature6-10 that reduced community mobility has decreased the estimated total number of COVID-19-related deaths in Brazil and worldwide. These measures associated with vaccination appear to be the only path for humanity in the current scenario.

As a set of these scientific evidences1-10, the United States Center for Disease Prevention and Control (CDC) 11 promoted the recommendation for the use of easy masking as a non-pharmacological measure to combat the COVID-19 pandemic. It involves the use of surgical masks with triple protection and cloth (made of cotton). Thus, it is highlighted that the use of facial masking is a non-pharmacological procedure that will improve the performance of this facial accessory and with the potential to reduce the chance of transmission and exposure to SARS-CoV-2.


Figure 1


The use of the masking procedure as a non-pharmacological measure of universal use and recommended delaying the spread of COVID-19, cloth masks, and medical procedure masks reduce infected users' exposure (source control) and reduce the exposure of uninfected users (user exposure).

It is worth mentioning that researchers Ueki, Furusawa, Iwatsuki-Horimoto et al.,10 carried out experiments with dolls similar to the human face and, after testing different types of masks, concluded that medical masks (surgical masks and even N95 masks) were not able to block the transmission of virus droplets/aerosols completely, even when completely sealed. In 95% of cases, they were effective as a protective barrier to the virus-like corpuscle.

Thus, based on scientific evidence6-10, the Center for Disease Control and Prevention in the United States promoted the recommendation of adjusting medical procedure masks with the overlay of a cloth mask over a medical procedure mask and with the need to tie the ear loops of a procedure mask. They also highlight11 that the adjustment between the masks is fundamental to obtain the best results of non-contact and exposure to SARS-COv2 and improve the masking procedure's effectiveness with the use of a double mask. However, it is necessary to guarantee the face's adjustment to prevent air leakage around the edges of the masks.

The guidelines of the CDC11 and the World Health Organization (WHO)12 recommend the use of facial masks to prevent the spread of the disease by a coronavirus (CoV) in 2019 (COVID-19), with guidance that there is an efficient protector of such masks against the airborne transmission of infectious droplets/aerosols from severe acute respiratory syndrome (SARS-CoV-2). The cotton masks, surgical masks, and N95 masks have a protective effect concerning the transmission of infectious droplets/aerosols from SARS-CoV-2. The protective efficiency was greater when the masks were used by a virus spreader.

As a consequence of the persistence of the COVID-19 pandemic in Brazil, the genetic mutation of the SARS-CoV-2 virus is observed, especially for its P.1 variant. It has shown itself to be more lethal, and because it found a population already tired of the virus and devoid of minimal measures of education and health, it found means conducive to its spread. Thus, non-pharmacological measures for the use of double facial masking appear to be an adequate and urgent measure to control the viral spread of SARS-CoV-2.

In this understanding, it is important to follow new recommendations regarding the use of facial masks and other non-pharmacological procedures. According to the current scientific evidence and recommendations from the CDC11, double-maskingis 95% effective. It is recommended that other non-pharmacological measures continue to be implemented, but they are to prevent viral spread by the vector and contagion by the subject, such as:

- Wash your hands frequently with soap and water for at least 20 seconds;

- Wash your hands, especially before eating and after coughing or sneezing;

- Avoid touching the eyes, nose, and mouth;

- Use disposable tissue for nasal hygiene;

- Cover your nose and mouth when sneezing or coughing with disposable tissue or the inside of your elbow;

- Do not share objects for personal use, such as cutlery, plates, glasses, or bottles;

- Keep the rooms well ventilated;

- Clean and disinfect frequently touched objects and surfaces, such as cell phones and computer keyboards;

- Avoid contact with people who are not close to you;

- Wear a surgical mask (triple protection) and cloth (cotton) as a collective protection measure, as well as avoiding crowding places.

Thus, the use of facial masking and the arrival of the vaccine in different corners of the world allow us to infer that we are going to live and immediately, an optimistic scenario in the course of the pandemic of COVID-19. It is current and urgent the importance of spreading the information to the population in order to provide educational actions that can contribute to the dissemination of these guidelines, providing the population with empowerment and who are responsible for their health.

Educational actions promote the health of the population and are important instruments in care and, at this moment when everyone must come together to prevent and control the pandemic, the triad management, health workers, and the community must each time strengthen the bonds so that these actions be effective and promote behavior change and are not just information transfer actions.

It is considered, therefore, that the editorial line of JHGD is of an optimistic model and that each life matters, and no one will be left behind. The optimistic model is the one advocated by everyone who works in the field of Public Health in its various scenarios.

In this way, the JHGD, as it does throughout its 31 years of uninterrupted publication, contributes to this debate, and in this issue 30.1 brings good and fruitful discussions about Public Health and the pandemic of COVID-1914-28, with emphasis on the use of fear scale for COVD-1913.

The place of residence, socioeconomic status, discrimination, and inequalities within and between countries contribute to early mortality and significant morbidities, particularly in environments with limited resources, with many children, adolescents, and their families at risk. In the previous period of the COVID-19 pandemic, many children and adolescents were neglected29.

During the COVID-19 pandemic, it remains for us to make efforts to avoid losing opportunities to fill the inequality gap. Immediate decision-making is essential to ensure that no one is left behind.



1. Pimentel RMM, Daboin BEG, Oliveira AG, Macedo Jr H. The dissemination of COVID-19: an expectant and preventive role in global health. J Hum Growth Dev. 2020; 30(1): 135-140. DOI:        [ Links ]

2. de Abreu LC. Integrated actions and strengthening of Public Health System in Brazil in a time of pandemic. Journal of Human Growth and Development. 2020; 30(1):05-8. DOI:        [ Links ]

3. da Silva e Silva CM, do Nascimento Andrade A, Nepomuceno B, Salgado Xavier D, Lima E, Gonzalez I, et al. Evidence-based Physiotherapy and Functionality in Adult and Pediatric patients with COVID-19. J Hum Growth Dev. 2020; 30(1): 148-155. DOI:        [ Links ]

4. FUNDAÇÃO OSWALDO CRUZ. Caracterização genética do SARS-CoV-2 circulante no Estado do Amazonas. Disponível em: Acessado em 23 mar 2021.         [ Links ]

5. Valenti VE, de Lemos Menezes P, de Abreu ACG, Vieira GNA, Garner DM. Social distancing measures may have reduced the estimated deaths related to Covid-19 in Brazil. Journal of Human Growth and Development. 2020;30(2):164-169. DOI:        [ Links ]

6. Honein MA, Christie A, Rose DA, et al; CDC COVID-19 Response Team. Summary of guidance for public health strategies to address high levels of community transmission of SARS-CoV-2 and related deaths, December 2020. MMWR Morb Mortal Wkly Rep 2020; 69: 1860-7. PMID: 33301434 DOI:        [ Links ]

7. Rothamer DA, Sanders S, Reindl D, Bertram TH. Strategies to minimize SARS-CoV-2 transmission in classroom settings: combined impacts of ventilation and mask effective filtration efficiency. medRxiv [Preprint posted online January 4, 2021]. DOI:        [ Links ]

8. Clapp PW, Sickbert-Bennett EE, Samet JM, Berntsen J, Zeman KL, Anderson DJ, et al. Evaluation of Cloth Masks and Modified Procedure Masks as Personal Protective Equipment for the Public During the COVID-19 Pandemic. JAMA Intern Med. Epub Dec 10, 2020. PMID:33300948. DOI:        [ Links ]

9. Mueller AV, Eden MJ, Oakes JM, Bellini C, Fernandez LA. Quantitative method for comparative assessment of particle removal efficiency of fabric masks as alternatives to standard surgical masks for PPE. Matter 2020; 3: 950-62. PMID: 32838296. DOI:        [ Links ]

10. Ueki H, Furusawa Y, Iwatsuki-Horimoto K, et al. Effectiveness of face masks in preventing airborne transmission of SARS-CoV-2. MSphere 2020; 5: e00637-20. PMID:33087517. DOI:        [ Links ]

11. Brooks JT, Beezhold DH, Noti JD, et al. Maximizing Fit for Cloth and Medical Procedure Masks to Improve Performance and Reduce SARS-CoV-2 Transmission and Exposure, 2021. MMWR Morb Mortal Wkly Rep 2021; 70(7): 254-257. DOI:        [ Links ]

12. OMS - Organização Mundial de Saúde. COVID-19: OMS atualiza guia com recomendações sobre uso de máscaras. Disponível em: Acessado em: 23/03/2021.         [ Links ]

13. Barros MN, Aguiar MM, Carvalho F, Macedo A, Pereira AT. COVID-19. Fear Scale - Validation and adaptation for the perinatal period. J Hum Growth Dev. 2021; 31(1): 09-17. DOI:        [ Links ]

14. Scherrer IRS, Alves CRL. Association of maternal depression, family composition and poverty with maternal care and physical health of children in the first year of life. J Hum Growth Dev. 2021; 31(1): 18- 27. DOI:        [ Links ]

15. Korz V, Kremr MM, Vargas DM, Nunes CRO. Cow's milk protein allergy, quality of life and parental style. J Hum Growth Dev. 2021; 31(1): 28-36. DOI:        [ Links ]

16. Camargo JSAA, Zamarchi TBO, Balieiro AAS, Pessoa FAC, Camargo LMA. Prevalence of obesity, high blood pressure, dyslipidemia and their associated factors in children and adolescents in a municipality in the Brazilian Amazon region. J Hum Growth Dev. 2021; 31(1): 37-46. DOI:        [ Links ]

17. Biasutti CM, Nascimento CRR. The adoption process in single-parent families. J Hum Growth Dev. 2021; 31(1): 47-57. DOI:        [ Links ]

18. Martins MIS, Vitoriano NAM, Martins CA, Carvalho EM, Jucá RVBM, Alves JSM, Ferreira HS, Mont'Alverne DGB. Aspects of motor development and quality of life in the context of child obesity. J Hum Growth Dev. 2021; 31(1): 58-65. DOI:        [ Links ]

19. Farias ES, de Carvalho WRG, Leitão FNC, dos Santos JP, Castro RF, Souza OF. Behavior in children and adolescents associated to screen time in Porto Velho, Brazilian Western Amazon. J Hum Growth Dev. 2021; 31(1): 66-75. DOI:        [ Links ]

20. Felix AM, Pereira TD, Costa CR, Giannichi BV, Leung MCA, Passadore MD, Martinez S, Mello APQ. Qualitative Analysis of the "Healthy Growing at School Program" - Vision of Health Professionals, School Community and Family. J Hum Growth Dev. 2021; 31(1): 76-83. DOI:        [ Links ]

21. Madeira FP, de Jesus AC, Moraes MHS, Barroso NF, Castro GVS, Ribeiro MAL, Mendes JET, Camargo LMA, Meneguetti DUO, Bernarde PS. Chagas Disease in the Western Brazilian Amazon: Epidemiological Overview from 2007 to 2018. J Hum Growth Dev. 2021; 31(1): 84-92. DOI:        [ Links ]

22. Targino AN, da Silva AP, Leitão FNC, Zangirolami-Raimundo J, Echeimberg JO, Raimundo RD. Low cost simulator for cardiopulmonary unobstructed and reunion procedures in infants. J Hum Growth Dev. 2021; 31(1): 93-100. DOI:        [ Links ]

23. Alves JSA, Gama SGN, Viana MCM, Martinelli KG, Santos-Neto ET. Socioeconomic characteristics influence attitudes towards sexuality in adolescents. J Hum Growth Dev. 2021; 31(1): 101-115. DOI:        [ Links ]

24. Callado AN, Bezerra IMP, Sousa LVA, de Abreu LC. Mortality and hospitalization for liver disease in the western Amazon from 2008 to 2017. J Hum Growth Dev. 2021; 31(1): 116-124. DOI:        [ Links ]

25. Ferreira T, Figueiredo TC, Bick MA, Langendorf TF, Padoin SMM, de Paula CC. Opportunities in child motor development at home: bibliometric and scientometric review. J Hum Growth Dev. 2021; 31(1): 125- 144. DOI:        [ Links ]

26. Bezerra HS, Mendes TMC, de Souza TA, Nascimento AKF, Macedo HKS, Andrade FB. Coverage of screening for cervical cancer in a northeastern state of Brazil. J Hum Growth Dev. 2021; 31(1): 145-151. DOI:        [ Links ]

27. Pérez-Riera AR, Mendes JET, Silva FF, Yanowitz F, de Abreu LC, Figueiredo JL, Raimundo RD, Barbosa-Barros R, Nikus K, Brugada P. Brugada syndrome: current concepts and genetic background. J Hum Growth Dev. 2021; 31(1): 152-176. DOI:        [ Links ]

28. Martins MA, Moreira CA, Queiroz MCGAA, Martins WH, Pereira GV, Abreu LC. Malignant adnexal cutaneous tumor of the scalp: a case report of difficult differential diagnosis between metastatic breast cancer and primary sweat gland tumor. J Hum Growth Dev. 2021; 31(1): 177-183. DOI:        [ Links ]

29. Elmusharaf K, Daboin BEG, & Crocetta TB. Do we really know who are left behind and who are at risk of being left behind?. Journal of Human Growth and Development, 2018: 28(3), 218-222. DOI:        [ Links ]




Creative Commons License