What is the role of the scientific community in the fight against COVID-19 pandemic? Observations concerning fake news, predatory journals and public policies

Abstract

Brazil is one of the countries most affected by COVID-19 pandemic, with approximately 684,262 confirmed deaths, 1 second only to the United States in deaths by the disease. 2 It is estimated that four fifths of these deaths could have been prevented. 3 Besides the high number of cases and deaths by COVID-19, the maternal mortality by the disease draws attention, an aspect that was not verified in other countries. Before the pandemic onset, the maternal mortality ratio (MMR) in the country was already unjustifiably high, far above the goals agreed in international treaties -such as the Sustainable Development Goal that proposes the reduction of maternal mortality rate in 30% by 2030. In 2019, a 57.9 MMR was observed, and after COVID-19 onset, the mortality rate increased in 77% in 2 years, exceeding 107 maternal deaths per 100.000 live births in 2021. 4 Meanwhile, international documents informed that, besides the higher risk of unfavorable maternal outcomes, pregnant women with COVID-19 did not have higher probability of death. 5 The main hypothesis to justify this phenomenon is the inequality in access to healthcare services in Brazil. Even relying on a public healthcare system, unpaid and universal, approximately 22% of patients in the gravidic-puerperal cycle that died because of COVID-19 did not have access to Intensive Care Units and 14% had not even been intubated. 5,6 Brazil has continental dimensions, and tertiary and high-complexity services are still concentrated in capitals, which leads patients in the countryside to be vulnerable to delays and lack of access to adequate care due to logistic and transport issues. Besides, SUS (Unified Health System) has been underfunded through the years, receiving governmental incomes of only 3.8% of the GDP in 2019 -a value currently limited by Constitutional Amendment n° 95 (Public Costs Limit), approved in 2016. Due to this, patients of middle and low income, which do not have access to supplementary healthcare, challenge consequences of overcrowding and insufficient material and human resources.Another determinant factor for the high mortality of the disease in Brazil was the lack of consistent public policies and in timely manner in order to ensure social distancing, vaccines, medications and high complexity resources for the entire population. The government invested in the promotion of a so called "herd immunity", and with this stimulated people to be in the streets, did not promote lockdowns, recommended medications without confirmed effectiveness against COVID-19 and initially adopted an anti-vaccine attitude. 8 Furthermore, investments in informative campaigns were minimal, whilst we are unfortunately challenging the spread of fake news, including in the scientific community environment. Several health professionals, mainly those involved with the government, defended the prescription of medications without confirmed benefits, exposing false side effects of vaccines and propagandizing actions based on preprint texts and articles published in predatory journa...