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On March 12, 2020, the World Health Organization (WHO) declared the disease caused by the novel coronavirus (SARS-CoV-2) a pandemic 1. The infection (COVID-19) is more transmissible and has a higher case-fatality rate than influenza, estimated at some 14 times greater 2. The high infection rate, with each case infecting 2 to 3 other individuals on average, leads to the epidemic’s expansion in geometric progression 3. In Brazil, where community transmission throughout the country was declared on March 20, more than 147,000 cases and 10,000 deaths from COVID-19 had been confirmed as of May 9, 2020 4. Isolation of cases and contacts and social distancing of the general population have been the main strategies recommended to delay the expansion of COVID-19 and allow the health system’s adjustment to the rapidly increasing demand for hospital beds, especially in intensive care, avoiding the collapse of hospital care 5,6. The initial clinical presentation of COVID-19 is flu-like, with fever, cough, sore throat, and coryza. About 80% of patients recover without complications and are classified as mild or moderate cases (either without pneumonia or with mild viral pneumonia) 7. The other 20% evolve with dyspnea and hypoxemia secondary to extensive viral pneumonia and require hospitalization for oxygen therapy and other interventions 8. One fourth of these (some 5% of the total) evolve to critical conditions due to respiratory failure, disseminated intravascular coagulation, circulatory shock, or multiple organ dysfunction, requiring intensive care. Case-fatality in the latter group is more than 40% 9,10. COVID-19 treatment aims to meet the patients’ needs in different phases of the infection and throughout the spectrum of severity, in a line of care that ranges from monitoring mild cases in isolation at home, with instructions on management of symptoms and the identification of early warning signs, to admission in intensive care units (ICUs) and post-discharge rehabilitation. Mitigation of risks of infection to health professionals and other patients should guide the choice of the best strategies for organizing the health care system to meet these needs 11. To reduce transmission and limit mortality from COVID-19, government should create the conditions for individuals and families to maintain social distancing while preparing the health system to deal with the pandemic. In Brazil, the Unified National Health System (SUS) should prepare to provide care for the growing number of COVID-19 patients, maintain care for other acute and chronic illnesses, and ensure the safety of health professionals and patients during care 12. 1 Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil. 2 Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brasil. 3 Organização Pan-Americana da Saúde/ Organização Mundial da Saúde, Brasília, Brasil. 4 Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil. 5 Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brasil. 6 Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, Brasil.

O papel da atenção primária na rede de atenção à saúde no Brasil: limites e possibilidades no enfrentamento da COVID-19