From COVID-19 hospital center to public infectious disease hospital. Analysis of the production of a new model for the study, management and control of (re)emerging infectious diseases in the Brazilian Single Health System (SUS).

On February 26, 2020, the first confirmed case of COVID-19 was notified to the Brazilian Ministry of Health. Adopting a denialist attitude, President Jair Bolsonaro instituted a neo-liberal epidemiological strategy that particularly impacted the most vulnerable communities. Brazil quickly became the epicenter of the COVID-19 pandemic in Latin America. Hopes for a governmental response to the pandemic that would limit its detrimental impacts faded away. Though, the existence of the Universal Health System (SUS) and Brazil's successful experiences in dealing with several epidemics in the past rose hope for a less bleak scenario. In this uncertain context, the Oswaldo Cruz Foundation (Fiocruz) emerged as a national and international reference in the response to the pandemic. Despite the presidential posture, this organ of the Ministry of Health undertook important efforts in research, care and control of COVID-19. In Rio de Janeiro, the action of the Fiocruz took a spectacular turn in March 2020, with the construction of a 200-beds COVID-19 hospital in seven weeks. The hospital appeared as the product of a generalized hospital-centrism pandemic-mitigation tool. Affiliated to the National Institute of Infectious Diseases (INI/Fiocruz), the Evandro Chargas Hospital had the particularity of being a permanent infrastructure. This structure was to become a public hospital of infectious diseases dedicated to research as well as semi-intensive and intensive care of patients. This project intends to assess the development of a new model of study, medical care and control of (re)emerging infectious diseases in the wake of the COVID-19 pandemic. Considering the hospital as a plural object of study, as a full societal issue and a mirror of the society and culture in which it is embedded, the aim will be to analyze the properties and work of the hospital center by focusing on three research axes. Firstly, the project will assess the clinical care by looking at the care and research practices deployed within this structure. Secondly, it will consider the issues of access to care and health inequalities by documenting the transition of this COVID-19 hospital center to a hospital for infectious diseases. How does this new exceptional structure fit into the public offer of (semi-)intensive care in the state of Rio where chronic demand exceeds the capacities of the local public health system? Finally, it will analyze, from a double socio-historical and political economy perspective, the genesis of this hospital, its origins, and the modalities of its sustainability in a particularly volatile political context. This project will be based on a multidisciplinary approach combining sociology and anthropology of health as well as public health, using a qualitative research method. It will consist in conducting an ethnography of the Evandro Chargas hospital from a monographic perspective. The research will be based on ethnographic direct observation sequences in the hospital; ethnographic interviews with hospital workers and public health decision-makers interacting with this space; the review and collection of written sources and (audio)visual supports related to the hospital. The research will be carried out in a close Franco-Brazilian collaboration with the teams of the hospital and the INI/Fiocruz.