The virus has already killed more than 300,000 people in Brazil, its spread aided by a highly contagious strain, political fights and mistrust in science.
PORTO ALEGRE, Brazil – Patients started arriving at the hospitals in Porto Alegre much sicker and younger than before. Funeral homes were experiencing a steady increase in business, while exhausted doctors and nurses pleaded in February for a life-saving blockade.
But Sebastião Melo, mayor of Porto Alegre, argued that there was a greater imperative.
“Put your life at risk so that we can save the economy,” Melo appealed to his voters at the end of February.
Now, Porto Alegre, a thriving city in southern Brazil, is at the center of an impressive collapse in the country’s health care system – a predicted crisis.
After more than a year of the pandemic, deaths in Brazil are at their peak and highly contagious variants of the coronavirus are sweeping the country, made possible by political dysfunctions, widespread complacency and conspiracy theories. The country, whose leader, President Jair Bolsonaro, has minimized the threat of the virus, is now reporting more new cases and deaths per day than any other country in the world.
“We have never seen a health system failure of this magnitude,” said Ana de Lemos, executive director of Médecins Sans Frontières in Brazil. “And we don’t see a light at the end of the tunnel.”
On Wednesday, the country surpassed 300,000 deaths from Covid-19, with about 125 Brazilians succumbing to the disease every hour. Health officials in public and private hospitals were struggling to expand intensive care units, stock up on dwindling supplies of oxygen and acquire scarce sedatives for intubation that are being sold at an exponential price.
Intensive care units in Brasília, the capital, and 16 of the 26 Brazilian states report a dire shortage of available beds, with capacity below 10 percent, and many are experiencing increasing contagion (when 90 percent of these beds are full, the situation is considered terrible).
In Rio Grande do Sul, a state that includes Porto Alegre, the waiting list for beds in intensive care units has doubled in the past two weeks, to 240 critically ill patients.
At Hospital Restinga e Extremo Sul, one of the main medical centers in Porto Alegre, the emergency room became a crowded Covid ward, where many patients were treated in chairs, due to lack of free bed. Last week, the military built a field hospital across from the main entrance, but hospital officials said the additional bed space is of little use to medical staff who are over the limit.
“The whole system is on the verge of collapse,” said Paulo Fernando Scolari, director of the hospital. “People are coming up with more serious symptoms, lower oxygen levels and are in desperate need of treatment.”
The collapse is a total failure for a country that, in recent decades, has been a model for other developing nations, with a reputation for presenting agile and creative solutions to medical crises, including an increase in HIV infections and the Zika outbreak.
Melo, who campaigned last year with a promise to lift all pandemic restrictions in the city, said a blockade would cause people to starve to death.
“Forty percent of our economy, our workforce, is informal,” he said in an interview. “They are people who need to go out and work to eat something at night”.
President Bolsonaro, who continues to promote ineffective and potentially dangerous drugs to treat the disease, also said the blockages are unsustainable in a country where so many people live in poverty. Although several Brazilian states have ordered companies to close in recent weeks, there has been no strict blockade.
Some of the president’s supporters in Porto Alegre have protested the closure of companies in recent days, organizing caravans that stop outside hospitals and blow their horns while Covid’s wings overflow.
Epidemiologists say that Brazil could have avoided additional blockades if the government had promoted the use of masks and social distance and aggressively negotiated access to vaccines under development last year.
Instead, Bolsonaro, a close ally of former President Donald J. Trump, called Covid-19 a “measles flu”, often encouraged large crowds and created a false sense of security among supporters by endorsing antimalarial drugs and antiparasitic – contradicting the main health officials who warned that they were ineffective.
Last year, Bolsonaro’s government rejected Pfizer’s offer of tens of millions of doses of its Covid-19 vaccine. Later, the president celebrated setbacks in the clinical trials of CoronaVac, the Chinese vaccine on which Brazil has come to depend largely, and joked that pharmaceutical companies would not be held responsible if people who received newly developed vaccines turned into crocodiles.
“The government initially dismissed the threat of the pandemic, then the need for preventive measures, and then goes against science by promoting miracle cures,” said Natália Pasternak, a microbiologist from São Paulo. “It confuses the population, which means that people feel safe when they go out on the street.”
Terezinha Backes, a 63-year-old retired shoemaker, living in a municipality on the outskirts of Porto Alegre, was extremely careful in the last year, venturing out only when necessary, said her nephew, Henrique Machado.
But his 44-year-old son, a security guard tasked with taking the temperature of people entering a medical center, appears to have brought the virus home earlier this month.
Mrs. Backes, who was in good health, was taken to a hospital on March 13 after she started having trouble breathing. With no spare beds, she was treated with oxygen and an intravenous in the corridor of an overflowing wing. She died three days later.
“My aunt did not have the right to fight for her life,” said Machado, 29, a pharmacist. “She was left in a corridor.”
His body was among the scores that made March the busiest month of all time at a funeral parlor by a friend of the family, Guaraci Machado. Sitting in his office on a recent afternoon, Machado said he was impressed by the number of young Covid-19 patients who had been brought to their facilities in coffins in the past few weeks.
Even so, Machado, 64, who took off his face mask in the middle of an interview, said he opposed blocking or closing deals. From the beginning, he said, he is convinced that the virus was created by China so that it could sell medical supplies worldwide and ultimately develop a profitable vaccine.
When he had Covid-19 in June last year, Machado said he took the anti-malarial drug advocated by the president, hydroxychloroquine, to which he credits “keeping me alive”.
Mr. Machado will be eligible in the coming weeks for a vaccine against Covid-19 in Brazil. But he will not receive one even if he is “being beaten with a stick,” said Machado, noting that he recently read on the Internet that vaccines are more lethal than the virus.
These conspiracy theories about Covid-19 vaccines have spread widely on social media, including WhatsApp and Facebook. A recent public opinion poll conducted by the company IPEC found that 46% of respondents believed in at least one widely publicized lie about vaccines.
Mistrust of vaccines and science is new in Brazil and a dangerous feature of the Bolsonaro era, said Dr. Miguel Nicolelis, a Brazilian neurologist at Duke University who led a coronavirus task force in the northeast of the country last year.
“In Brazil, when the president of the republic speaks, people listen,” said Nicolelis. “Brazil has never had an anti-vaccine movement – ever.”
But many radical supporters of Bolsonaro, who maintains the support of about 30% of the electorate, argue that the president’s instincts about the pandemic were solid.
Geraldo Testa Monteiro, a retired firefighter from Porto Alegre, praised the president as he and his family prepared to bury his sister, Maria de Lourdes Korpalski, 70, who died in Covid-19 last week.
In recent months, Monteiro said he started taking the antiparasitic medication ivermectin as a preventive measure. The drug is part of the so-called Covid drug kit, which also includes the antibiotic azithromycin and the antimalarial hydroxychloroquine. Mr. Bolsonaro’s health ministry has endorsed its use.
Leading medical experts from Brazil, the United States and Europe have said that these drugs are not effective in treating Covid-19 and some can have serious side effects, including kidney failure.
“Lies,” said Monteiro, 63, about the scientific consensus on the Covid kit. “There are so many lies and myths.”
He said medical professionals sabotaged Bolsonaro’s plan to control the pandemic by refusing to prescribe these drugs more decisively in the early stages of the disease.
“There was a solution: listen to the president,” he said. “When people elect a leader, it is because they trust him.”
The mistrust and denials – and the caravans of Bolsonaro supporters honking outside hospitals to protest against the pandemic restrictions – are overwhelming for medical professionals who have lost colleagues to the virus and to suicide in recent months, said Claudia Franco, the president of the gaúcho union nurses.
“People are denying it,” said Franco, who is caring for Covid-19 patients. “The reality we are in today is that we don’t have enough respirators for everyone, we don’t have oxygen for everyone.”
Reporting by Ernesto Londoño from Porto Alegre. Letícia Casado reported from Brasília.