RIO DE JANEIRO – Covid-19 has already left a trail of death and despair in Brazil, one of the worst in the world. Now, a year after the pandemic began, the country is setting another dramatic record.
No other nation that has experienced such an outbreak is yet battling the record death toll and a health care system on the verge of collapse. Many other hard-hit nations are instead taking provisional steps towards an appearance of normalcy.
But Brazil is battling a more contagious variant that ran over a large city and is spreading to others, even when Brazilians throw away precautionary measures that could keep them safe.
On Tuesday, Brazil recorded more than 1,700 deaths from Covid-19, the largest number of victims of the pandemic in a single day.
“The acceleration of the epidemic in several states is leading to the collapse of their public and private hospital systems, which may soon become the case in all regions of Brazil,” said the National Association of Secretaries of Health in a note. “Unfortunately, the anemic release of vaccines and the slow pace at which they are being made available does not yet suggest that this scenario will be reversed in the short term.”
And the news got worse for Brazil – and possibly for the world.
Preliminary studies suggest that the variant that swept the city of Manaus is not only more contagious, but also seems capable of infecting some people who have already recovered from other versions of the virus. And the variant crossed the borders of Brazil, appearing in another two dozen countries and in a small amount in the United States.
Although tests with several vaccines indicate that they can protect against serious diseases, even when they do not prevent infection with the variant, most of the world has not been inoculated. This means that even people who have recovered and thought they were safe for the time being may still be at risk, and that world leaders can, once again, lift restrictions too soon.
“You need vaccines to get in the way of these things,” said William Hanage, an epidemiologist at the Harvard School of Public Health TH Chan, talking about variants that can cause reinfections. “The immunity you get with your cemeteries running out of space, even that will not be enough to protect you.”
The danger of new variants has not gone unnoticed by scientists around the world. Rochelle Walensky, director of the United States Centers for Disease Control and Prevention, pleaded with Americans this week not to let their guards fall. “Please listen to me clearly,” she said. “In this level of cases with propagation of variants, we can completely lose the ground conquered with so much effort.”
Brazilians expected to have seen the worst of the outbreak last year. Manaus, capital of the state of Amazonas, was so badly hit in April and May that scientists wondered if the city could have achieved collective immunity.
But then, in September, cases in the state started to increase again, leaving health officials perplexed. An attempt by the governor of Amazonas, Wilson Lima, to impose a new quarantine before the Christmas holiday, met with strong resistance from prominent businessmen and politicians close to President Jair Bolsonaro.
In January, scientists discovered that a new variant, which became known as P.1, had become dominant in the state. Within a few weeks, the danger became clear when the city’s hospitals ran out of oxygen amid a crowd of patients, leading dozens of people to suffocated death.
Dr. Antonio Souza remains astonished by the horrified faces of his colleagues and relatives of patients when it became clear that the oxygen supply at his hospital in Manaus had run out. He thinks of the patient he sedated, to save her from an agonizing death, when the oxygen ran out at another clinic.
“No one should have to make that decision,” he said. “It is too terrible.”
Maria Glaudimar, a nurse from Manaus, said she felt trapped in a nightmare earlier this year, with no end in sight. At work, patients and their family members begged for oxygen and all intensive care beds were occupied. At home, her son caught tuberculosis after contracting Covid-19 and her husband lost 22 pounds while battling the virus.
“Nobody was prepared for this,” said Glaudimar. “It was a horror movie.”
Since then, the coronavirus crisis has eased somewhat in Amazonas, but has worsened in most of Brazil.
Scientists struggled to learn more about the variant and to track its spread across the country. But limited testing resources have kept them behind the curve as they try to determine what role they are playing.
Anderson Brito, a Brazilian virologist at Yale University, said his laboratory alone sequenced nearly half of the coronavirus genomes across Brazil. While the United States performs genetic sequencing in about one in 200 confirmed cases, Brazil sequences about one in 3,000.
The variant spread quickly. In late January, a study by government researchers found that it was present in 91 percent of the sequenced samples in the state of Amazonas. At the end of February, health authorities reported cases of variant P.1 in 21 of the 26 Brazilian states, but without further testing it is difficult to assess its prevalence.
During the pandemic, the researchers said that Covid-19 reinfections appear to be extremely rare, which allowed people who recovered to assume that they had immunity, at least for a while. But that was before P.1 came along and the doctors and nurses started to notice something strange.
João Alho, a doctor from Santarém, city of Pará, a state bordering the Amazon, said that several colleagues who recovered from Covid-19 months ago fell ill again and tested positive.
Juliana Cunha, a Rio de Janeiro nurse who works at Covid-19 testing centers, said she assumed she was safe after catching the virus last June. But in November, after experiencing mild symptoms, she tested positive again.
“I couldn’t believe it,” said Cunha, 23. “It must be the variants.”
But there is no way to be sure what is happening to people who are reinfected, unless their old and new samples are kept, genetically sequenced and compared.
One way to contain the increase would be through vaccines, but implantation in Brazil, as in so many countries, has been slow.
Brazil started vaccinating priority groups, including health professionals and the elderly, in late January. But the government has failed to guarantee a sufficiently large number of doses. The richest countries have taken up most of the available supply, while Bolsonaro is skeptical about the impact of the disease and vaccines.
Just over 5.8 million Brazilians – about 2.6 percent of the population – received at least one dose of the Covid-19 vaccine by Tuesday, according to the Ministry of Health. Only about 1.5 million received both doses. The country currently uses Chinese-made CoronaVac – which laboratory tests suggest is less effective against P.1 than other variants – and that of Swedish-British pharmaceutical AstraZeneca.
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Margareth Dalcolmo, pulmonologist at Fiocruz, an important scientific research center, said that Brazil’s failure to mount a strong vaccination campaign set the stage for the current crisis.
“We should vaccinate more than a million people a day,” she said. “That’s the truth. We are not, not because we don’t know how to do it, but because we don’t have enough vaccines.”
Other countries should pay attention, said Ester Sabino, an infectious disease researcher at the University of São Paulo who is among the leading experts on the P.1 variant.
“You can vaccinate your entire population and control the problem for only a short time if, in another part of the world, a new variant appears,” she said. “You will get there someday.”
Health Minister Eduardo Pazuello, who called the variant the “new stage” of the pandemic, said last week that the government is stepping up its efforts and expects to vaccinate about half of its population by June and the rest by the end of the year. .
But many Brazilians have little faith in a government led by a president who has sabotaged blockades, repeatedly minimized the threat of the virus and promoted untested drugs long after scientists said they clearly did not work.
Just last week, the president spoke contemptuously of the masks, which are among the best defenses to contain contagion, claiming that they harm children, causing headaches and difficulty concentrating.
Projections of the Pazuello vaccine were also met with skepticism. The government last week placed an order for 20 million doses of an Indian vaccine that has not completed clinical trials. This prompted a federal prosecutor to argue in a lawsuit that the $ 286 million purchase “puts millions of lives at risk”.
Even if it proves effective, it will be too late for many.
Tony Maquiné, a 39-year-old marketing specialist from Manaus, lost a grandmother, an uncle, two aunts and a cousin, in a few weeks, during the latest increase in cases. He says time has become a blur of frantic efforts to find hospitals with free beds for the living, while organizing funerals for the dead.
“It was a nightmare,” said Maquiné. “I am afraid of what is to come.”
Manuela Andreoni and Ernesto Londoño reported from Rio de Janeiro and Letícia Casado from Brasília. Carl Zimmer contributed reporting from New Haven, Connecticut.