The rapid growth of the Covid-19 variant in Brazil, worrying scientists

While researchers are still in the early stages of investigating the Amazon variant, epidemiologists say it is at least partly responsible for an increase of more than four times last month in Manaus, the city of two million in the heart of the rainforest.

They also say it may explain an intriguing increase in severe cases of the disease among younger patients, echoing early findings about the UK variant. A health advisory panel from the UK government recently said that studies point to a death rate about 30% higher among patients infected with variant B.1.1.7 first identified last year.

The largest country in Latin America is at risk of becoming a breeding ground for potentially dangerous coronavirus mutations, infectious disease experts say. The more the virus spreads, they say, the greater the chance of other mutations that can increase transmissibility or even make the virus more difficult to check through vaccination.

“The virus found a favorable home in Brazil – there is no real block here, many people do not respect measures of social distance or even wear masks,” said Ana Tereza Vasconcelos, a researcher at the LNCC laboratory supported by the government in Rio de Janeiro state that has been tracking the variants of the Covid-19 do Brasil.

Although P1 mutations have raised most concerns among geneticists, a number of other variants born in Brazil warrant further investigation, she said.

The P1 variant was not detected in Manaus between March and November last year, but by December it was already responsible for 52.2% of new cases in the city, according to research led by Nuno Faria, professor of virus evolution at the University of Oxford and Imperial College London, whose team first tracked the P1 variant to the Amazon. In January, the variant caused 85.4% of new infections there, he said.

The consequences were devastating. About 100 people die each day in the city, according to government statistics. More than 30 people suffocated after the oxygen supply ran out of overcrowded public hospitals.

“Everything is much worse than before,” said Suziele Pereira da Silva, a 35-year-old cleaning lady from Manaus. Her sister’s father-in-law died of Covid-19 a week ago, after spending his last hours lying on two chairs in a hospital corridor for lack of beds.

In neighboring Peru, amid a further increase in the number of deaths, the government last week banned flights from Brazil. And the Colombian government cut flights to its capital Bogotá from the Amazon city of Letícia, which borders Brazil. A 24-year-old woman infected with the variant was treated at a hospital in Leticia.

Brazil reported more than 220,000 deaths from Covid-19, second only to the United States. Some public health researchers say President Jair Bolsonaro’s government has been too slow to acquire vaccines and has focused its efforts on controversial alternative treatments such as chloroquine antimalarial.

The federal government of Brazil has guaranteed enough injections for just about six million people – not enough to cover all health professionals, let alone the elderly in a country with more than 210 million. Bolsonaro, a former army captain who recovered quickly from a mild outbreak of the disease last year, called Covid-19 a “small flu”. He said he does not plan to be vaccinated.

Margareth Dalcolmo, a leading researcher at the Oswaldo Cruz Foundation, supported by the government that investigates public health issues, burst into tears during an award ceremony two weeks ago, saying it was unacceptable that Bolsonaro’s government had not used the vast size from Brazil and, therefore, competitive advantage to negotiate supply agreements with vaccine manufacturers.

“What can justify that Brazil does not have vaccines available at this time for its population?” Asked Mrs. Dalcolmo. In an interview, she also blamed the federal government for last-minute attempts to buy more syringes. “The right time to do this was six months ago,” she said.

Health Minister Eduardo Pazuello, an active army general who served alongside Bolsonaro, said the federal government had been taking “rescue measures”, adding that the sudden increase in cases in Manaus took everyone by surprise. He also blamed the problems at the public hospitals in Manaus that, according to him, preceded the Bolsonaro government.

The Supreme Federal Court of Brazil has opened an investigation into how Pazuello is dealing with the health crisis in Manaus. Pazuello said the federal government was aware that Manaus was facing a possible oxygen supply problem a week before patients began to suffocate, sparking criticism that Bolsonaro’s government had not acted before.

Manaus was one of the cities hardest hit during the first outbreak of Covid-19 infections in Brazil in April-July last year, with some scientists concluding that collective immunity had been achieved. The latest wave of infections has turned this conclusion inside out.

One explanation, the researchers say, is that the new P1 variant contains the E484K mutation, which has been linked to the virus’s ability to escape neutralizing antibodies, allowing it to reinfect people who once had Covid-19.

Although São Paulo is the only other Brazilian state besides Amazonas to have confirmed cases of the P1 variant so far, the researchers say it has probably spread to much of the country.

The World Health Organization said Wednesday that the P1 variant has already been identified in the United States, Italy, Germany, the United Kingdom, Ireland and South Korea, as well as in Japan. As concerns about its global expansion increased, the United Kingdom banned travelers from much of South America in January.

Flávia Lenzi, head of the doctors’ union in the adjacent state of Rondônia, said she suspected that the P1 variant was, at least in part, to blame for the increase in new cases, which more than doubled in the last month in the state.

“We are also seeing more serious cases and more cases involving younger patients,” said Lenzi. Last week, health officials from the Yanomami indigenous community in the state of Roraima, northern Amazonia, reported that nine children died with symptoms similar to Covid’s, although it is not clear whether the new strain was the cause.

The Brazilian Ministry of Health said in a statement that it is investigating the deaths and has not yet confirmed whether they are related to the virus.

The lack of genetic data from the first wave of cases in Brazil makes it harder to draw conclusions than in places like the UK, geneticists said.

Felipe Naveca, a researcher at the Oswaldo Cruz Foundation whose team identified the first case of a patient in Manaus reinfected with Covid-19 as a result of the P1 variant, also blamed poor governance for the terrible health crisis in the region.

“One of the main factors behind this situation is the total lack of control,” he said, explaining that parties and family reunions during the holidays led to more infections.

Write to Samantha Pearson at [email protected] and Luciana Magalhaes at [email protected]