The Guardian
‘Covid is taking over’: Brazil delves into the deadliest chapter of its epidemic
Last year, Jair Bolsonaro declared that Brazil had reached “the tail end” of one of the worst outbreaks in the world. Three months later, the country has already lost almost 100,000 more lives to patients with coronavirus in a field hospital installed inside a sports coliseum in Santo André, on the outskirts of São Paulo, Brazil, on March 4. Photo: André Penner / AP In mid-February, André Machado realized that the coronavirus catastrophe in Brazil was entering a new, disconcerting and relentless phase. “The floodgates opened and the water flowed,” recalled the infectologist at the Nossa Senhora da Conceição hospital, in Porto Alegre, one of the largest cities in southern Brazil. Since then, Machado’s hospital, as well as health centers across the country, has been engulfed by a flood of nervous and breathless patients – many of whom were previously healthy and frighteningly young. Among the recent admissions was a 37-year-old pregnant woman, who complained of breathing difficulties and coughing. Doctors performed an emergency cesarean section to give birth to the baby in a desperate attempt to take the pressure off the lungs plagued by Covid’s mother. “We are trying to help people, but this disease is much faster and more aggressive than the tactics we are using,” said Machado, 44, of his team’s efforts to keep up with triple admissions. “It is as if we are whipping a dead horse,” he said, before adding: “This disease is going to kill many more people in Brazil.” At the end of last year, Brazil’s President Jair Bolsonaro – a populist-loving Donald Trump who cheerfully sabotaged Covid’s containment efforts – declared that his country had reached the “tail end” of what was already one of the worst outbreaks of the world. Bolsonaro was wrong. Three months later, the largest nation in Latin America lost almost 100,000 lives – bringing the total death toll to more than 275,000, second only to the United States – and plunged into the deadliest chapter of its 13-month epidemic. Jair Bolsonaro speaks to the media in Brasilia, Brazil, on March 10. Photo: Ueslei Marcelino / Reuters This week, with a record 2,349 daily deaths, former left-wing president Luiz Inácio Lula da Silva criticized Bolsonaro’s “idiotic” way of dealing with the crisis and asked citizens to confront their incompetent leader “bully”. “This country is in a state of great turmoil and confusion because there is no government. I will repeat: this country has no government, ”said Lula, blaming Bolsonaro’s“ uncivilized ”leadership and the rejection of science by the scale of Brazil’s disaster. “So many lives could have been saved,” said Lula, warning: “Covid is taking over the country.” With the intensification of the emergency this week, frontline health professionals from Porto Alegre to Recife, a coastal city 3,000 km further north, described scenes of sadness, despair and exhaustion as the intensive care units and cemeteries filled up as never before. Workers bury a person who died with Covid in Manaus, Amazonas, Brazil, on January 27. Photo: Raphael Alves / EPA “It looks like we’re putting a bandage on a gunshot wound,” said Eduarda Santa Rosa Barata, a 31-year-old infectious disease specialist who works in three ICUs in the state’s Pernambuco capital, all now stretched to the limit. “We are committed to harm reduction … You open new beds and they fill up immediately.” A few days earlier, Barata had admitted a 37-year-old man who had no underlying medical problems, but whose lungs were so damaged that he needed intubation. “It looks so random,” she said. “It is a bizarre disease. That’s scary. Machado saw several explanations for the torrent of cases he and other doctors are seeing, including political mismanagement and easing of social distance measures, especially among young people. In recent months, such containment efforts have largely failed, with schools and businesses reopening and Bolsonaro’s tourism minister even asking citizens to go back on vacation. But the doctor suspected that a third, more worrying element was also at work: an enigmatic and apparently more contagious variant called P1, which is believed to have appeared in the Amazon region in late 2020, but is now circulating throughout Brazil, including the state. from Rio Grande do Sul, where Machado works. People walk in a shopping mall in São Paulo, Brazil, on March 4. Photography: Cris Faga / NurPhoto / Rex / Shutterstock “This is not just theoretical. It is something we are seeing in practice, ”said Machado of the variant, of which at least 10 cases were detected in the United Kingdom and 15 in the United States. “Before the end of 2020, you would have a family and one member would be infected, but not the other three or four members, even though they lived in the same environment. You don’t see that anymore. If there is a confirmed case, everyone ends up being infected by the virus, ”he said. “It is obvious that this new variant is already circulating among us.” How much of Brazil’s current crisis is due to the new variant, or other variants tracked in the United Kingdom and South Africa, is a matter of intense debate. Some experts believe that the variant provided a convenient smokescreen for political leaders who failed to control a disease that President Bolsonaro classified as a “small flu”. By ordering a two-week emergency stoppage in Brazil’s most populous state on Thursday, São Paulo’s governor, João Doria, said the variant played a key role in pushing hospitals to the limit. “This new strain of the virus is very aggressive and very dangerous”, warned Doria, claiming that Brazil was “collapsing” with the weight of the increase in cases. Jesem Orellana, an epidemiologist in the Amazon city of Manaus, where hospitals recently ran out of oxygen as a result of the explosion of infections, was not convinced that the mutations were the main culprits. “From a political point of view, it is much easier to place the blame on the variant. But we all know that the worst variant of all is the way the epidemic has been handled inappropriately, ”he said. Orellana suspected that, having failed to stop the coronavirus with unpopular and economically painful blocks, politicians at all levels of government were now “using the variant as a crutch to support themselves and justify their errors and neglect with the epidemic”. Patients in the emergency room of an overcrowded hospital in Porto Alegre, Brazil, on March 11th. Photo: Diego Vara / Reuters But Marcos Boulos, a leading infectious disease specialist, said he had no doubt that the P1 variant was contributing to the growing number of cases in Brazil: “There is no way to hide it.” Boulos also said that anecdotal evidence from hospitals across Brazil suggests that the variant is also producing more serious cases in young people. “We do not yet have data to state this categorically, but it is possible, as far as doctors are seeing,” said the professor at the University of São Paulo. “Here at the hospital, we have a 20-year-old woman in our ICU in serious condition. Today you have severe ICU patients of all age groups. Before, we would say that they were almost 90% elderly. Today they are still the majority, but not in the same way ”, added Boulos. “We still don’t know how it works, but that’s what we’re seeing … There is no other reason why young people suddenly start to suffer from a more serious illness.” São Paulo’s health secretary, Jean Gorinchteyn, told reporters this week that in many of the ICUs in that state, half of the patients are now under 50 years old. “I’m talking about 26, 29 and 30 year olds – often in very serious condition,” he said, asking citizens to avoid crowds and stay home. “We all need to understand that what is happening now is a different pandemic than what we saw last year,” said Gorinchteyn. Barata said he also had the impression that his Covid patients were getting younger and arriving at the hospital in a worse state. Despite being immunized with the CoronaVac vaccine produced in China in February, she admitted to feeling more fearful now than during the previous peak last June. “It seems that with each passing day the virus gets closer … Wherever you look around you can say that there is someone with symptoms, or that he is sick, or in the hospital … The mother-in-law of one of my colleagues is in critical condition in intensive care, ”she said. Barata said she was not sure what role the new variants were playing in Brazil’s last misfortune, if any, but whatever – or whoever it was – was responsible, she feared that the human tragedy was far from conclude: “It seems that the disease is surrounding us, approaching and infecting everyone who has not yet caught it. ”Machado said that after the delivery of her 36-week-old baby, the expectant mother and her son were rushed to the ICU, where the first was placed on a respirator. “We don’t know if it will survive,” he admitted last week, when the hospital’s Covid-19 wards came to the brink of collapse and heightened fears about the global impact of the uncontrolled epidemic in Brazil. Twenty-four hours later, ten minutes after midnight, the woman is gone, leaving five orphaned children and a country in disarray.