Brazil plunges into crisis as a second wave and deadly new variant overwhelm hospitals
By Flora Charner and Marcia Reverdosa, CNN
While a new variant of the coronavirus spreads throughout the country, many Brazilians continue to defy mask mandates mobility restrictions following the example of President Jair Bolsonaro, who recently said people need to “stop being sissies” and “whining” about the virus.
The consequences of that combination are deadly, experts say. “We are going through the worst-case scenario since the beginning of the pandemic. You just have to look at the trends in the average number of deaths,” Gonzalo Vecina Neto, a Sao Paulo University professor of Public Health, recently told Reuters television. “This could have been avoided and the most important factor is gatherings.”
Brazil has broken its own record three times this month for number of deaths in a 24-hour period. On Wednesday, Brazil’s Health Ministry registered a devastating new high — 2,286 lives lost to the virus. In total, more than 270,000 people are known to have died due to Covid-19, making Brazil’s the second-highest national death toll after the United States.
In 22 of Brazil’s 26 states, ICU occupancy has surpassed 80%. In the southern state of Rio Grande do Sul, hospital patients must line up to wait for beds as occupancy rates in intensive care units soar past 103%. The neighboring state of Santa Catarina has already surpassed 99% occupancy and is on the verge of collapsing, as cases surge throughout the state.
One hospital in Santa Catarina’s capital, Florianopolis, is already beyond capacity. David Molin, the hospital’s head nurse, tells CNN his team is exhausted and overwhelmed.
“I was here during the first wave and it wasn’t like this. We are completely overwhelmed, with our occupancy rate at over 100%. Many of those patients who are waiting for an ICU don’t make it,” Molina told CNN during a telephone interview.
Health workers blame gatherings
Molina and other health care workers blame the recent surge of Covid-19 cases on larges parties and gatherings that began around New Year’s Eve and continued through the pre-Lent carnival holiday and into today. Many of these were held in defiance of local city and state restrictions.
Last week, Rio de Janeiro’s Mayor Eduardo Paes announced a new curfew for bars and restaurants throughout the city, limiting hours of operation from 6:00 am to 5:00 pm. But hundreds of people stayed out anyway — 230 curfew-related fines and closures were issued from Friday to Saturday alone, according to the city government. At one bar, more than 200 mostly-maskless partygoers were found at a party that had been going for seven hours, reported CNN affiliate CNN Brasil.
Many municipal and state health officials and lawmakers blame Bolsonaro’s government for undermining their efforts to slow the spread of the coronavirus. And the country’s National Council of Health Secretaries (CONASS) has asked the federal government to adopt stricter measures to support hospitals and enforce social distancing.
“The health system in Brazil is on the verge of collapse,” Sao Paulo Governor Joao Doria told CNN’s Becky Anderson during a recent interview. “There is no national coordination to combat the pandemic in Brazil. It would be important for the President and the governors to send the same message to the population, but this unfortunately, doesn’t happen in Brazil.
The issue of social distancing measures and lockdowns has become a political football in Brazil. While Doria ordered nonessential businesses to close for two weeks in his state last weekend, Bolsonaro claims that such restrictions sink Brazil’s economy and lead to an increase of suicides and depression. He has made disobeying health guidance a point of pride, congratulating agricultural workers at an event last week for not staying home “like cowards.”
“We have to face our problems. Stop being sissies, enough whining, how long are they going to keep on crying? We have to confront the problems, respecting the elderly, those with illnesses, chronic conditions. But where is Brazil going to end up if we all stop?” he said.
This week, Bolsonaro declared that he had the “power” to declare a national lockdown — but would never do so. “My army is not going to force the people to stay at home,” he said.
Fears over new variant
With Brazilian hospitals overloaded and government officials divided over lockdown measures, the country has few defenses against a coronavirus variant that may be even more contagious.
A preprint of a new modelling study by researchers in Brazil and the UK suggests the variant first detected in the northern city of Manaus late last year, known as P.1, may be up to 2.2 times more transmissible.
The study, which has not yet been peer-reviewed or published in a medical journal, suggests that even people who have already had the coronavirus could be vulnerable. The same study showed that the P.1 variant could evade immunity from previous Covid-19 infection by up to 61%.
That variant is now prevalent in Covid-19 patients across at least six Brazilian states, according to a study earlier this month released by the Oswaldo Cruz Foundation (Fiocruz), a Brazilian Ministry of Health research institution. P.1 has also been detected in the United States, United Kingdom and neighboring Venezuela.
“The emergence of new variants, which combine both the potential to be more transmissible and the absence of broad and articulated mitigation and suppression measures, are highly worrisome,” the study’s authors wrote, urging Brazil to encourage behaviors that limit the viral spread.
“The data showing the prevalence of this variant in several states and its ample spread throughout the country, as well as the challenges presented due to its high level of transmission, reinforce the immediate need to adopt non-pharmaceutical measures in order to reduce the speed or its spread and the increases in cases.”
Felipe Naveca, virologist and researcher at Fiocruz Amazonia and one of the main authors of the study, told CNN that the Covid-19 virus and the different variants and strains are likely to get stronger if not stopped.
“This is what viruses do: They evolve, they get stronger. The only way to stop it is to contain its spread, which is why we need restrictive measures — there is no other solution. Even if the Government decrees a national lockdown, we need the population to adhere. The action of each one of us will impact everyone as a whole,” Naveca said.
Hope could be on its way, in the form of vaccines. But Brazil’s vaccination rollout was slow in comparison to other countries, including others in the region, like Chile and Mexico.
In January, health regulator Anvisa authorized emergency use of vaccines by Sinovac and Oxford/AstraZeneca. Since then, roughly 4% of Brazil’s 211 million citizens have received at least one vaccine dose, according to data from the Brazilian Health Ministry, and 2.3 million have had two doses.
According to the Health Ministry, Brazil is in negotiation to buy Pfizer, Moderna, Janssen, Sputinik and Covaxin vaccines as well, though only the Pfizer/BioNTech vaccine among those has been granted authorization from Anvisa.
Bolsonaro had long promoted the Oxford AstraZeneca vaccine as the only one he would back, dismissing and discrediting many of the other vaccines on the market, including Pfizer’s. Brazil’s health minister Eduardo Pazuello even turned down an August offer from Pfizer to purchase up to 70 million doses of its vaccine.
“Pfizer says this very clearly on the contract, ‘we are not responsible for any collateral side effects’ – if you turn into an alligator it’s your problem,” Bolsonaro said in December. “If you become Superman, or grow a beard as a woman, or a man’s voice becomes high pitched, they say they have nothing to do with that.”
But a New England Journal of Medicine study now suggests that the Pfizer/BionTech vaccine could “efficiently” neutralize the P.1 variant. The news came as Bolsonaro held a virtual meeting Monday with Pfizer Global CEO Albert Bourla and other executives to negotiate the purchase of 100 million vaccines.
“I thank you for this meeting and we recognize Pfizer as a great world company,” Bolsonaro said, during an excerpt of the meeting posted to his official Twitter account. “We would like to close these deals with you, even more given the aggressiveness of this virus in Brazil.”
For now, Brazil’s failure to contain the virus is increasingly a cautionary tale for the world. Dr. Michael Ryan, the executive director of the World Health Organization’s Health Emergencies Program, said at a briefing last week that he worried the country’s surge in cases could be repeated elsewhere.
“The story in Brazil can be and will be repeated elsewhere if we stop implementing the measures as we need to implement them,” he said. “Countries are going to lurch back into third and fourth surges if we’re not careful.”
For Molina, the exhausted Santa Catarina nurse, Brazil’s future seems bleaker than ever.
“Unfortunately, I don’t think we’ve learned our lesson,” Molina said. “We [health workers] are tired, exhausted and are getting sick. We feel powerless. We need a more coordinated action if we’re going to keep this from happening again.
Journalist Marcia Reverdosa reported from Sao Paulo and CNN’s Flora Charner reported from Atlanta.