Brazil’s Coronavirus Catastrophe Is Spreading Into the Country’s Vulnerable Interior

After ravaging Brazilian cities, the coronavirus pandemic is moving into Brazil’s interior, where hospitals are unprepared for the crisis.

Aerial view showing gravediggers burying a person at the Nossa Senhora Aparecida cemetery in the neighbourhood of Taruma, in Manaus, Brazil, on June 2, 2020 during the COVID-19 novel coronavirus pandemic. - The pandemic has killed at least 375,555 people worldwide since it surfaced in China late last year, according to an AFP tally at 1100 GMT on Tuesday, based on official sources. Brazil is the fourth worst-hit country with 29,937 deaths so far. (Photo by Michael DANTAS / AFP) (Photo by MICHAEL DANTAS/AFP via Getty Images)
Aerial view showing gravediggers burying a person at the Nossa Senhora Aparecida cemetery in the neighbourhood of Taruma, in Manaus, Brazil, on June 2, 2020 during the COVID-19 novel coronavirus pandemic. Photo: Michael Dantas/AFP via Getty Images

Jason Silva was 24 years old when he caught the coronavirus in the Brazilian Amazon town of Altamira. He played soccer, practiced martial arts, studied physical education at a local university, and was active in a group that protested environmental and social damage caused by the region’s hydroelectric dams, such as the notorious Belo Monte.

According to Brazil’s far-right President Jair Bolsonaro — a populist pandemic denier who attacks isolation measures and dismissed the pandemic as a “little flu” — Silva’s age and physical condition should have protected him from the virus. Bolsonaro, who is 65, claimed his own athletic background would protect him from Covid-19. After revealing he had caught the disease on July 7, he said young people had no reason to fear it.

Instead, Silva got sicker and sicker. He tried to go to the hospital but was only admitted after four visits to a local health center and a social media campaign by friends and family. Just days after arriving at hospital, on July 6, Silva died.

“I will always remember how amazing, intelligent, smart, lively, and kind he was,” said his girlfriend Victória Paes, a student who worked with Silva delivering lunches. “He gave out a positive energy that infected anybody nearby.”

Brazil’s Covid-19 catastrophe is the world’s second worst, after the United States.

With 2.098 million confirmed cases and 79,488 deaths, as of July 20, Brazil’s Covid-19 catastrophe is the world’s second worst, after the United States.

Silva’s death is part of the latest — and troubling — wave of casualties to the coronavirus pandemic in Brazil. After ravaging major cities, the virus is spreading to Brazil’s sprawling interior. Brazilians like Silva are dying in remote towns whose health systems can’t handle the caseload. And doctors and health specialists say Bolsonaro’s dismissal of the pandemic has confused Brazilians, eroded lockdowns, and helped propagate Covid-19.

“When you don’t communicate in a scientific and technical way, you confuse less educated people, and transform a pandemic that needs a technical response into a political struggle,” said Julio Croda, a professor of medicine who until March ran Brazilian Health Ministry’s Transmissible Diseases and Immunization Department. “It’s very detrimental.”

In Brazil, those states that were hit hard with the coronavirus as it began to spread throughout the country are seeing obits slow down. These areas are ramping down isolation measures and opening up parks, restaurants, and gyms. In the interior of the country, however, deaths are rising.

The city of Dourados had 3,729 cases as of July 20, nearly a quarter of all the infections in its interior state of Mato Grosso do Sul. Andyane Tetila, an infectious diseases specialist working for its state health service, said hospitals may soon be unable to handle the load.

Bolsonaro’s stance “did not help anything,” she said. “We see it as a big problem.”

Brazil’s interior is especially vulnerable to the coronavirus. According to government research institute Fiocruz, in February, 90 percent of Brazilian municipalities did not have intensive care beds and 59 percent did not have respirators. In Altamira, two hospitals serve nine municipalities around them; the town now has 28 intensive care beds for 340,000 people – but had just 18 when Silva died.

As Latin America became a Covid-19 hotspot, Brazil’s neighbor Argentina locked down. Though Argentina has a quarter of Brazil’s 212 million population, it has only 6 percent of its caseload. Bolsonaro, on the other hand, argued isolation measures would cause economic damage and unemployment, and instead fought against lockdown.

“The collateral effects of the measures to fight the coronavirus cannot be worse than the actual illness,” he said during a television address in March. Mask-less, he repeatedly mingled with crowds of far-right supporters, even riding a horse among them. Tasked over Brazil’s towering number of victims, he said: “So what?”

Bolsonaro is popular in Amazon towns like Altamira, where 63 percent of voters cast their ballots for him in the 2018 election. Last month, business owners there demonstrated against closures.

“The president’s posture is a big part of why the population doesn’t practice social isolation,” said Renan Granato, a doctor in Altamira. “He has a lot of supporters here.”

Jason Silva was appalled, his girlfriend said, by the amount of people in town without masks (for instance, crowding supermarkets), as well as the president’s pandemic denial.

Left/Top: Photo of Jason alone was taken on Day of the Tree in the municipality of Brasil Novo, state of Pará on Sept 21, 2019. Right/Bottom: Jason (right) and Welinton Freitas (left) on June 6, 2020, at the Água Azul settlement in Altamira, state of Pará. Photos: Coletivo de Comunicação do MAB

As coronavirus cases grew, Silva and fellow activists from the Movement of Those Affected by Dams, a national network that deals with the ill environmental and societal effects of hydroelectric and industrial dams, distributed food to poorer Brazilians who lost work or income during the pandemic. Coronavirus hit poorer Brazilians living in densely packed communities especially hard. Local and national networks have sprung up to help them.

Amid his mutual aid work, Silva washed his clothes every time he got home and isolated as much as he could.

“There is always a queue for both hospitals. The beds in wards and intensive care are at maximum capacity.”

He first got sick on June 16. When admitted to the municipal hospital, he had a fever over 102 degrees, a scan that showed 25 to 30 percent of his lung compromised, and a low readout of 87 percent blood oxygen saturation level, Paes said. Two days later, Silva was transferred to a state government-run hospital — the only one in the region with intensive care beds.

“There is always a queue for both hospitals,” said Granato, the doctor in Altamira who trained as a surgeon but is now working in intensive care. “The beds in wards and intensive care are at maximum capacity.”

On June 19, construction was finished on a field hospital in Altamira which will have 60 beds — including 10 for intensive care — but it only opened on July 17.

“The municipality of Altamira currently faces problems with intensive care beds,” a spokesperson for the city government said in an email on July 10. He said the city’s legal obligation was “basic care” and that Silva was given oxygen in the municipal hospital as he waited for an intensive care bed. “The municipality profoundly regrets the loss of another life,” he said.

Brazil had a head start on the pandemic. Its first Covid-19 cases were reported in February. In March, states like Rio de Janeiro and São Paulo closed schools and shops and introduced isolation measures pushed by Health Minister Luiz Henrique Mandetta, a doctor.

In March, Bolsonaro declared that less than 800 people would die of coronavirus in Brazil. His health ministry, though, circulated a six-figure death toll projection if nothing was done, said Croda, the professor and former ministry official.

Official warnings were watered down. In mid-March, the Health Ministry put out a bulletin. Shortly after, it was amended and now reads “recommendation excluded for technical revision.” The revision never came: Until days ago, the ministry’s site still said it was “updating guidance on isolation and social distancing” and has recently removed the phrase — without providing the guidance.

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As the Brazilian summer turned to fall, in March, Bolsonaro issued a decree giving him powers to decide what could and could not stay open. Brazil’s Supreme Court overruled him and decided states and towns could take their own decisions and that Bolsonaro did not have the power to “exercise a genocidal public policy,” as one judge put it.

A Health Ministry spokesperson suggested to The Intercept that the federal government was now behind a more regional approach. “The actions should be taken in accord with the needs of each region,” the spokesperson said in an email. She added that the Health Ministry has funded 9,200 intensive care beds and contracted over 6,000 health professionals.

Mandetta, the health minister, was giving detailed daily briefings that public health experts applauded. Before March came to a close, however, Bolsonaro’s government would intervene. He set up a “crisis cabinet” and installed his chief of staff, retired Army Gen. Walter Souza Braga Netto, to lead public policy on the pandemic.

“The health ministry was no longer leading Covid actions,” said Croda. The shift caused him to leave his post. In April, Mandetta was sacked.

Brazil’s Covid-19 strategy began to fall apart.

Mandetta’s successor was Nelson Teich, an oncologist who resigned a month later after refusing to back Bolsonaro’s insistence on pushing chloroquine and hydroxychloroquine treatment — a drug pushed by Bolsonaro’s ally, U.S. President Donald Trump, and which has not been proven to help Covid-19 patients. In May, Brazil recommended the drugs for even mild Covid-19 cases. On July 7, after testing positive, Bolsonaro appeared in one video with a pill in his hand and declared: “I trust hydroxychloroquine, and you?”

“They are focussed on treatment with no scientific proof. The Ministry is doing nothing from the technical point of view.”

The health ministry said it has distributed 4.4 million chloroquine pills, millions of which were produced by the army. Meanwhile, the U.S. Food and Drug Administration has revoked the emergency authorization for both drugs because of “known and potential risks” — some of which can be fatal

“They are focused on treatment with no scientific proof,” said Croda. “The Ministry is doing nothing from the technical point of view.”

The sense that Bolsonaro’s government is adrift was confirmed for many in May, when video of an expletive-filled ministerial meeting was released by order of a Supreme Court judge.

The pandemic was barely mentioned. Human Rights Minister Damares Alves alleged Indigenous people in the Amazon were being deliberately infected with Covid-19 to hurt the president: an extraordinary claim other participants ignored. Bolsonaro seemed more worried about the future of his own government. “We still don’t know… where our boat is going,” he said, citing the virus. “It could be heading toward an iceberg.”

A worker from the Special Secretariat for Indigenous Health assists 19-year-old Janete Vasconcelos da Silva, an indigenous woman from the Tupinamba tribe and 8 months pregnant and who has been diagnosed with the novel coronavirus, after bringing her to a hospital in Santarem, Para State, Brazil on July 17, 2020.

A worker from the Special Secretariat for Indigenous Health assists 19-year-old Janete Vasconcelos da Silva, an indigenous woman from the Tupinamba tribe and 8 months pregnant and who has been diagnosed with the novel coronavirus, after bringing her to a hospital in Santarem, Para State, Brazil on July 17, 2020.

Photo: Tarso Sarraf/AFP via Getty Images

Brazil still has no health minister. Interim Minister Gen. Eduardo Pazuello is one of a number of military officers now in the ministry but has no health experience. “What’s most frightening is the quantity of military officers they put there. Career technicians were removed to nominate colonel, captain, and sergeant,” Mandetta told the O Globo newspaper in comments published July 15. “It’s absurd.”

(The ministry “has a technical staff of qualified employees who maintain the normality of its activities,” the spokesperson said.)

Brazil’s Covid-19 statistics have also come under scrutiny because of widespread underreporting. Brazil has performed 2.1 million antibody tests — 945,000 of them in private laboratories — the health ministry said, and 2.6 million less accurate “fast” tests – less than one-tenth of what Teich had promised to buy. The United States, by contrast, has done almost 50 million tests, according to the Centers for Disease Control and Prevention. In June, Brazil’s health ministry even stopped publishing total numbers of deaths and cases, until a Supreme Court judge intervened and ordered the reporting to resume.

Jesem Orellana, an epidemiologist with Fiocruz, said he believes Brazil’s total deaths could already be as high as 90,000 to 100,000, because many victims are buried without tests or even reaching a hospital. He and four other researchers calculated 22,000 excess deaths in just four cities — Rio de Janeiro, São Paulo, Manaus, and Fortaleza — from February 23 to June 13, compared to the averages from 2015 to 2019 for the same periods.

In the Amazon city of Manaus, where Orellana is based, overloaded hospitals turned sick people away and victims were buried in mass graves when cases peaked in April. Deaths at home in Manaus and outside hospitals increased 363 percent from February 9 to May 10, compared to 2019, he said, a rise driven by Covid-19. Some of the excess deaths from other causes, here, occurred when people were unable or too scared to go to overloaded hospitals.

“This shows the size of the collapse,” Orellana said.

Brazil’s public health service, called SUS, serves 70 percent of the population who don’t have health plans. In 2016, under President Dilma Rousseff, Brazil won plaudits for its handling of a Zika epidemic blamed for thousands of cases of the birth defect microcephaly. Now an epidemiologist at Fiocruz in Brasília, Cláudio Maierovitch was one of the Health Ministry officials in charge of that response. He believes that under Bolsonaro, Brazil’s government has failed. “There is no national plan,” he said. “This has been a flagrant omission by the government.”

In some parts of Brazil, civil society, private companies, and NGOs have stepped up to fill the gap, building field hospitals and buying respirators and protective equipment.

When Covid-19 cases spiked in May, the isolated Amazon town of Tefé improvised its own “semi-intensive care” beds with respirators. Doctors Without Borders has helped train primary care staff to care for seriously ill patients in the town. The region had seen 81 deaths as of July 19.

“Towns and states had to act for themselves,” said Laura Crivellari, a doctor in Tefé. “We felt very alone.”

As of July 19, Altamira had reported 2,708 Covid-19 cases and 75 deaths. “The cases are rising,” Granato said.

Jason Silva’s death showed the cost of local communities needing to fend for themselves in an uphill battle. His mutual aid work amid a crisis of resources did not go unnoticed by the community: Silva was widely mourned in Altamira.

“I’ll never forget how he loved to help people,” said Victória Paes. “He made a difference.”

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