Brazil’s hospitals are collapsing as a highly contagious coronavirus variant spreads across the country, the president insists on unproven treatments and the only attempt to create a national plan to contain COVID-19 has fallen short.
Over the past week, Brazilian governors have tried to do something that President Jair Bolsonaro stubbornly rejects: put together a proposal for states to help curb the deadliest virus outbreak to date in the country. The effort was expected to include a curfew, a ban on crowded events and limits on the hours non-essential services can operate.
The final product, unveiled on Wednesday, was a one-page document that included general support for activity restriction but no specific action whatsoever. Six governors, still fearful of confronting Bolsonaro, refused to sign him.
The one from Piaui state, Wellington Dias, told AP that unless pressure is eased on hospitals, more and more patients will have to go through the disease without a bed in a hospital or hoping to receive treatment in an intensive care unit.
“We have reached the limit all over Brazil; exceptions are rare,” said Dias, who heads the governors’ forum. “The possibility of dying without help is real.”
These deaths have already begun. In Brazil’s richest region, Sao Paulo, at least 30 patients died this month waiting for a place in the ICU, according to a count published Wednesday on the G1 news website. In Santa Catarina, in the south of the country, 419 people are waiting to be transferred to a bed in an intensive care unit, and in the neighboring Gran do Sul River, ICUs are at 106% of their capacity.
Alexandre Zavascki, a doctor in the capital of Rio Grande do Sul, Porto Alegre, described the constant arrival of patients with breathing problems.
“I have many colleagues who sometimes stop crying. This is not the medicine we are used to practicing. This is a medicine adapted for a war scenario,” said Zavascki, who oversees the treatment of infectious diseases in a private hospital. “We see that a good part of the population refuses to see what’s going on, they resist the facts. These people may be the next to step on a hospital and they will want beds. But there will be none.”
The country, he added, needs “stricter measures” from local authorities.
Despite the president’s objections, Brazil’s Supreme Federal Court upheld the jurisdiction of cities and states to impose restrictions on activity. However, Bolsonaro has constantly condemned his movements, alleging that the economy needs to remain active and that isolation would cause depression. The measures relaxed in late 2020, when COVID-19 infections and deaths dropped, the campaign for municipal elections began and Brazilians returning home were tired of their forties.
The latest rise is driven by the P1 variant, which according to the country’s health minister last month, is three times more transmissible than the original. He first became dominant in the Amazonian city of Manaus, and in January forced the transfer of hundreds of patients by air to other regions.
Brazil’s failure to contain the virus since then is increasingly seen as a concern not only for its Latin American neighbors, but also as a warning to the world, said the director general of the World Health Organization. Health (WHO), Tedros Adhanom Ghebreyesus, at a press conference on 5 March.
“Across the country, the aggressive use of public health measures, of social measures, will be very, very crucial,” he said. “Without doing things that have an impact on transmission or suppress the virus, I don’t think there can be a downward trend in Brazil.”
The more than 10,000 deaths reported last week in Brazil were their worst since the start of the pandemic, and this week’s count is on track to be even higher after nearly 2,300 were recorded. deaths only on Wednesday, breaking the previous day’s record.
“Governors, like much of the population, are fed up with all this inaction,” said Margareth Dalcolmo, a prominent state-run pulmonologist at the Fiocruz Institute. The proposed pact is vague and will remain symbolic unless it is far-reaching and confrontational to the federal government, he added.
The National Council of State Ministers of Health last week called for the establishment of a nationwide curfew and quarantine in regions where hospital capacity is at its peak. Once again, Bolsonaro objected.
“Don’t decree it,” the politician noted at an event Monday. “And they can be sure of one thing: my army won’t go out on the street to force people to stay home.”
Restrictions could already be felt outside the presidential palace after Federal District Governor Ibaneis Rocha implemented a curfew and partial confinement. Rocha warned on Tuesday that it could increase restrictions, excluding only pharmacies and hospitals, if people do not break the rules. Currently, the waiting list for a bed in an ICU in the region is 213 people.
Bolsonaro told reporters Monday that the curfew is “an offense, inadmissible” and that even the WHO believes the confinements are inadequate because they disproportionately affect the poor. Although the United Nations Health Agency acknowledges the “profound negative effects” of this measure, it notes that some nations have no choice but to impose very strict measures to slow the spread of infections, and that governments must take advantage of the maximum additional time to test and track cases, in addition to caring for patients.
This nuance escaped Bolsonaro. His government continues to seek miraculous solutions that have so far served no purpose other than to feed false hopes. Any ideas seem worthy of consideration, except those of public health experts.
The Bolsonaro government spent millions on producing and distributing malaria pills, which in rigorous studies showed no benefit. However, the president supported this drug. He also supported treatment with two drugs to fight the parasites, none of which have been shown to be effective. On Wednesday he again praised his ability to avoid hospitalizations during an event at the presidential palace.
Bolsonaro also sent a committee to Israel this week to evaluate an untested nasal spray that he has described as a “miracle product.” Dalcolmo, whose sister is in an ICU, described the trip as “really pathetic.”
Camila Romà, a researcher at the Institute of Tropical Medicine at the University of Sao Paulo, hopes the test her lab is developing to identify worrying variants, including P1, will help monitor and control its spread. In addition, it calls for stricter government measures and for citizens to do their part.
“Every day there is a new surprise, a new variant, a city the health system collapses,” said Roman. “We’re in the worst phase now. If this is the worst phase, (because) unfortunately we don’t know what’s to come.”