Brazil’s COVID crisis is a warning to everyone, scientists say


Military personnel disinfect the Christ the Redeemer monument in Rio de Janeiro on August 13, 2020 (Dado Galdieri / The New York Times).

Military personnel disinfect the Christ the Redeemer monument in Rio de Janeiro on August 13, 2020 (Dado Galdieri / The New York Times).

RIO DE JANEIRO – COVID-19 has already left a trail of death and despair in Brazil, one of the worst in the world. Now, a year after the pandemic, the country is setting another heartbreaking record.

No other nation that experienced such a major outbreak is still dealing with a record number of deaths and a healthcare system on the brink of collapse. Instead, many other affected nations are taking tentative steps toward a semblance of normalcy.

But Brazil is battling a more contagious variant that has trampled on one major city and is spreading to others, even as Brazilians scrap precautionary measures that could keep them safe.

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On Tuesday, Brazil recorded more than 1,700 deaths from COVID-19, the highest number from the pandemic in a single day.

“The acceleration of the epidemic in several states is leading to the collapse of their public and private hospital systems, which could soon become the case in all regions of Brazil,” the national association of health secretaries said in a statement. “Unfortunately, the anemic launch of vaccines and the slowness with which they are available still do not suggest that this scenario will reverse in the short term.”

And the news got worse for Brazil, and possibly for the world.

Preliminary studies suggest that the variant that swept through the city of Manaus is not only more contagious, but also appears capable of infecting some people who have already recovered from other versions of the virus. And the variant has crossed the borders of Brazil, appearing in two dozen other countries and in small numbers in the United States.

Although trials of various vaccines indicate that they can protect against serious diseases even when they do not prevent infection with the variant, most of the world has not been inoculated. That means that even people who had recovered and thought they were safe for now could still be at risk and that world leaders could, once again, lift restrictions too soon.

“You need vaccines to get in the way of these things,” said William Hanage, a public health researcher at Harvard’s TH Chan School of Public Health, speaking of variants that could cause reinfections. “The immunity you get from your graveyards running out of space, even that won’t be enough to protect them.”

That danger of new variants has not gone unnoticed by scientists around the world. Rochelle Walensky, director of the US Centers for Disease Control and Prevention, pleaded with Americans this week not to let their guard down. “Please hear me clearly,” he said. “At this level of cases with spreading variants, we can completely lose our hard-won ground.”

Brazilians expected to have seen the worst of the outbreak last year. Manaus, capital of the northern state of Amazonas, was hit so hard in April and May that scientists wondered if the city could have achieved herd immunity.

But then, in September, cases in the state began to rise again, puzzling health officials. An attempt by the governor of Amazonas, Wilson Lima, to impose a new quarantine before the Christmas holidays, met with fierce resistance from businessmen and prominent politicians close to President Jair Bolsonaro.

In January, scientists had discovered that a new variant, which became known as P.1, had become dominant in the state. In a matter of weeks, their danger became apparent when the city’s hospitals ran out of oxygen amid a crush of patients, causing dozens of people to die from suffocation.

Dr. Antonio Souza remains haunted by the horrified faces of his colleagues and relatives of the patients when it became clear that the oxygen supply of his Manaus hospital had been depleted. Think of the patient who was sedated, to avoid a painful death, when oxygen ran out at another clinic.

“No one should have to make that decision,” he said. “It’s too terrible.”

Maria Glaudimar, a nurse in Manaus, said she felt trapped in a nightmare earlier this year with no end in sight. At work, patients and their families asked for oxygen and all intensive care beds were full. At home, her son contracted tuberculosis after contracting COVID-19, and her husband lost 22 pounds while battling the virus.

“No one was prepared for this,” said Glaudimar. “It was a horror movie.”

Since then, the coronavirus crisis has eased somewhat in the Amazon, but has worsened in most of Brazil.

Scientists have been quick to learn more about the variant and trace its spread across the country. But limited resources for testing have kept them behind as they try to determine what role it is playing.

Anderson Brito, a Brazilian virus expert at Yale University, said his lab only sequenced nearly half of the coronavirus genomes that all of Brazil had. While the United States has performed genetic sequencing in approximately one in 200 confirmed cases, Brazil sequences approximately one in 3,000.

The variant spread quickly. At the end of January, a study by government researchers found that it was present in 91% of the samples sequenced in the state of Amazonas. By the end of February, health officials had reported cases of the P.1 variant in 21 of the 26 Brazilian states, but without further testing it is difficult to measure its prevalence.

Throughout the pandemic, researchers have said that COVID-19 reinfections appear to be extremely rare, allowing people recovering to presume they have immunity, at least for a time. But that was before P.1 appeared and the doctors and nurses started to notice something strange.

João Alho, a doctor from Santarém, a city in Pará, a state bordering the Amazon, said that several colleagues who recovered from COVID-19 months ago had fallen ill again and tested positive.

Juliana Cunha, a nurse from Rio de Janeiro who has been working at the COVID-19 testing centers, said she assumed she was safe after contracting the virus in June. But in November, after experiencing mild symptoms, she tested positive again.

“I couldn’t believe it,” said Cunha, 23. “It must be the variants.”

But there is no way to be sure what is happening to people who are reinfected, unless both old and new samples are preserved, genetically sequenced, and compared.

One way to curb the increase would be through vaccines, but deployment in Brazil, as in so many countries, has been slow.

Brazil began vaccinating priority groups, including health professionals and the elderly, in late January. But the government has failed to secure a sufficient number of doses. Richer countries have seized most of the available supply, while Bolsonaro has been skeptical of both the disease’s impact and vaccines.

Just over 5.8 million Brazilians, about 2.6% of the population, had received at least one dose of the COVID-19 vaccine as of Tuesday, according to the Ministry of Health. Only about 1.5 million had received both doses. The country currently uses the Chinese-made CoronaVac, which according to laboratory tests is less effective against P.1 than other variants, and that manufactured by the British-Swedish pharmaceutical company AstraZeneca.

Margareth Dalholm, a pulmonologist at Fiocruz, a leading scientific research center, said that Brazil’s failure to mount a robust vaccination campaign set the stage for the current crisis.

“We should vaccinate more than a million people a day,” he said. “That’s the truth. We are not, not because we don’t know how to do it, but because we don’t have enough vaccines.”

Other countries should pay attention, said Ester Sabino, an infectious disease researcher at the University of São Paulo, who is among the leading experts on the P.1 variant.

“You can vaccinate your entire population and control the problem for only a short period if, elsewhere in the world, a new variant appears,” he said. “It will get there one day.”

Health Minister Eduardo Pazuello, who called the variant a “new stage” of the pandemic, said last week that the government was intensifying its efforts and hopes to vaccinate approximately half of its population by June and the rest by the end. of year.

But many Brazilians have little faith in a government led by a president that has sabotaged the lockdowns, repeatedly downplayed the threat from the virus and promoted unproven remedies long after scientists said they clearly didn’t work.

Just last week, the president spoke dismissively of masks, which are among the best defenses to curb contagion, claiming they are harmful to children, causing headaches and difficulty concentrating.

Pazuello’s vaccine screenings have also been greeted with skepticism. Last week, the government placed an order for 20 million doses of an Indian vaccine that has not completed clinical trials. That led a federal prosecutor to argue in a legal file that the $ 286 million purchase “puts millions of lives at risk.”

Even if it is effective, it will be too late for many.

Tony Maquiné, a 39-year-old marketer in Manaus, lost a grandmother, an uncle, two aunts and a cousin in the span of a few weeks during the latest wave of cases. He said time has become a blur of frantic efforts to find hospitals with free beds for the living, while funerals are organized for the dead.

“It was a nightmare,” Maquiné said. “I am afraid of what lies ahead.”

This article originally appeared in The New York Times.

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