RIO DE JANEIRO – Covid-19 has already left traces of death and despair in Brazil, one of the worst in the world. Now, a year after the start of the pandemic, the country sets another heartbreaking record.
No other country that has experienced such a large epidemic has yet to grapple with a record number of deaths and a health care system on the brink of collapse. Instead, many other hard-hit countries are taking interim measures towards a semblance of normalcy.
But Brazil is battling a more contagious variant that has trampled on one major city and spread to others, even as Brazilians reject precautionary measures that could protect them.
As of Tuesday, Brazil recorded more than 1,700 deaths linked to Covid-19, the highest toll in a single day from the pandemic.
“The acceleration of the epidemic in various states is leading to the collapse of their public and private hospital systems, which could soon become the case in all regions of Brazil,” said the national association of health secretaries in a statement. “Unfortunately, the anemic roll-out of vaccines and the slowness with which they become available still do not suggest that this scenario will be reversed in the short term.”
And the news got worse for Brazil – and possibly the world.
Preliminary studies suggest that the variant that has swept through the city of Manaus is not only more contagious, but it also appears capable of infecting some people who have already recovered from other versions of the virus. And the variant has slipped Brazil’s borders, appearing in two dozen other countries and in small numbers in the United States.
Although trials of a number of vaccines indicate that they can protect against serious disease even if they do not prevent infection with the variant, most countries around the world have not been inoculated. This means that even people who had recovered and thought they were safe at the moment could still be in danger and world leaders could, once again, lift restrictions too soon.
“You need vaccines to get in the way of these things,” said William Hanage, an epidemiologist at Harvard TH Chan School of Public Health, of variants that could cause re-infections. “The immunity you get with your space-strapped cemeteries, even that won’t be enough to protect you.”
This danger of new variants has not been lost on scientists around the world. Rochelle Walensky, director of the U.S. Centers for Disease Control and Prevention, pleaded with Americans this week not to let down their guards. “Please hear me clearly,” she said. “At this level of cases where variations are spreading, we risk completely losing the hard-earned ground that we have gained.”
Brazilians hoped they had seen the worst of the epidemic last year. Manaus, capital of the northern state of Amazonas, was hit so hard in April and May that scientists wondered whether the city could have achieved herd immunity.
But then, in September, cases in the state started to rise again, confusing health officials. An attempt by Amazonas governor Wilson Lima to impose a new quarantine before the Christmas break has met fierce resistance from business owners and prominent politicians close to President Jair Bolsonaro.
By January, scientists discovered that a new variant, known as P.1, had become dominant in the state. Within weeks, his danger became clear as hospitals across the city ran out of oxygen amid a patient crash, which led to dozens of people suffocating to death.
Dr Antonio Souza remains haunted by the horrified faces of his colleagues and patients’ relatives when it became clear that the oxygen supply at his Manaus hospital was depleted. He thinks of the patient under sedation, to save her an excruciating death, when the oxygen ran out in another clinic.
“No one should ever have to make this decision,” he said. “It’s too terrible.”
Manaus nurse Maria Glaudimar said she felt trapped in a nightmare at the start of this year with no end in sight. At work, patients and their families pleaded 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,” Ms. Glaudimar said. “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 scrambling to learn more about the variant and track its spread across the country. But limited resources for testing have kept them behind the curve as they try to determine what role it plays.
Anderson Brito, a Brazilian virologist at Yale University, said his lab alone has sequenced nearly half the number of coronavirus genomes as all of Brazil. While the United States has DNA sequenced about one in 200 confirmed cases, Brazil sequesters about one in 3000.
The variant spread quickly. At the end of January, a study conducted by government researchers found that it was present in 91% of samples sequenced in the state of Amazonas. As of the end of February, health officials had reported cases of the P.1 variant in 21 of Brazil’s 26 states, but without more testing, it is difficult to assess its prevalence.
Throughout the pandemic, researchers have said re-infections from Covid-19 appear to be extremely rare, which has allowed people who recover to assume they are immune, at least for a while. But that was before the appearance of P.1 and the doctors and nurses started to notice something strange.
João Alho, a doctor from Santarém, a town in Amazonas, said several colleagues who had recovered from Covid-19 months earlier fell ill again and tested positive.
Juliana Cunha, a nurse from Rio de Janeiro who worked in Covid-19 testing centers, said she assumed she was safe after catching the virus last June. But in November, after experiencing mild symptoms, she tested positive again.
“I couldn’t believe it,” Ms. Cunha, 23, said. “It must be the variants.”
But there is no way to be sure what happens to re-infected people, unless their old and new samples are stored, genetically sequenced, and compared.
One way to curb the outbreak would be to get vaccinated, but the rollout in Brazil, as in many countries, has been slow.
Brazil began immunizing priority groups, including healthcare workers and the elderly, at the end of January. But the government failed to obtain a sufficiently large number of doses. Wealthier countries have grabbed most of the available supply, while Mr Bolsonaro has been skeptical of both the impact of the disease and the vaccines.
Just over 5.8 million Brazilians – or about 2.6% of the population – had received at least one dose of a Covid-19 vaccine on Tuesday, according to the Ministry of Health. Only about 1.5 million had received both doses. The country is currently using the Chinese-made CoronaVac – which lab tests suggest is less effective against P.1 than against other variants – and one made by Anglo-Swedish pharmaceutical company AstraZeneca.
Margareth Dalcolmo, pulmonologist at Fiocruz, a major scientific research center, said Brazil’s failure to mount a strong vaccination campaign paved the way for the current crisis.
“We should be vaccinating over a million people a day,” she said. “It’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 take this into account, 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 only vaccinate your entire population and control the problem for a short time if elsewhere in the world a new variant appears,” she said. “He will get there one day.”
Health Minister Eduardo Pazuello, who called the variant a “new stage” in the pandemic, said last week that the government was stepping up efforts and hoped to vaccinate about half of its population by June and the rest of it. ‘by the end of the year.
But many Brazilians have little faith in a government led by a president that has sabotaged lockdowns, repeatedly downplayed the virus threat and promoted untested cures long after scientists said they clearly were not working.
Just last week, the president spoke with contempt of masks, which are among the best defenses to curb contagion, saying they are harmful to children, cause headaches and difficulty concentrating.
Mr Pazuello’s vaccine screenings were also met with skepticism. The government last week placed an order for 20 million doses of an Indian vaccine that has not completed clinical trials. This prompted a federal prosecutor to argue in a legal case that the $ 286 million purchase “puts millions of lives at risk.”
Even if this proves to be 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 within a matter of weeks in the latest wave of cases. He says the time has turned a blur of frantic efforts to find hospitals with free beds for the living, while also having funerals for the dead.
“It was a nightmare,” said Maquiné. “I’m afraid of what awaits me.”
Manuela Andreoni and Ernesto Londoño reported from Rio de Janeiro and Letícia Casado de Brasilia. Carl Zimmer contributed reporting from New Haven, Conn.