Over the past week, the Brazilian governor has sought to do something President Jair Bolsonaro has firmly rejected: draft a proposal for states to help curb the country’s deadliest COVID-19 outbreak. The efforts are expected to include curfews, bans on crowded events and limits on the hours non-essential services can operate.
The final product, presented Wednesday, is a one-page document that includes general support for limiting activity but without specific actions. Six governors, apparently still wary of Bolsonaro’s opposition, refused to sign.
State governor Piaui Wellington Dias told The Associated Press that unless the pressure on hospitals eases, more and more patients will have to endure illness without hospital beds or expectations of treatment in intensive care units.
“We have reached the limit all over Brazil; There are rarely exceptions, ”said Dias, who chaired the governor’s forum. “The chance of dying without help is real.”
Death has already started. In Brazil’s richest state, Sao Paulo, at least 30 patients died this month while waiting for ICU beds, according to a tally published Wednesday by news website G1. In the southern state of Santa Catarina, 419 people are waiting to be transferred to ICU beds. In neighboring Rio Grande do Sul, ICU capacity stands at 106%.
Alexandre Zavascki, a doctor in Rio Grande do Sul’s capital, Porto Alegre, described hospital patients who were constantly arriving and having trouble breathing.
“I have many colleagues who, sometimes, stop crying. This is not a drug that we routinely take. It is a drug adapted for war scenarios, ”said Zavascki, who oversees infectious disease treatment at a private hospital. “We see that a large part of the population refuses to see what’s going on, rejects the facts. These people may be admitted to the hospital later and need a bed. But nothing will. “
The state, he added, needed “more rigid action” from the authorities.
Over the president’s objection, the Supreme Court last year upheld city and state jurisdiction to impose restrictions on activity. Even so, Bolsonaro has consistently condemned such a move, saying the economy must continue to spin and that isolation would lead to depression.
The latest spike was driven by the P1 variant, which Brazil’s health minister said last month was three times more contagious than the original strain. It first became dominant in the Amazon city of Manaus and in January forced the transport of hundreds of patients to other states.
Brazil’s failure to contain the spread of the virus since then is increasingly a concern not only for Latin America’s neighbors, but also as a warning to the world, Tedros Adhanom Ghebreyesus, director of the World Health Organization, told a March 5 press conference.
“Across the country, aggressive use of public health measures, social measures, will be very, very important,” he said. “Without doing things to influence transmission or suppress the virus, I don’t think we will be able in Brazil to experience a downward trend.”
Last week’s tally of more than 10,000 deaths was Brazil’s highest since the pandemic began, and this week is on a worse track after the country posted nearly 2,300 deaths on Wednesday – wiping out the previous day’s total which was also a record.
Brazil has decades of experience with mass immunization campaigns, but their rollout was hampered by delays, many of which were self-defeating; 5.5% of the population has been vaccinated.
“The governors, like many other residents, are fed up with all this inaction,” said Margareth Dalcolmo, a leading pulmonologist at the state-run Fiocruz Institute. He added that the pact they are proposing is vague and will remain symbolic unless it becomes distant and confronts the federal government.
Brazil’s national council of state health secretaries last week called for the establishment of a national curfew and lockdowns in areas close to maximum hospital capacity. Bolsonaro objected again.
“I’m not going to decide,” Bolsonaro said Monday at an event. “And you can be sure of one thing: My soldiers are not going to take to the streets to force people to stay at home.”
Restrictions can already be found outside the presidential palace after the Governor of the Federal District, Ibaneis Rocha, imposed a curfew and partial lockdowns. Rocha warned Tuesday that he could press harder, excluding only pharmacies and hospitals, if people continue to ignore regulations. Currently, 213 people in the district are on the waiting list for ICU beds.
Bolsonaro told reporters Monday that the curfew was “insulting, unacceptable,” and even the WHO believed the lockdowns were inadequate because they disproportionately hurt the poor. While the WHO acknowledges the “profound negative effects”, it says some countries have no choice but to impose crackdowns to slow transmission, and that governments should take advantage of the extra time provided to test and trace cases, while treating patients.
That nuance is missing at Bolsonaro. His government continues to look for a silver bullet solution which has so far only fueled false hopes. Every idea seems to need consideration, except from public health experts.
The Bolsonaro government spent millions of dollars producing and distributing malaria pills, which did not show any benefit in careful research. Still, Bolsonaro supports the drug. He also supported treatment with two drugs to fight parasites, neither of which showed effectiveness. He again praised their capacity to prevent hospitalization during Wednesday’s events at the presidential palace.
Bolsonaro also sent a committee to Israel this week to assess unproven nasal sprays which he called a “miracle product”. Fiocruz’s Dalcolmo, whose younger sister is currently in ICU, called the trip “very sad”.
Meanwhile, the city of Araraquara, in the interior of Sao Paulo, saw a drop in new cases for weeks after announcing a lockdown amid a crippling surge dominated by the P1 variant. Mayor Edinho Silva told AP in a message that, without mass vaccination, there was no alternative.
Camila Romano, a researcher at the University of Sao Paulo’s Institute of Tropical Medicine, hopes the tests her lab is developing to identify variants of concern, including P1, will help monitor and control its spread. He also wanted to see stricter government measures, and citizens doing their part.
“Every day there are new surprises, new variants, cities where the health system collapses,” said Romano. “We are now in the worst phase. Whether this will be the worst phase of all, unfortunately we don’t know what’s coming. “
——— Álvares reported from Brasilia. Associated Press video journalist Tatiana Pollastri contributing from Sao Paulo.