Brazil hospitals buckle in absence of national virus plan

RIO DE JANEIRO

Brazil’s hospitals are faltering as a highly contagious coronavirus variant tears through the country, the president insists on unproven treatments and the only attempt to create a national plan to contain COVID-19 has just fallen short.

For the last week, Brazilian governors sought to do something President Jair Bolsonaro obstinately rejects: cobble together a proposal for states to help curb the nation’s deadliest COVID-19 outbreak yet. The effort was expected to include a curfew, prohibition of crowded events and limits on the hours nonessential services can operate.

The final product, presented Wednesday, was a one-page document that included general support for restricting activity but without any specific measures. Six governors, evidently still wary of antagonizing Bolsonaro, declined to sign on.

Piaui state’s Gov. Wellington Dias told The Associated Press that unless pressure on hospitals is eased, growing numbers of patients will have to endure the disease without a hospital bed or any hope of treatment in an intensive care unit.

“We have reached the limit across Brazil; rare are the exceptions,” Dias, who leads the governors’ forum, said. “The chance of dying without assistance is real.”

Those deaths have already started. In Brazil’s wealthiest state, Sao Paulo, at least 30 patients died this month while waiting for ICU beds, according to a tally published Wednesday by the news site G1. Occupancy of ICUs is above 90% in 15 of 27 capitals, according to the state-run Fiocruz institute. In southern Santa Catarina state, 419 people were waiting for transfer to ICU beds. Neighboring Rio Grande do Sul’s capacity was at 106%. Alexandre Zavascki, a doctor in its capital, described a constant arrival of hospital patients struggling to breathe.

“I have a lot of colleagues who, at times, stop to cry. This isn’t medicine we’re used to performing routinely. This is medicine adapted for a war scenario,” said Zavascki, who oversees infectious disease treatment at a private hospital. “We see a good part of the population refusing to see what’s happening, resisting the facts. Those people could be next to step inside the hospital and will want beds. But there won’t be one.”

The country, he added, needs “more rigid measures” from authorities.

Over the president’s objections, the Supreme Court last year upheld cities’ and states’ jurisdiction to impose restrictions on activity. Even so, Bolsonaro consistently condemned any such moves, saying the economy needed to keep churning and that isolation would cause depression.

The most recent surge is driven by the P1 variant that first became dominant in the Amazonian city Manaus.
Brazil’s failure to arrest the virus’ spread since then is increasingly a concern not just for Latin American neighbors, but also as a warning to the world, Tedros Adhanom Ghebreyesus, director of the World Health Organization, said in a March 5 press briefing.

“In the whole country, aggressive use of the public health measures, social measures, will be very, very crucial,” he said. “Without doing things to impact transmission or suppress the virus, I don’t think we will be able in Brazil to have the declining trend.”

Last week’s tally of more than 10,000 deaths was Brazil’s highest since the pandemic began, and this week is on track to be even worse after the country posted nearly 2,300 deaths Wednesday _ blowing away the prior day’s total that was also a record. At the Vila Formosa cemetery in Sao Paulo, burials are being done one after another, with mourners and cars lined up awaiting their turn.

Brazil has decades of experience with mass immunization campaigns, but rollout has been hobbled by delays, some self-inflicted; 5.5% of its population has been vaccinated.

“Governors, like a lot of the population, are getting fed up with all this inaction,” said Margareth Dalcolmo, a prominent pulmonologist at Fiocruz. She added that their proposed pact will remain symbolic unless it is far-reaching and confronts the federal government.

Brazil’s national council of state health secretaries last week called for the establishment of a national curfew and lockdown in regions that are approaching maximum hospital capacity. Bolsonaro again demurred.

“I won’t decree it,” Bolsonaro said Monday at an event. “And you can be sure of one thing: My army will not go to the street to oblige the people to stay home.”

Restrictions can already be found just outside the presidential palace after the Federal District’s governor, Ibaneis Rocha, implemented a curfew and partial lockdown. Rocha warned Tuesday that he could clamp down harder, sparing only pharmacies and hospitals, if people keep disregarding rules. Currently, 213 people in the district are on the wait list for an ICU bed.
Bolsonaro told reporters Monday that the curfew is “an affront, inadmissible,” and said that even the WHO believes lockdowns are inadequate because they disproportionately hurt the poor. While the WHO acknowledges “profound negative effects,” it says some countries have had no choice but to impose heavy-handed measures to slow transmission, and that governments must make the most of the extra time provided to test and trace cases, while caring for patients.

Such nuance was lost on Bolsonaro. His government continues its search for silver-bullet solutions that so far has served only to stoke false hopes. Any idea appears to warrant consideration, except the ones from public health experts.

Bolsonaro’s government spent millions producing and distributing malaria pills, which have shown no benefit in rigorous studies. Still, Bolsonaro endorsed the drugs. He has also supported treatment with two drugs for fighting parasites, neither of which have shown effectiveness. He again touted their capacity to prevent hospitalizations during a Wednesday event in the presidential palace.

Bolsonaro also dispatched a committee to Israel this week to assess an unproven nasal spray that he has called “a miraculous product.” Fiocruz’s Dalcolmo, whose younger sister is currently in an ICU, called the trip “really pathetic.”
Meanwhile, the city of Araraquara, in Sao Paulo’s interior, has seen new cases turn downward weeks after declaring lockdown amid a crippling surge dominated by the P1 variant. Mayor Edinho Silva told the 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 a test her lab developed to identify worrisome variants, including P1, will help monitor and control their spread. She also wants to see stricter government measures, and citizens doing their part.

“Every day is a new surprise, a new variant, a city whose health system enters collapse,” Romano said. “We’re now in the worst phase. Whether this will be the worst phase of all, unfortunately we don’t know what’s yet to come.”