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Rows of nearly naked patients, men and women in cramped wards, too close to each other, all hot, all diapered, but the most striking thing about the scene was the lack of oxygen, and an overwhelmed system unable to provide crucial life-saving care. These patients need ventilators, there are dozens of others waiting for a bed, but the massive new COVID-19 wave has health systems in much of Brazil on the brink of collapse. In hospital hallways, people are fighting for every breath, waiting to die. Where there are ventilators, reports are of people intubated without ICU, cared for by untrained doctors and untrained nurses. In 2020, 80 per cent of intubated patients died, compared to a global average of 50 per cent.
All 26 states and Brasilia are at or close to capacity, few have ICU availability. Now, problems are exacerbated by the more aggressive variants. Cases spiked countrywide last week.
A year into the global outbreak and 10 months since the Amazonian city of Manaus became the world’s hardest-hit city at the time, President Jair Bolsonaro last week described as “tyrants” the state governors who have ordered shutdowns in order to contain coronavirus. And he continues to campaign against closures with his supporters holding large maskless rallies. He has ordered his administration to seek a court order against cities’ and states’ nighttime lockdown restrictions.
Historically people tended to lose patience with pandemic precautions as time wears on, but Bolsonaro’s Brazil never got its federal level on board with full measures to protect its population in the first place, and Bolsonaro has consistently minimised the threat from the virus.
To the shock of the opposition, he has now expanded his campaign and has been providing dangerous misinformation about vaccines, such as his suggestions one could turn into a crocodile if vaccinated. All of that has led to extreme anti-vac postings in Brazilian social media, stoked by the president, who has repeated publicly he will not get vaccinated.
In the midst of the politicking, Brazil has just taken over as the new global epicentre of the COVID-19 pandemic, the government vaccination program has barely started, Bolsonaro fired the health minister and his administration is now on its 4th health minister in the worst of the greatest global health threat of our lifetimes. Renowned cardiologist Ludhmila Hajjar declined to accept the post, concluding after two days of conversations with Bolsonaro, that “this was not the moment for her to assume the job,” she told CNN-Brasil.
“I understood it was not just an invitation from the president but from many Brazilians who want to save the country,” she said, noting there were diverging points with Bolsonaro that she says she left explicit in accordance with science. The entire world knows, she said, that science has demonstrated that patients have to be attended to and that certain medicines such as chloroquine (heavily promoted by Bolsonaro, and Trump) have shown not to have any efficacy in the treatment of this illness.
“I think that Brazil today, in order to battle the pandemic, has to find scientific evidence to save peoples’ lives, to try to treat those people better with early diagnostics, with better hospital care, with a program of vaccination, with a unified message so that people can really understand the threat and not underestimate the virus.” While grateful to Bolsonaro for the choice to offer her the ministry, Hajjar said she is really worried for Brazil, decried people dying in ambulances, outside hospitals, and defended the use of lockdowns to manage the outbreaks across the huge country. “I think without a doubt,” she said, “that he [Bolsonaro] will find a person who will be aligned with what his government wants to do and if it is God’s will it will work to save Brazil.”
On a parallel track almost as if on another universe from the direction of Brasilia, the government of Sao Paulo is working to extend and enhance the emergency phase of lockdown closing offices, prohibiting sales at stores, stopping most services and sports activities. The city of São Paulo will shut down during the entire Easter Week, with no working days between March 26 until April 4. The entire state of São Paulo is in the emergency phase, which prohibits the opening of shops, bars, and restaurants, and has a curfew between 8 pm and 5 am.
While Bolsonaro enjoys heavy support in the rural inland areas and many of his truck-driving supporters make their way into the east coast cities in patriotic, anti-mask, reopen the economy rallies, in central Sao Paulo there are frequent pot-and-pan-banging anti-Bolsonaro protests from balconies and windows of apartments. “Fora Bolsonaro” (out with Bolsonaro), and “impeachment now” shouts interrupt the downtown air almost nightly. Now, conservative parties that had previously always supported Bolsonaro join in the calls for impeachment.
“No need to panic,” says Bolsonaro, “we are all going die eventually, people are going to die, what do you want me to do? People have to work.” Bolsonaro recently told people to stop whining, but opposition politicians and people say he is not responsible, “like a child,” they say, “calling names, and promoting cures.”
Twelve million Brazilians have already become infected, and nearly 300,000 have died. The situation is tense. In many places like the western states of Amazonas and Acre, oxygen for artificial respiration has been lacking since the new outburst months ago, and people have to be evacuated to other states for treatment, spreading the ability of the virus to find new beachheads.
The secretary of health of the State of Sao Paulo put out a statement that said the crisis increasingly challenging in the routine of thousands of health professionals. “The number of deaths is exorbitant and does not stop growing.”
At the Unicamp Hospital das Clínicas Emergency Room in the city of Campinas inland Sao Paulo, chief nurse Ludimila de Melo called on people to “hold on a little longer! The vaccine is coming and we hope that soon everything will return to normal. But, at this moment, we need the population’s awareness”.
“Protect yourself and take care of the one you love. If you can, stay home,” advises the state.
Among federal government warnings of side-effects as states try to convince people to get vaccinated as soon as possible, new vaccines from the COVAX program arrived in the country Monday morning. But the national immunisation campaign is not gaining momentum, as Bolsonaro continues to play down the danger of COVID-19, play up the danger of the vaccines, and question the need and efficacy of a vaccine in the first place.
The Washington Post has called the situation in Brazil a global problem and a “threat to the entire planet” as the virus spreads out of control in the country and has likely moved across its porous borders and beyond. “Brazil is a COVID-19 disaster.”
Bolsonaro himself is a global health threat, says Robert Muggah, a principal of the SecDev Group which runs a volunteer-based COVID-19 Cyber Defense Force from Canada, and also co-founder of the Igarape Institute, a Brazilian-based think tank that focuses on emerging security.
“The failure to slow the outbreak coupled with an anemic vaccination campaign has not only created a domestic tragedy, but a full-blown global threat,” wrote Muggah. “Much of the blame for Brazil’s disastrous health crisis lies squarely at the feet of the country’s far-right president, Jair Bolsonaro.”
Fighting against virus and Bolsonaro, the country’s mayors and governors are attempting to implement more and more stringent measures in order to give their health systems a chance to recover without being overwhelmed with more cases. Citizens in the cities, too, are worried that the cases are getting out of control and that they can’t get the medical attention they need for other conditions, but they see the Bolsonaro approach as negligent and dangerous to their lives.
For now, as they did a year ago, they continue to make their protests reverberate around Sao Paulo; they realize that their fate is tied to the personality of their leader, so they hope that momentum can build to either reverse his positions or to oust him and to put instead a COVID-fighting general in charge of the pandemic war. But the real battle is in the country’s ICU wards, a battle for another day of life, for a chance to see family once more, and, often, with speeding frequency, a battle to take just one more breath.
