Coronavirus Spreads Into Parts of Brazil Without ICUs or Clean Water

As Brazil’s accelerating caseload propels it into the second worst coronavirus hotspot, one of the most alarming aspects is the epidemic’s path — spreading into areas so poor they lack not only intensive care units but often clean water.

Restricted at first to Brazil’s rich neighborhoods and capitals in close contact with international travelers, the virus has migrated inland, and also to states like Maranhao, where 20% of the population live in extreme poverty and most workers have unregulated jobs.

“There are places where people don’t have soap and water to wash their hands,” the state’s health secretary, Carlos Lula, said in an interview. “How can we talk to them about wearing masks and teach coughing and sneezing etiquette?”

Ever since mid-March when Covid-19 was declared a pandemic, global health officials have feared that a country with limited infrastructure, crowded dwellings and poor health facilities could explode with illness and overwhelm its systems. Brazil may be that country.

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Trails Only U.S.

A sprawling land of 210 million inhabitants and Latin America’s largest economy, Brazil has, in the past week, overtaken Spain, Italy, the U.K. and Russia in number of cases, nearly 375,000 with more than 23,000 deaths. It trails only the U.S. in confirmed infections.

One of the country’s poorest states, Ceara, now has almost as many cases as Rio de Janeiro with less than half its population. In Pernambuco, where the governor is sick, the daily average of deaths has doubled to 90.

Lula, the Maranhao health secretary, says the state has 388 ICU beds, 230 of which are in the capital. One recent day, he said, there were 916 new cases, only 200 of them in the capital.

Mayor Arthur Virgilio of Manaus, the capital of Amazonas state, said the pandemic has shown how unprepared Brazil’s heath system is.

Home Deaths

Manaus, with some 2 million inhabitants, was one of the first cities where hospitals were overwhelmed by Covid-19. Pictures of mass graves and bodies lying next to patients flooded the Internet. Since many couldn’t get into hospitals and others feared they couldn’t, there was a surge in deaths at home.

A month ago, the city saw as many as 167 fatalities in a day. It is down to a third of that, but as the disease spreads to smaller towns nearby, the numbers could jump again. Manaus is the only city in Amazonas which has intensive care units. If patients flow in from the hinterland, the health system could be driven again to its knees.

All of this is happening as Brazil’s president, Jair Bolsonaro, continues to stand out for his belittling of the pandemic’s significance. He has appeared at political rallies and mingled with supporters while health experts say the central tool for limiting the virus’ spread is maintaining distance from others.

“We have to fight not only the virus, but the president,” Mayor Virgilio said. He called Bolsonaro “an accomplice” to the deaths in Brazil.

Brazil is a federal system and governors and mayors have established their own quarantine rules. But the president has pushed to get people back to work and criticized governors for increasing restrictions and implementing lockdowns, often saying more will starve from the looming recession than die from the disease he has dubbed “just a flu.”

The divergence between federal and local governments has led to open conflicts between Bolsonaro and governors -- not only in the Northeast, where the relationship with the president was already fraught, but also with some former allies including the governors of Rio de Janeiro and Sao Paulo, who have implemented social isolation measures.

As in most countries, the meaning and reliability of virus data are under intense debate. The high numbers in Ceara state -- 36,185 cases and 2,493 deaths -- can partially be explained by a push to increase testing, said Magda Almeida, the state’s secretary of health surveillance. The state has done 20,867 tests so far, while the country has done about 415,000.

A scientific committee put together by the Northeastern states is recommending seven cities declare lockdowns as hospitals run out of room. Cities from Belem to Sao Luis have already done so, implementing some of the harshest measures in the country. The committee also noted that coronavirus is not the only disease to worry about: dengue cases are also growing.


Bahia, one of the top tourist destinations in the Northeast, has made some progress. Health Secretary Fabio Vilas-Boas says new cases are growing at 6% a day, half the pace from before. But even there, it has been difficult to lower the numbers because the virus has reached poor neighborhoods, where people live in smaller spaces.

In Sao Paulo, the country’s richest state and the virus epicenter since the pandemic began, the disease is also moving away from the capital city. In April, infection rates outside of the capital were three to four times higher than in Sao Paulo and kept rising this month, according to government data. Almost 80% of the cities in the state now have cases, from less than 50% in late April.

“Unfortunately, the numbers are confirming what we had been saying since March,” Sao Paulo’s state secretary for regional development Marco Vignoli said at a press conference last week. “Now we’re seeing an acceleration in the state’s countryside and on the coast.”

— With assistance by Mario Sergio Lima

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