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Covid-19: Brazil’s hospitals close to collapse as cases reach record high

BMJ 2021; 372 doi: (Published 23 March 2021) Cite this as: BMJ 2021;372:n800

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Covid-19 in Brazil: the government has failed to prevent the spread of the virus/p>

  1. Luke Taylor
  1. Portsmouth, UK

Hospitals across Brazil are on the brink of collapse as the country faces the worst chapter of its pandemic yet.

Out of the country’s 26 states, 24 have 80% or more of their covid-19 intensive care beds occupied and 15 states have at least 90%, according to Fiocruz, a Brazilian health institute, in a bulletin published on 17 March.1 The pandemic is causing “an extremely critical situation across the country” and “the biggest health system collapse in the history of Brazil.”

Last week saw the highest mortality in the country since the pandemic began, with daily deaths regularly exceeding 2000 and reaching a record high of 2841 on 16 March.

To slow the spread of the coronavirus and ease pressure on hospitals, experts at Fiocruz called for non-essential activities to be restricted, greater enforcement of social distancing and mask wearing, and an acceleration of the vaccination campaign.

President Jair Bolsonaro has refused to act on the latest calls for a national lockdown, saying it would damage the economy and calling regional governors who enforced local lockdowns “tyrants.” It is the latest in the political feud between Bolsonaro, who has consistently played down the threat of the coronavirus, and governors of cities and states requesting more radical action and support.

João Doria, the governor of São Paulo who closed the city’s non-essential businesses on 6 March, blamed the president for the ongoing crisis. His “denialism” has contributed to cases surging, a stuttering vaccination campaign, and shortage of syringes and intensive care beds, Doria told the BBC on 5 March.2 “There is no national coordination to combat the pandemic in Brazil,” he said.

Brazil has recorded more than 12 million covid-19 cases and 295 000 deaths, the second highest numbers in the world after the US. The country’s population of 212 million and socioeconomic factors like multigenerational housing and poverty have aided the virus’ spread but mortality is particularly high. Nearly eight out of 10 Brazilians intubated in the past year have died, according to Fiocruz. The world average is around five out of 10.

While Brazil’s vaccination campaign has been rolled out only 6% of the population has been vaccinated—ahead of some South American countries but behind Europe and North America.3 It has not proved enough to slow virus transmission, which could be accelerated by the variant known as P.1.

P.1 is suspected to have emerged in the city of Manaus in the Brazilian Amazon in November 2020 before it caused hospitals there to collapse in January 20214 and spread to the rest of the country. Studies suggest that P.1 spreads and evades antibodies more easily than previous variants.

Bolsonaro has set the task of bringing the virus under control to a new health minister, Marcelo Queiroga, the fourth to hold the office since the pandemic began, and like his predecessor, military general Eduardo Pazuello, a close ally of Bolsonaro. The cardiologist has ruled out implementing a national lockdown and is unlikely to bring the pandemic under control, says Paulo Lotufo, an epidemiologist at the University of São Paulo, who doubts the minister’s autonomy.

“I have no hope in Queiroga,” Lotufo says. “There is only one boss in Brazil: Bolsonaro. The solution is to impeach him.”

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