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Covid-19: Brazil breaks record daily death toll as crisis spreads through South America

BMJ 2021; 373 doi: https://doi.org/10.1136/bmj.n930 (Published 08 April 2021) Cite this as: BMJ 2021;373:n930

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Opinion

The catastrophic Brazilian response to covid-19 may amount to a crime against humanity

Opinion

Brazil, a country collapsing during the covid-19 pandemic

  1. Luke Taylor
  1. Portsmouth, UK

Brazil recorded over 4195 deaths from covid-19 on 6 March, the highest daily record to date as the country’s health crisis showed evidence of spreading through South America

Daily covid-19 deaths in Brazil have doubled since February and 90% of the country’s intensive care unit beds are occupied, with mortality increasing, according to the Oswald Cruz Foundation (Fiocruz), a research institute attached to Brazil’s Ministry of Health.1 Some regions are reporting shortages of oxygen and anaesthesia. The situation is a “huge catastrophe,” said Maragareth Portela, a senior researcher at Fiocruz.

Deaths in Brazil now exceed those of the US, which was the main driver of previous waves of covid-19 in the Americas, and account for around a quarter of the global total.

Sylvain Aldighieri, deputy director for the Pan American Health Organization, told The BMJ that the new high rates of hospital admissions and deaths are the result of increased travel during the Christmas and Easter holidays which facilitated virus transmission. “During these two periods the implementation of public health measures was suboptimal in most of Brazil,” Aldighieri told a press briefing on 31 March. The variant known as P1, which is more transmissible and possibly more lethal, is also playing a role. “The circulation of the P1 variant is clearly contributing to the increase in cases,” Aldighieri said.

P1 is estimated to be 1.4 to 2.2 times more transmissible than previous variants and better at evading antibodies. It is thought to be responsible for the increase in mortality in young Brazilians in recent weeks, suggesting it could be more lethal too.2

The responsibility for the health crisis does not, however, lie with P1, say epidemiologists. They blame President Jair Bolsonaro, who they say has downplayed the threat of the virus, refused to implement measures like a national lockdown to slow its spread, and has been slow to purchase vaccines. Though some regional leaders have brought case numbers down by restricting mobility and closing businesses, regions run by followers of Bolsonaro continue to record growing case numbers and hospital admissions, says Paulo Lotufo, an epidemiologist at the University of São Paulo. Although the situation in hospitals remains critical in São Paulo, cases are declining after two weeks of lockdowns. There is a growing disparity in the public health situation between regions where leaders enforce restrictions and those run by “denialists” who refuse to take action, he says.

Cristovam Barcellos, a researcher at Fiocruz, said that nationally the number of cases, deaths, hospital admissions, and positive test rates continue to increase. “Many indicators show that the pandemic will hit Brazil hard in April and maybe May,” he said, estimating that daily deaths could reach 5000. “Vaccination campaigns are slow, new variants of public health concern are circulating, and there is no national plan to curb the pandemic, such as social support for the poor.”

Concerns have also been raised that the spread of the coronavirus in Brazil is facilitating the rise of new variants which could be more deadly, transmissible, or better at evading vaccines than P.1. The latest new variant of interest was identified by Fiocruz on 7 April. Like P.1 it features the E484K mutation, which is believed to help the virus evade the body’s immune defences. Miguel Nicolelis, a Brazilian doctor and professor at Duke University, told Reuters, “It’s a nuclear reactor that has set off a chain reaction and is out of control. It’s a biological Fukushima.”

The impact of Brazil’s spiralling crisis is increasingly being felt across South America as P1, which originated in the country’s Amazon, spreads. Daily deaths reported in Latin America currently make up around a third of the world total despite it only being home to 8% of the world’s population. In countries such as Perú and Uruguay authorities say the variant is becoming increasingly dominant as covid-19 cases surge to new highs.

Uruguay recorded 3924 new cases on 7 April, the highest to date, and Paraguay reported 2380, its fourth highest total since the pandemic began.

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