RIO DE JANEIRO — Weeks ago, when this seaside metropolis had recorded fewer than 10,000 cases of the novel coronavirus and there still appeared to be time, some of Brazil's most respected scientists made their last-ditch appeal. The country had reached a pivotal juncture. Cases were skyrocketing. The hospital system was teetering at capacity. Thousands had already died.
So Carlos Machado, a senior scientist with Brazil’s Oswaldo Cruz Foundation, wanted the language to be strong. At the request of Rio officials, his team was assembling a list of recommendations. He needed to make clear what would happen if they didn’t immediately impose a complete lockdown.
“It would result,” the team warned in the early-May report, “in a human catastrophe of unimaginable proportions.”
But officials never instituted a lockdown. The numbers of cases and deaths soared. People stopped isolating, choosing instead to pack beach boardwalks on weekends. And the warning turned out to be just one more exit ramp that Brazil declined to take on its way to becoming the second-most coronavirus-ravaged country in the world.
Latin America’s largest country has so far registered more than 888,000 coronavirus cases and nearly 44,000 deaths, second on both counts only to the United States. But while other countries have been through steep curves and are now focused on preparations for a possible second wave, Brazil can’t even get past its first.
What is happening here appears to be globally unique. Despite soaring numbers, officials have not implemented measures largely successful elsewhere in the world. There has been no national lockdown. No national testing campaign. No agreed-upon plan. There has been insufficient health-care expansion. Instead, the hardest-hit cities are throwing open the doors to malls and churches even as the country is routinely posting more than 30,000 new cases a day — five times more than Italy reported at the peak of its outbreak.
The inaction has pushed the country onto a path that scientists call uncharted.
“We are doing something that no one else has done,” said Pedro Hallal, an epidemiologist at the Federal University of Pelotas. “We’re getting near the curve’s peak, and it’s like we are almost challenging the virus. ‘Let’s see how many people you can infect. We want to see how strong you are.’ Like this is a game of poker, and we’re all in.”
Brazil is on a trajectory to register more than 4,000 deaths per day and overtake the United States in both infections and deaths by the end of July, according to researchers at the University of Washington. But just as the pandemic is magnifying the similarities between the United States and Brazil — two continent-size countries with extreme inequality and populist presidents — it is also revealing the chasm between them. Brazil has neither the world’s biggest economy nor one of the strongest health-care systems. Nor does it have the U.S. Centers for Disease Control and Prevention.
Limited resources always meant that Brazil had far less room for error — less room for political disagreement in the face of an outbreak — than its more-developed peers. But despite the stakes, the country never found unity. President Jair Bolsonaro, who continues to dismiss the disease and its victims, has urged a policy of doing nothing. He has attacked governors who advocated restrictive measures as corrupt liars, waded into crowds of supporters in defiance of his advisers’ admonitions and threatened to host a large barbecue to spite public health recommendations.
Limits on coronavirus testing in Brazil are hiding the true dimensions of Latin America’s largest outbreak
Bolsonaro did not empower health experts and scientists to lead a response. Instead, they were undermined and ignored, sidelined and pushed out. He fired his first health minister, Luiz Henrique Mandetta, whose sober briefings had calmed anxious Brazilians, after he and Mandetta clashed over the need for social distancing. Then he pushed out Mandetta’s replacement, Nelson Teich, who failed to share his zeal for using chloroquine as a coronavirus treatment. (The U.S. Food and Drug Administration this week revoked its emergency authorization for the anti-malarial drug and the related hydroxychloroquine to be used to treat the coronavirus, saying they were unlikely to be effective but carry “potential serious side effects.”)
Bolsonaro has replaced Teich with a military man who not a doctor.
The unfolding disaster underscores the limits of scientific persuasion in a country where faith in institutions has been falling for years. Federal officials are not alone in declining to follow the experts’ guidelines. Large portions of the population, either because of poverty or apathy, are living their lives largely as before — going to beaches, attending parties and other get-togethers, riding crowded buses.
“It was a failure,” said Lígia Bahia, a professor of public health at the Federal University of Rio de Janeiro. “We didn’t have enough political force to impose another way. The scientists alone, we couldn’t do it. There’s a sense of profound sadness that this wasn’t realized.”
Having decided to open up despite scientific consensus that it should not, the country is lurching down a path that so far only Sweden has deliberately tried to navigate — but in a much less tactical, methodical fashion. In some pockets of the country — particularly the north — one-fourth of people have developed antibodies to the disease. If herd immunity is to happen in any country, it might happen first in Brazil.
“The question is, ‘Where will this go?’ ” said Theo Vos, a professor of health metrics sciences at the University of Washington whose models are used by the White House. “It could be that in Brazil, you could start reaching saturation, where so many people in the population have been in contact with the virus that it starts to come down.”
“But it comes at an enormous toll. It’s the sort of situation that we’re advising governments to try and avoid.
“We don’t have another example of where, for the moment, it is looking bleaker.”
One city in the throes of this wrenching process is Boa Vista, in the underdeveloped and isolated Amazonian state of Roraima. More than one-fourth of its 277,000 residents have developed antibodies to the disease, according to Brazilian scientists conducting an ongoing study. The public system has stopped testing people. Promised field hospitals never materialized. The situation has grown so grave that patients are being flown to Manaus, itself a global symbol of the damage the virus can inflict in the developing world.
But most of the country is far from achieving herd immunity, which occurs when between 60 and 70 percent of the population has been infected by or exposed to a disease or vaccine and can now resist the pathogen. By early June, less than 3 percent of the population had covid-19 antibodies. In Rio, where 5,000 people have died, the rate was less than 8 percent.
“No end in sight,” read a large headline in O Globo newspaper last week.
When Machado, the Oswaldo Cruz Foundation scientist, was asked how much could have been averted if his warnings had been heeded, he looked pained.
“From the point of view of public health, it’s incomprehensible that more-rigorous measures weren’t adopted,” he said. “We could have avoided many of the deaths and cases and everything else that is happening in Rio de Janeiro.”
“It was an opportunity lost.”
Heloísa Traiano contributed to this report.
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