The Washington PostDemocracy Dies in Darkness

Brazil’s growing coronavirus outbreak poses a threat far beyond its borders

People line up in Duque de Caxias, Brazil, last week for their first dose of Sinovac’s coronavirus vaccine. (Pilar Olivares/Reuters)
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RIO DE JANEIRO — The people started queuing up before first light. The line of cars soon stretched for miles — streaking out of the city, winding into the countryside, thousands of elderly people hoping it would finally be their day.

The mayor of Duque de Caxias, a working-class suburb of Rio de Janeiro, announced last week that anyone over the age of 60 was eligible to receive a coronavirus vaccine. But there was a problem. More than 80,000 people fit that age bracket — but the city had only 6,100 doses. Thousands of people battled huge crowds, waited for hours and exposed themselves to infection, only to return home, frustrated and unvaccinated — one more public health failure in a Brazilian tragedy riddled with them.

“Because of this criminal mass gathering today, I COULDN’T GET MY MOTHER VACCINATED,” one resident vented on Facebook. “I don’t know what to do.”

Much of the world is seeing coronavirus cases fall. Brazil’s outbreak is worse than ever.

The question in Brazil, which has suffered more coronavirus deaths than any country outside of the United States, is no longer how it got into this mess. Under the chaotic leadership of President Jair Bolsonaro, Latin America’s largest country long ago succumbed to denialism, disorganization, apathy, hedonism and medical quackery — and buried more than 266,000 people along the way.

The question is whether the failure to control the virus poses an international threat that will undermine the hard-won gains other countries have made.

“If Brazil is not serious, then it will continue to affect all of the neighborhood there — and beyond,” Tedros Adhanom Ghebreyesus, director general of the World Health Organization, said last week. “This is not just about Brazil. It’s about the whole Latin America, and even beyond.”

Brazil has become an explosive breeding ground for the P.1 variant, which was first identified in the Amazon rainforest and has now been detected in more than two dozen countries, including the United States.

More transmissible and possibly capable of reinfecting people who have recovered from the disease covid-19, the variant began devastating the Amazonian city of Manaus in early January, then stormed south. Late last week, the research institution Fiocruz announced that “variants of concern” including P.1 have become dominant in six of eight states studied.

Brazil dispatch: My wife and I got covid-19. Our doctor prescribed a medication used to treat parasites in livestock.

“This information is an atomic bomb,” said Roberto Kraenkel, a biological mathematician with the Covid-19 Brazil Observatory. “I’m surprised by the levels found. The media isn’t getting what this means.

“All of the variants of concern are more transmissible . . . and this means an accelerated phase of the epidemic. A disaster.”

Scientists across Brazil expressed deep pessimism for the coming weeks. The ICU occupation rate is at least 80 percent in most states, much higher in some. Patients are being transferred from state to state — sometimes traveling hundreds of miles — in a nationwide hunt for hospital resources. Without ventilators, nurses have pumped infected patients’ lungs manually. Cemeteries are running out of space to put the bodies. Refrigerated containers wait outside hospitals to take the overflow. People all over the country are dying at home, unable to get treatment.

The situation is unpredictable for both Brazil and the world. As viruses course through a population, they inevitably mutate. Most genetic changes are functionally insignificant. The coronavirus pandemic, which has infected more than 117 million people worldwide, has produced countless variants.

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But uncontrolled outbreaks in communities with mounting immunity, scientists say, can give rise to more dangerous variants. It’s not by coincidence that one of the world’s most virulent variants emerged in Manaus, one of the world’s hardest-hit cities.

The virus wants to infect, said Denise Garrett, the vice president of applied epidemiology at the Sabin Vaccine Institute in Washington. Not unlike bacteria, it will mutate to get around obstacles and barriers. That might have happened with the P.1 variant: Preliminary research based on modeling and cell cultures has suggested it can dodge a certain amount of immunity in people who have recovered from a previous infection.

“Brazil makes me extremely worried,” Garrett said. “The country that doesn’t control its outbreak is a risk for other countries in that it’s a breeding site for new variants.”

Health analysts say the best way to ensure that doesn’t happen would be to control the outbreak with more restrictive measures. Then a rapid mass vaccination campaign. The United Kingdom followed this path. Israel vaccinated many residents with restrictive measures in place.

But in Brazil, none of that appears likely. There’s little national coordination. The vaccine rollout has been bogged down in delays, vaccine shortages and political infighting. It has left the country in disarray: Every city, every state, every Brazilian has taken their own direction. As things stand now, few scientists think the country will be able to stop the carnage.

“We are in big trouble,” said Margareth Dalcolmo, a lead scientist at Fiocruz.

The Amazonian city that hatched the Brazil variant has been crushed by it

The pandemic was always going to be difficult to control in Brazil, a country of vast territory, diversity and inequality. But given its built-in advantages — a younger population, warmer climate, national vaccination programs, universal health care — there was reason at first to believe it could fare better than others. The fact that it hasn’t, and that conditions now are worse than ever, is a public health riddle that analysts say can be understood only through the lens of politics.

From the beginning, Bolsonaro has set himself apart from virtually every world leader in his drive to play down the disease’s risks, his aversion to basic health measures, his skepticism of vaccines and his promotion of miracle cures.

As vaccine doses ran out across the country, and the federal government repeatedly scaled back how many it was expecting to import, Bolsonaro announced he was dispatching a delegation of top officials to Israel to investigate an untested nasal spray. “It even seems to be a miraculous product,” Bolsonaro declared last week.

Then, when daily deaths hit a record high, health systems faltered and local officials announced emergency restrictions, he seethed. He decried the restrictions on commercial activity.

“Stop with the fussing and whining,” he told an audience in Goiás state. “For how much longer will people all be crying? For how much longer will people stay at home and close everything? No one can take it anymore.”

She’s young, has no serious health conditions — and hasn’t left isolation since March

Bolsonaro retains the support of about 30 percent of Brazilians. Opinions of the president influence almost every pandemic decision. Some doctors prescribe medications touted by Bolsonaro despite scant scientific proof. Local leaders spurn calls to close businesses. The mayor of Duque de Caxias, a fierce supporter of Bolsonaro, waded through crowds of constituents waiting in vain for a vaccine — hugging people, mask dangling beneath his chin.

“Bolsonaro’s words are shocking and anti-scientific,” said Bernardo Mello Franco, a columnist at the newspaper O Globo. “But they are influencing a significant percentage of people in Brazil. They are sabotaging health measures, motivating people not to obey them, calling people who stay home a bunch of cowards.”

They have further polarized a divided country, leaving millions of Brazilians feeling unmoored. Many have had trouble reconciling the news of hospital failures and deaths with the scenes of indifference playing out in clandestine parties, packed bars and overflowing beaches. Even when Carnival was canceled across much of the country, some revelers found a way to attend mass parties.

“I expected things would be difficult in Brazil during the pandemic,” Drauzio Varella, a famed Brazilian doctor, wrote in the magazine Época. “But I never imagined we’d be living in such a savage fight, with parties, mass gatherings and the dissemination of the virus by people who don’t seem to care about the lives of their own family members.”

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