The United States is clearly ground zero for the coronavirus outbreak at the moment, but the next one may already be emerging 4,500 miles south.
“Brazil is probably the next epicenter of the pandemic in the world,” Luciano Cesar Azevedo, a physician who has been spending his days and nights treating COVID-19 patients in intensive-care units in São Paulo, the country’s largest city, told me this week. “I think Brazil is going to get close to 100,000 deaths.” On the day we spoke, Azevedo noted that ICU beds in the city’s public health-care system were at 90 percent occupancy. He said Rio de Janeiro, whose health-care system is already seriously strained by the outbreak, could become Brazil’s New York.
Tom Inglesby of the Johns Hopkins Bloomberg School of Public Health notes that the country reported 3,700 new daily cases on April 23. Less than two weeks later, on May 6, new daily cases had more than tripled, to 11,896. The developments in Brazil “are really concerning,” Inglesby told me.
The nation of more than 200 million people has so far recorded fewer than 10,000 deaths from COVID-19, a small fraction of America’s death toll. But confirmed cases and fatalities are rapidly growing, each day leading to dismal new records and rendering Brazil the hardest-hit country in Latin America and one of the worst-off in the world. Flu season hasn’t even arrived yet (the Southern Hemisphere is heading into winter), and a dengue outbreak in the country may peak just as the coronavirus outbreak does. Inadequate testing means that Brazil’s official case count, which is already well over 100,000, could actually be as much as 10 times higher, according to Azevedo, who is also a professor of critical care and emergency medicine at the University of São Paulo, which runs a public hospital, and the head of education at Hospital Sírio-Libanês, a private facility. Brazilian President Jair Bolsonaro, one of the world’s leading coronavirus deniers, is pushing to ease social-distancing restrictions and reopen the economy, which could accelerate the spread of the virus. “We are only at the beginning,” Azevedo said.
Just as it has in countries such as the United States, the virus is also mixing toxically with Brazil’s ugliest underlying conditions—most significantly, its status as one of the most unequal countries on the planet. If COVID-19 initially seemed like an egalitarian affliction, upending the lives of everyone, everywhere, it has with time revealed itself to be a plague that often hitches a ride on social inequities. It disproportionately torments poor people who don’t have the luxury to social distance, to adhere to lockdowns, in some cases to even wash their hands, and who are more prone to the health risks associated with the virus. The cruel irony is that in several countries, including Brazil, the wealthy first brought the disease there, before retreating into self-isolation as it began ravaging the poor.
In Brazil, “the first wave of people infected were better off, with high purchasing power, who traveled abroad and returned with the virus,” Maria Laura Canineu, the Brazil director for Human Rights Watch, told me. “They were mostly white people who have access to tests and to private hospital services. But more recently, we’ve seen increasing numbers of infections, hospitalizations, and deaths among black people in the same manner that you guys have seen in the U.S.”
Black Brazilians are concentrated in poor, crowded urban neighborhoods, including the sprawling favelas in Rio de Janeiro and São Paulo, where Canineu is based. Many who live in these areas lack proper sanitation such as access to clean water, let alone soap or hand sanitizer. So the simplest and most consistent advice during the pandemic—wash your hands—isn’t necessarily practical for them. Some families live with 10 or 12 people in a single room, which makes social-distancing impossible. Many work in Brazil’s large informal sector (as, say, construction workers or street vendors) and must leave home to earn money, presenting them with an awful choice: Risk your health to protect your livelihood, or risk your livelihood to protect your health. These “are the perfect conditions for the spread of the virus,” Canineu said.
Residents of favelas, where about 13 million Brazilians live, also largely depend on the public health-care system, which is being battered by coronavirus cases. Chronic diseases such as diabetes, tuberculosis, and high blood pressure are especially prevalent among this population, putting them at higher risk for serious complications from COVID-19.
Gilson Rodrigues, the president of the residents’ association in São Paulo’s Paraisópolis favela, told me that public policies on COVID-19 don’t yet include “guidelines that take into account the reality of favelas.” In the absence of those, he helped found a national network of favelas that has hired its own doctors, enlisted its own fleet of private ambulances, manufactured its own masks, provided accommodation for those who can’t otherwise self-isolate, organized food deliveries, and offered financial assistance to self-employed professionals who have lost their jobs.
In Manaus, the capital of Amazonas state, the public health-care system is reeling from a surge in COVID-19 patients. Speaking about the bleak situation recently, Manaus’s mayor burst into tears on television. “Videos circulating on social media have demonstrated the desperation of families seeking urgent care, while bodies pile up next to patients in understaffed hospitals in Manaus,” Jocelyn Getgen Kestenbaum, an international-human-rights expert at Cardozo Law in New York, wrote in a recent analysis of Brazil’s predicament.
This “perfect storm” of public-health vulnerabilities, as Kestenbaum described it, is descending on Brazil just as it struggles with political paralysis at the highest levels of government. Bolsonaro, keen to jump-start the economy, is battling local officials and the courts to relax lockdowns. (“Some people will die,” he said. “That's life.”) The president is also mired in a scandal that could lead to his impeachment.
In a country where a quarter of the population lives in poverty, and one that is still recovering from a major recession even as it hurtles toward another economic collapse, the poor are being hit hard every which way—by the coronavirus and by efforts to contain it. As Brian Winter, the editor in chief of Americas Quarterly, memorably put it to me, “Street vendors can’t work from home.”
Kestenbaum argued that the Brazilian government’s actions are also indicative of the nation’s underlying inequities. Policy makers who can easily socially distance and have access to proper health care assess risk differently from “most of the individuals living in the country,” she told me. She argued that the only reason Brazilian officials have had to resort to such severe lockdown measures is because the government was so slow in rolling out testing and contact tracing to contain the outbreak. “Right now, we have to make sure that everyone stays healthy,” she said. “Healthy people equals a productive workforce, right?”
Canineu noted that millions of poor Brazilians have not been able to access a government benefit of about $100 a month to help tide them over, because of a lack of good internet, a lack of information about how the process works, or hiccups with the process itself. That includes her manicurist, an informal worker with two kids, who downloaded the necessary app and registered to receive the relief, only to be told for nearly two months now that her case is “under analysis.”
She “cannot go to work” and therefore “doesn’t have money to do anything,” Canineu said. “She is desperate.”