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14 April 2021updated 04 Sep 2021 8:45am

“A threat to the world”: Brazil’s Covid-19 tragedy

Lax lockdowns, a slow vaccine roll-out and the spread of a new Covid variant have resulted in the highest number of daily deaths in the world.

By Katharine Swindells

Brazil now has the highest number of daily coronavirus deaths anywhere in the world, with over 4,000 fatalities per day recorded twice this month, according to figures collated by Our World in Data, a project by Oxford University. 

The country’s total confirmed death toll from coronavirus now stands at over 350,000, the world’s second-highest, behind the US, which has a larger population. 

Brazil has the second highest Covid-19 death toll in the world
Cumulative confirmed Covid-19 deaths, by country

In March, the country recorded 89,984 excess deaths above the death-toll average during the same month from 2015 to 2019. That figure is over four times that recorded in the United States, a country with a population one and a half times the size. The number in neighbouring Peru was 3,740, a rate per capita nearly four times lower. 

 

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So how and why has the pandemic developed this way in Brazil? 

A number of factors are likely contributing to the virus’s rampant spread, including ta new variant of Covid-19 known as P.1, as well as a dysfunctional federal government response, headed by the president Jair Bolsonaro, which has resisted the implementation of most lockdown measures to curb the disease.

The following graphs unpack various facets of the crisis.

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The spread of the P.1 variant

The P.1 variant is thought to have first emerged in Brazil’s Amazonian city of Manaus late last year. It contains several worrying mutations, including E484K, which appears to provide the virus with some ability to avoid the immunity acquired through natural infection or vaccination. Several other lineages of Covid-19 have also developed E484K, including the South African variant – but P.1 includes two other mutations of particular concern, termed K417T and N501Y, which also modify the virus’s spike protein.

Despite estimates that perhaps 76 per cent of Manaus residents had antibodies linked to infection during the first wave, the city has been ravaged by a second wave of coronavirus thought to be linked to the emergence of the P.1 variant. 

The P.1 variant is now estimated to have over 80% prevalence in Brazil
Percentage of P.1-positive sequences with upper and lower confidence intervals, 7-day rolling average

 
“We are very sure that the huge number of cases is caused by this variant, because it is more transmissible. There is no doubt about this,” José Eduardo Levi, a researcher at the University of São Paulo, told the New Statesman. In São Paolo state, Brazil’s most populous, the arrival of P.1 displaced all other variants within a short space of time, demonstrating its higher transmissibility, he added. 

The prevalence of P.1 has grown considerably since its discovery in December 2020. It is now thought to represent an estimated 80 per cent of new cases across the country. It is also spreading out of Brazil into neighbouring countries, including Colombia and Chile, as well as farther afield, including a handful of confirmed cases in the US and UK. 

The Brazilian variant is still spreading into neighbouring countries
Cumulative prevalence of the P.1 variant in Brazil and other countries

Intensive Care Units filling up with the under 40s

By the middle of last month, Brazilian intensive care units (ICUs) were close to capacity, with only two states reporting occupancy below 80 per cent. Pressure on the hospital system is likely to have been sustained in the month since, as deaths and daily cases have stayed at a high rate. 

By mid-March, only two Brazilian states had below 80% occupancy in their ICU beds
Occupancy rates for ICU Covid-19 beds for adults in the Brazilian public health system on 16 March
Fiocruz Covid-19 Observatory

In addition, one recent study by the Brazilian Association of Intensive Medicine indicates that over half of ICU beds are now filled by patients aged 40 and under, a trend which some scientists believe may at least partly due to P.1. 

Over half of ICU patients in Brazil are aged under 40
Percentage of ICU patients, by characteristic

“A high number of cases among young people does not explain why, once they are infected, they face worse outcomes,” Levi said, adding that scientists may soon prove that P.1 is more lethal, including among younger patients, in addition to being more transmissible.  

A slow vaccination roll-out

Despite Brazil’s well-respected public health system, its vaccination programme has lagged behind even compared to other South American countries. As of 13 April, Brazil has delivered just 27 million doses, as shown on the New Statesman International Vaccine Tracker, which works out as 13 doses per 100 people, well behind Chile at 63 and Uruguay’s 30 per 100. 

 

In addition, over 40 per cent of the vaccine doses Brazil has purchased are of China’s Sinovac jab, according to the Duke University Global Health Innovation Center. The jab is now being produced in São Paulo, but is just 50.7 per cent effective against the P.1 variant, according to one study.

A lax lockdown

Bolsonaro has largely resisted lockdown measures, which he argues result in economic damage more harmful than the virus he once called “a little flu”. 

“We’re not going to accept these policies of ‘stay home, close everything, lock down,’” he said last week. “There’s not going to be a national lockdown. Our army isn’t going into the streets to force the Brazilian people into their homes.” 

Brazilian workers never stayed away from work as much as other countries
Percentage change in the number of visitors to workplaces, relative to the period before the pandemic, 7-day rolling average

Although some states and municipalities have implemented restrictions independently of the federal government, Google mobility data shows that the lack of a coordinated federal response has led many more Brazilians to move around compared to people in neighbouring countries. Brazilian workers have also not stayed away from work as much as in other nations, the data shows, with dips in activity around late December and early April likely related to the Christmas and Easter holidays.

Bolsonaro “prioritised economic openness versus lockdowns and downplayed the relevance of the virus”, Elena Lazarou, an associate fellow at the Chatham House think tank, told the New Statesman. “In a number of states, governors have had a very different approach to the federal government and of Bolsonaro particularly,” but were not given sufficient government funding to implement restrictions, she added. 

The lack of a coordinated federal response means that there are few travel restrictions between states, which contributed to the rapid spread of the P.1 variant, Levi said. “Manaus can only be reached by boat or by plane. Simply by restricting people from boarding without a PCR [Covid] test, we could have significantly restricted the spread of the P.1 variant.”

Without more vaccine doses the virus will likely continue spreading in Brazil, not only among the unvaccinated but also among those who have already been infected by other variants, creating an ideal petri dish for the emergence for further variants of concern, Levi said, adding: “Brazil represents a threat to the world.” 

[See also: Everything you need to know about the Brazilian Covid-19 variant]