Coronavirus in Brazil: What You Need to Know

Latin America became the epicenter of the coronavirus pandemic in late May, largely driven by Brazil’s ballooning caseload, as the number of infections in the United States and Europe fell.

In recent weeks, Brazil has reported upward of 1,000 new deaths a day from Covid-19, the disease caused by the coronavirus, eclipsing the death toll in every country other than the United States. On June 19, the country reported 54,771 new cases, the biggest one-day total for any country hit by the pandemic. If the trend lines hold, some epidemiologists project the death toll of the epidemic in Brazil could surpass that in the United States by late July.

The country’s response to the crisis has been widely criticized at home and abroad. President Jair Bolsonaro has dismissed the danger posed by the virus, sabotaged quarantine measures adopted at the state level and called on Brazilians to continue working to keep the economy from collapsing.

Even as the country’s coronavirus crisis worsened in recent weeks, some major cities eased preventive measures in mid-June. Shopping malls have begun to reopen in São Paulo and Rio de Janeiro. Beaches are starting to draw crowds again, even as some hospital systems are close to running out of intensive care beds.

Brazil declared a public health emergency in early March, just a few days after the World Health Organization did. The Ministry of Health urged state officials to cancel public events and put social-distancing measures in place.

Some experts thought Brazil was well equipped to rise to the challenge, based on its track record during past public health emergencies. Brazil had months to study the responses of the first countries hit by the virus, and it has a public health care system that, while underfunded, provides robust coverage across the country.

But the country’s response quickly went awry, with efforts by state governments to combat the virus often at odds with the positions adopted by the president. Mr. Bolsonaro pressured public health officials to do away with social distancing recommendations, calling Covid-19 a “cold.” He touted the use of hydroxychloroquine as the solution to the crisis. On Monday, the U.S. Food and Drug Administration said it was revoking emergency authorization of the drug to treat Covid-19 in hospitalized patients, saying that it and chloroquine are “unlikely to be effective” and could carry potential risks.

Mr. Bolsonaro’s cavalier response to the pandemic pitted him against governors and against officials at the Ministry of Health, who were urging people to stay home to the extent possible. Two health ministers left after clashes with Mr. Bolsonaro, one fired and one quitting, leaving a military general with no public health training in charge of the response.

The conflicting messages from the government, experts say, left Brazilians uncertain about the merits of isolation measures, which led to low compliance. That in turn led to Brazil’s contagion rate being one of the highest in the world.

The Ministry of Health has yet to present a comprehensive plan to fight the virus. One of its main initiatives has been boosting the production of hydroxychloroquine and encouraging doctors in the public health care system to prescribe it.

Brazil has struggled to import essential and lifesaving equipment, like coronavirus tests and ventilators. The lack of tests has made it difficult for officials to understand in real time where and how fast the virus is spreading. Experts believe Brazil’s official coronavirus figures significantly undercount the scope of the problem.

Between Jan. 1 and June 6, 23,171 people who were not diagnosed with the coronavirus died from acute respiratory infections, according to data released by Fiocruz, one of Brazil’s state-run health research institutes. Experts believe most of them died from Covid-19.

To ease the economic pain, Brazil offered three monthly installments of $120 to $240 to people who lost their income as a result of the pandemic. That program has been marred by widespread allegations of fraud and by the difficulty many eligible people experienced in accessing the funds. It is unclear whether there will be additional payments.

Brazil’s chaotic response has deepened political polarization among supporters and critics of the president. Hospital systems have largely coped with the crush of patients, but the virus has taken a devastating toll on health care workers. Dozens of nurses and hospital technicians have died after contracting the virus at work.

In the deeply unequal country, some groups have been hit worse than others. According to a United Nations report, black people in the state of São Paulo are 62 percent more likely to die from the virus than white people.

  • Updated June 16, 2020

    • I’ve heard about a treatment called dexamethasone. Does it work?

      The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth.

    • What is pandemic paid leave?

      The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave.

    • Does asymptomatic transmission of Covid-19 happen?

      So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.

    • What’s the risk of catching coronavirus from a surface?

      Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.

    • How does blood type influence coronavirus?

      A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.

    • How many people have lost their jobs due to coronavirus in the U.S.?

      The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.

    • Will protests set off a second viral wave of coronavirus?

      Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission.

    • My state is reopening. Is it safe to go out?

      States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.

    • What are the symptoms of coronavirus?

      Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.

    • How can I protect myself while flying?

      If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)

    • Should I wear a mask?

      The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.

    • What should I do if I feel sick?

      If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.

Poor Brazilians who get sick are less likely to receive high quality health care. Although most public hospitals are operating near full capacity, several private hospitals have plenty of room to spare. The death rate in poorer cities has been substantially higher than the rate in rich ones.

The pandemic has exacerbated several of Brazil’s chronic problems. Deforestation in the Amazon rainforest has surged, and the police have continued killing scores of people in Rio de Janeiro’s low-income communities.

Brazil’s economy is expected to contract by 8 percent this year, and capital flight is reaching levels not seen since the 1990s, when the country was grappling with hyperinflation.

And as Brazil reels from its worst crisis in decades, Mr. Bolsonaro and his allies are using the prospect of military intervention to protect his grip on power.

There are some signs that the outbreak in Brazil is starting to stabilize. A study by the Imperial College London estimated that Brazil’s contagion rate reached 1.05 this week, down from 2.8 in April. The current rate means every 100 people who are contaminated infect another 105. The outbreak is only considered to be under control when the contagion rate is bellow 1.

“The rise is not as exponential as it was previously,” Michael Ryan, the World Health Organization’s executive director, told reporters on Wednesday. “[But] the disease can take off again.”

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