What is the next step for Brazil in its fight against coronaviruses? | News from Brazil

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True to form, a maskless Brazilian president, Jair Bolsonaro, rode a police horse in a crowd in Brasilia this weekend, shaking hands with his supporters, again rejecting social distancing and other measures in place to stem the spread of the new coronavirus, which has killed at least 31,000 and infected more than half a million.

The scene followed similar incidents in the preceding weeks.

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” So what? Bolsonaro told a reporter in May that he was concerned about the growing number of deaths from coronaviruses in Brazil.

“I’m sorry but what do you want me to do about it?” “

Bolsonaro, a former army captain who called the virus a “small flu”, opposed social isolation measures imposed by state governors and called for wider use of antimalarials to treat COVID -19, in defiance of public health. experts warning of their potential health risks.

He continued to argue that protecting Brazil’s economy is the most important consideration, despite numerous national and international criticisms of its management of the epidemic – and a rapidly increasing death toll.

His open contempt resulted in the loss of two health ministers – one dismissed, the other resigned, after openly opposing the far-right leader on how to fight the spread of the pandemic of coronavirus.

Experts said the two sudden changes in leadership in the health ministry, compiled with Bolsonaro’s continued opposition to the closings, are already having devastating consequences for Brazil, a large developing country with widespread poverty and a underfunded public health system.

“The two ministers focused on implementing health policies in line with the public health guidelines of the World Health Organization (WHO), as well as Brazil’s own epidemiologists and experts,” said Anya Prusa, Senior Associate at the Brazilian Institute at the Wilson Center.

“But they ran into a government and a president who were not interested in developing a policy based on health guidelines,” Prusa told Al Jazeera. “He’s a president who focuses on the economy to the exclusion of everything else. “

People standing in front of a store in Rio de Janeiro, Brazil [Pilar Olivares/Reuters]

Last week, a study by the University of Washington warned that the death toll in Brazil could reach 125,000 in early August and urged the country to impose more stringent restrictions to reduce the rate of transmission.

“Brazil must follow the example of Wuhan, China, as well as Italy, Spain and New York by applying mandates and measures to take control of a rapidly evolving epidemic and reduce Coronavirus transmission, “said Christopher Murray, director of the university Institute of Metrology and Health Assessment (IHME).

“Until then, the IHME predicts that the death toll in Brazil will continue to increase, that there will be a shortage of critical hospital resources and that the peak of death may not occur before mid-July” said Murray.

The disastrous warnings are only compounded by a public health system that has been underfunded and strained for years. Health experts say that with the number of cases and the increased demand for intensive care unit (ICU) beds, it will be very difficult for hospitals to cope.

“Uneven system”

Brazil’s universal health system provides free care to the majority of its 212 million citizens. But the sprawling system is severely under-resourced and offers uneven health services across the country.

“We have a system where everyone has the right to health, everyone has the right to certain health services, but due to underfunding, the distribution is absolutely uneven,” said Miguel Lago, Executive Director from the Institute for Health Policy Studies.

“It is uneven geographically and in terms of social class,” added Lago.

Lago said more than half of the population lives in areas with insufficient numbers of intensive care beds – which is crucial in the treatment of severe COVID-19 cases.

Coronavirus infections in Brazil were initially limited to affluent neighborhoods and large cities in close contact with international travelers, but experts say the virus has recently entered poorer and more isolated areas – with devastating effects.

“COVID in Brazil has gone through the penthouse, but nowadays it goes through the dungeons,” said Ana Maria Malik, professor at the Faculty of Medicine at the University of Sao Paulo.

“The heterogeneity of the country means that people will die simply because they are poor or because they live in states where there is no infrastructure,” Malik said in a roundtable discussion. line on health care in Brazil last week.

Brazil Hospital

A patient with coronavirus disease is treated in the intensive care unit of a field hospital in Guarulhos, Sao Paulo state, Brazil [Amanda Perobelli/Reuters]

In the most remote parts of Brazil, such as the state of Amazonas, residents rely on philanthropic hospitals run by churches or charities.

Although the private healthcare sector – which treats millions of patients a year, but mainly in the big cities and wealthiest regions of the country – is better equipped, it too has been inundated with coronavirus patients, which puts hospitals and staff to the test.

“Our occupancy rate is very high,” said Joel Velasco, executive vice president of UnitedHealth Group, one of Brazil’s largest private hospital groups.

“We have some idle capacity, but not much,” said Velasco at an online health care roundtable in Brazil last week.

“All intensive care units are 80-85 percent [capacity], and in cities like Rio, it’s 90%, it means that there are no beds, that there is a waiting list for people to enter ICU “, has -he declares.

Relaxation of restrictions

Experts warn that the situation will only get worse as states ease blockages and stay at home.

Shopping centers, stores and real estate operations were allowed to operate for 15 days Monday as part of phase two of the reopening plan in the city of Sao Paulo, the largest city in Brazil and the city most affected by COVID-19 infections.

Observers said Sao Paulo, the country’s financial center, was facing increasing pressure to allow businesses to reopen after two months of loosely applied quarantine had an impact on the economy.

City Mayor Bruno Covas said the city meets all state criteria to move forward with softening restrictions and that the move will be based on clear protocols on hygiene and the tests.

He added that the city could only progress during the next stages of reopening if the indicators were maintained for 14 days.

“If the numbers get worse, we can go back to phase one,” Covas said at a press conference on Thursday.

Jair Bolsonaro

Brazilian President Jair Bolsonaro salutes his supporters during a demonstration in Brasilia, Brazil [Ueslei Marcelino/Reuters]

Experts fear that the continued outbreak of cases is inevitable.

Last week, the WHO declared that the Americas had become the new global epicenter of the virus, warning that Brazil would not see the end of the pandemic any time soon.

“Now is not the time for countries to loosen restrictions,” said Carissa Etienne, WHO director for the Americas during a video conference.

Filipe Carvalho, Brazilian analyst within the Eurasia group, said that the reopening plans come after local leaders had great difficulty in coordinating the response to the epidemic and in the absence of a stable team with a national plan .

Carvalho said that with the two leadership changes and a president at the helm who refused to follow health experts’ recommendations on social distancing let alone promote them, local leaders had to face a tough battle to impose bans – leading to a conflicting picture of the dangers of the virus and eroding compliance with quarantine measures.

“The danger is that you will increase the pressure on the healthcare system very suddenly and the states will be forced to close again,” Carvalho told Al Jazeera. “They would have this unpredictable stop and go scenario where cities would open up but would have to withdraw again because the numbers were rising too quickly again. “

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