Brazil’s Disastrous COVID-19 Response Exposes Profound Inequalities

SÃO PAULO and BRASÍLIA — Brazil’s death toll from the coronavirus surpassed Italy’s on Thursday after the nation’s health ministry reported 1,437 deaths in the previous 24 hours. The latest grim data was released three hours later than usual and came too late for evening news bulletins.

Brazil has now reported 34,021 deaths from COVID-19 as of Saturday afternoon, trailing only the United States and the United Kingdom. With 30,925 new confirmed cases reported Thursday, the total number of infections reached 614,941, second only to the United States.

But experts consider the tally a significant undercount due to insufficient testing.

Since the beginning of the pandemic, Brazilian President Jair Bolsonaro has downplayed the coronavirus, criticizing social distancing measures and urging regional governments to lift restrictions for the sake of the economy.

On Tuesday, Bolsonaro told Brazilians that death is “everyone’s destiny.” The impact of COVID-19 on Brazilians, however, has been far from equal.

From prevention measures and testing to access to health care and mortality rates, the virus is having a disproportionate impact on Brazil’s poorest and most vulnerable.

According to official figures from the Ministry of Health, coronavirus-related deaths have occurred at a higher rate in the north and the northeast of the country, regions that have a much lower GDP per capita than the rest of Brazil.

In seven regions of the state of Amazonas in the north ― which include Manaus, the capital — there are around 300 deaths per million people. Among the capitals, Belém, in the northern state of Pará, has the highest rate: 1,016 deaths per million. São Luís and Recife are also hard hit by the disease. These numbers are much higher than the national average of 155 deaths per million.

São Paulo, the country’s biggest city and the epicenter of the epidemic in Brazil, also shows how the poor are more likely to die from COVID-19. According to data collected up to April 21, there were more cases in the poor neighborhoods of Brasilândia, Sapopemba and São Mateus than in all 14 districts in central São Paulo.

The mortality rate is also higher among the Black population.

According to a recent study, Black people who lacked a formal education were 4 times more likely to die from the coronavirus than white people with a higher education. Among Brazilians with the same level of education, Black people were still 37% more likely to die from the coronavirus than white people.

The coronavirus is also spreading fast through Brazil’s Indigenous populations, with total deaths caused by the disease increasing more than fivefold in the past month, from 28 at the end of April to 182 on June 1, according to data collected by a national association of first peoples.

These numbers reflect underlying issues that range from access to clean water to the difficulty of maintaining isolation.

Almost 35 million Brazilians do not have access to clean water, including residents of 22 of the country’s 100 biggest cities, according to data from the National Water Agency. Without water, it is impossible to wash your hands, one of the most basic measures to contain the spread of the coronavirus.

“This is the result of our social inequality. Epidemics bring [social] differences to the forefront and also the lack of support from the government,” José Cássio de Moraes, an epidemiologist at the Brazilian Association of Public Health, told HuffPost Brazil. “Lack of clean water, no money to buy soap or hand sanitizer, the impossibility of being in isolation — these are all perfect conditions for the spread of respiratory diseases.”

In favelas and other vulnerable communities, hygiene essentials are difficult to come by, and social isolation is impossible.

“We are collecting donations and giving out basic hygiene items, because some families simply can’t afford them,” says Samantha Messiades, a member of the residents association for Cidade de Deus, one of Rio de Janeiro’s biggest favelas. “The other day I collected hygiene items for a friend of my neighbor. She has COVID-19, is completely isolated and did not have access to essential items.”

Raquel Rolnik, a professor of architecture and urbanism at the University of São Paulo, said that inequality is stark within Brazilian cities. “We’re talking about millions of people without access to basic stuff. From the homeless, who have no access to a tap with running water, to many people who see water coming out of the tap infrequently.”

Rolnik says the country must do more to support vulnerable groups. “Not only protecting them from the pandemic, because social isolation means economic hardship. We’re talking about people going hungry.”

The loss of income has immediately been felt in the poorer neighborhoods of big cities, where many of those who rely on the informal economy (such as street vendors) live. At least 38.3 million Brazilians do not have formal employment contracts, but take part in the country’s large informal job market.

Moraes, the epidemiologist, says that this is the hardest hit population. “Working from home is not an option for these people. We need financial support from the government to mitigate the impact of the pandemic.”

“We from the favelas are the first to be affected. It’s almost like we’re disposable. It’s very sad,” says Messiades, from Cidade de Deus.

“Everyone around here knows someone who no longer has income. There are manicurists, hairdressers, people who bake items at home to sell — none of them can work. Also, people who collect soda cans for recycling, people who watch cars, who work selling stuff on the beach. They are not making any money.”

Messiades’ mother is one of them. She works cleaning houses in the fancy neighborhood of Barra da Tijuca. “She works informally, so they stopped calling, she’s not being paid. I try to help,” Messiades says. “In addition, I used to be an apprentice for a lawyer that works here [in the favela], but she had to let me go because there’s no demand.”

With two kids, ages 6 and 11, Messiades says she’s uncertain about her future. “The father of my daughter works at a restaurant; the father of my son makes deliveries. Both jobs are impacted by the pandemic. It’s an avalanche, a domino effect. Companies are the first pieces to fall, followed by everyone else.”

The situation is the same in other big Brazilian cities. In Cidade Estrutural, one of the poorest neighborhoods of Brasília, the capital of Brazil, unemployment is the only subject of conversation.

“Everyone is worried. Our health is fragile, because our diet is fragile,” says Coracy Coelho, a resident of the neighborhood.

He says that people don’t want to be stuck at home. “Without work, everyone needs to rely on social programs. A lot of people depend on Bolsa Família [an assistance program run by the federal government]. Some had issues with the application process and are very anxious about it, because it is the only income source for the family,” says Coelho.

In April, the federal government announced that millions of Brazilians would be eligible for an emergency fund — 600 reais ($115) for informal sector workers and 1200 reais ($235) for mothers. The program has had some issues and delays, but now the government says 59 million people have received at least part of the money.

There is also a huge disparity in how COVID-19 has been diagnosed. According to the preprint version of one study, which HuffPost Brazil obtained, economic inequality played a major role in limiting access to tests during the first phase of the coronavirus epidemic in Brazil.

According to the study, two-thirds (66.9%) of the tests in São Paulo and Rio de Janeiro until March 25 were taken in private labs. The cost of a test was between 300 and 690 reais ($60-$130).

Up to then, four weeks after the first confirmed case of the coronavirus in the country, 67,344 other suspected cases were reported in 172 cities.

“There was a clear link between testing and income, which revealed a big socioeconomic gap in testing as the number of cases grew,” the study says.

There was also an increase in the correlation between tested cases and income in the second, third and fourth weeks of the pandemic, according to the research.

The authors of the study say the socioeconomic barriers to testing must be addressed in order for Brazil to understand and stop the spread of the coronavirus. Universal access to testing and the success of interventions will be the keys to the fate of the pandemic in Brazil.

“Along with changes in surveillance guidelines, the socioeconomic bias in testing suggests that the number of confirmed cases can substantially underestimate the actual number of cases in the population,” the study says.

Today, Brazil counts more than 600,000 cases and 34,000 deaths, and testing capacity has been expanded.

The federal government claims to have distributed more than 3 million tests that detect the presence of virus to state labs. More than 1.8 million tests have been taken, including serological tests — or 8,737 exams per million.

“Look at this paradox: People dying in hospital hallways while there are empty beds,” Francisco Braga, a researcher at the Oswaldo Cruz Foundation in Rio de Janeiro, one of Brazil’s top public health research institutions, told HuffPost Brazil, decrying the lack of resources in Brazil’s public health system.

In private hospitals in São Paulo, between 20% and 30% of beds remain open. These hospitals usually cater to people with private health insurance, which in most cases is part of an employee’s benefits package from their job.

“In Brazil, around 23% of the population has private insurance. In São Paulo, the percentage is 50%, while in some state capitals in the north and the northeast, it stays below 10%,” says Gonzalo Vecina Neto, a professor of public health at the University of São Paulo and superintendent of Sírio-Libanês, one of the biggest and better-equipped private hospitals in the city.

This regional disparity means that the burden on the public health care system is much greater in the country’s north and northeast regions. And it also explains why states like Amazonas have been on the verge of collapse for weeks due to the increasing number of COVID-19 cases.

Dealing with hundreds of patients with the new coronavirus is part of the routine for Uildeia Galvão da Silva, a doctor who has been working for 12 years in the emergency room of the main public hospital in Manaus.

She tells HuffPost Brazil that her life, and those of her fellow health care workers, “has been turned upside down” since the pandemic began.

“The day-to-day is wearing us out too much. This gets to you, physically,” says Silva, who, like many other health care professionals, has marks on her face due to wearing protective gear for hours on end. “Everything hurts. And the mask makes us distant [from patients].”

Seeing her patients struggling for life day after day, Silva says the past few weeks have been the hardest in her career.

“There were so many patients that we were unable to save in the last two months. This changes us a lot. It is something drastic and dramatic, even for those who have been working in the health sector for 25 years like me,” she says. “Knowing that you won’t be able to save one, two, three patients. … It hurts your soul.”

Marcella Fernandes reported from Brasília, and Grasielle Castro and Andréa Martinelli reported from São Paulo.