Covid 19: Brazil unarmed before the collapse of the health system (Le Monde, France)

“They killed my mother,” the 34-year-old Paula Ribeiro can’t calm down. The flow of words, punctuated with tears of despair and suffocating fury. April 22, the resident of Manaus, the largest city in the Amazon, and the epicenter distribution covid-19 in Brazil, lost his mother. She was a victim of the crisis and the collapse of the health system of the country.

Amalia fell ill in late March. She suffered from diabetes and hypertension. Pain, fever, fatigue, then cough and shortness of breath: the classic symptoms covid-19. “But the doctors, which we did, as the hospital refused to examine and treat my mother. They told us: “Too many people, go home. Come only in an emergency situation,” says Paula.

On April 22, as Amalia has deteriorated. She began to choke and was dying. “I called the ambulance, but they were already overloaded. In a panic, the family put the mother in the car and brought her to the emergency room at the hospital, Nilton-Lins. But this branch opened specifically for patients with covid-19, only accepts patients sent from other hospitals. Doctors are reluctant to accept patients that they already feel hopeless.

Heart-rending cries, the tears… ten minutes later the doctors started to Amalia, who was already unconscious. “She died two hours later, and they didn’t even do the test.” Paula said that the death certificate States that “the cause of death is not established”. “If she’s taken care of in time it could save. This is outrageous. What happened to my mother could happen to anyone”.

The epidemic is in full swing

At that time, as part of countries removes the quarantine in Brazil the epidemic is in full swing. As of may 17, the country officially was 241 000 confirmed cases, more than in Spain and Italy. The number of deaths now exceeds 16 000, and it has doubled in around ten days. This is the highest daily mortality in addition to the United States. And the peak is expected only in the month of June.

All the experts in a panic. According to doctors from the Brazilian centre Covid -19 in the country may be from 2.5 to 3.4 million infected, which is 15 times higher than the official data. According to the Royal College London, in Brazil, the world’s highest incidence. Each person in turn infects on average of 2.8 new people. Washington University expects to 193 000 victims by August.

In this critical situation and the lack of government response Jaira Bolsonaro local authorities have decided to tighten tone. In the cities of Fortaleza, Sao Luiz and Recife, announced a strict regime of isolation for the population. In Rio de Janeiro and Sao Paulo wearing of masks is mandatory. In some localities imposed a curfew, in others “sanitary barriers” at the entrance to the city. But all these measures are messy and poorly implemented, with 43% of the Brazilian population do not comply with requirements of isolation.

Niteroi is an exception

As the only positive example of the fight against the epidemic can result in niterói. It is a large city with a population of 500,000 people, located near Rio de Janeiro, across the Guanabara Bay. Here the local authorities have done everything possible from the beginning: a strict regime of isolation, police patrols on the streets, mandatory wearing of masks, disinfection of sidewalks, requisition of hotels, need a quick help to the most needy, sale of 40,000 tests, the closure of schools, parks, beaches and shops.

And all these measures work: may 17, Niteroi, there were only 65 deaths, with a mortality rate of 5.7%, which is twice lower than in Rio. “The results of competent management over the past 30 years,” says the mayor of Niteroi, Rodrigo Neves, who is proud of its achievements in health and education. “Brazil becomes the global epicenter distribution covid-19. I have no doubt that our example will be followed by other cities and will take more stringent measures,” continues the official.

But is it too late? According to daily newspaper in são Paulo, the number of intensive care beds for patients with covid-19 already exceeds 70%, at least 9 of the 27 Brazilian States, with a peak at 96% in Pernambuco (Nordeste) and 100% in Roraima (Amazonia).

Brazil powerless. In the country as at the front did not have enough ammunition, generals, and soldiers: they are ill-equipped and poorly protected. Since the beginning of the epidemic from covid-19 have already died 116 Brazilian doctors. According to the Ministry of health, almost 200,000 people showed symptoms of the disease. The same doctors and nurses are quarantined, and will be sorely missed during the peak of the epidemic.

The delay in purchasing equipment

The situation is compounded by the fact that the opening of new hospitals and acquisition of equipment far behind due to widespread bureaucracy and inadequate treatment methods. In the state of Rio were discovered only 4 of 9 field hospitals, promised by the local authorities. In some there is complete chaos. May 7, former Deputy Minister of state health, Gabriel Neves and three other persons were imprisoned on suspicion of fraud with the accounts for respirators, purchased by the region of 800 000 euros.

Initially, Brazil was the advantages to combat the pandemic: the powerful pharmaceutical industry, the experience of dealing with tropical epidemics, particularly the free and universal public health system, which cherishes the population. “But its resources are very limited, constantly short of funding,” explains Miguel Lago, Executive Director of the Brazilian Institute of research in the field of health. Brazil invests in health care 4% of its GDP compared to 8-10% in countries such as France or Germany, with similar health systems.”

According to the Brazilian Institute of research in the field of health, 72% of Brazilian regions, the number of intensive care beds, funded by the government, below the minimum recommendations of who (10 per 100 000 inhabitants). “In this context, local authorities will have no choice but to contract with wealthier private health services,” said Lago. It will cost nearly 10 billion euros, depending on the worst-case scenarios. “We are already in a terrible position. Now we need to avoid catastrophe,” said Lago.