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Brazil, Once a Leader, Struggles to Contain Virus Amid Political Turmoil Brazil, Once a Leader, Struggles to Contain Virus Amid Political Turmoil
(3 days later)
Thronged banks. Packed subway cars. Buses full of President Jair Bolsonaro’s fervent supporters, heading to rallies that call on Brazilians to brush aside stay-at-home orders from mayors and governors and instead follow the president’s directive to get back to work.Thronged banks. Packed subway cars. Buses full of President Jair Bolsonaro’s fervent supporters, heading to rallies that call on Brazilians to brush aside stay-at-home orders from mayors and governors and instead follow the president’s directive to get back to work.
Scenes like these are a reflection of Brazil’s contradictory and chaotic response to the coronavirus pandemic, which was on glaring display on Friday when the health minister resigned — just weeks after his predecessor was abruptly fired following clashes with Mr. Bolsonaro.Scenes like these are a reflection of Brazil’s contradictory and chaotic response to the coronavirus pandemic, which was on glaring display on Friday when the health minister resigned — just weeks after his predecessor was abruptly fired following clashes with Mr. Bolsonaro.
The national confusion has helped fuel the spread of the disease and contributed to making Brazil an emerging center of the pandemic, with a daily death rate second only to that of the United States.The national confusion has helped fuel the spread of the disease and contributed to making Brazil an emerging center of the pandemic, with a daily death rate second only to that of the United States.
Public health experts say the disorderly approach has further saturated intensive care units and morgues and contributed to the deaths of scores of medical professionals as Latin America’s largest economy plunges into what may be its steepest recession in history.Public health experts say the disorderly approach has further saturated intensive care units and morgues and contributed to the deaths of scores of medical professionals as Latin America’s largest economy plunges into what may be its steepest recession in history.
The crisis facing the country stands in stark contrast to Brazil’s track record for innovative and nimble responses to health care challenges that made it a model in the developing world in decades past.The crisis facing the country stands in stark contrast to Brazil’s track record for innovative and nimble responses to health care challenges that made it a model in the developing world in decades past.
“Brazil’s could have been one of the best responses to this pandemic,” said Marcia Castro, a professor at Harvard University who is from Brazil and specializes in global health. “But right now everything is completely disorganized and no one is working toward joint solutions. This has a cost, and the cost is human lives.”“Brazil’s could have been one of the best responses to this pandemic,” said Marcia Castro, a professor at Harvard University who is from Brazil and specializes in global health. “But right now everything is completely disorganized and no one is working toward joint solutions. This has a cost, and the cost is human lives.”
Brazil had months to study the errors and successes of the first countries struck by the virus. Its robust public health care system could have been deployed to conduct mass testing and trace the movements of newly infected patients.Brazil had months to study the errors and successes of the first countries struck by the virus. Its robust public health care system could have been deployed to conduct mass testing and trace the movements of newly infected patients.
Its failure to act early and aggressively is at odds with the country’s ingenious approaches to past medical crises, health experts said.Its failure to act early and aggressively is at odds with the country’s ingenious approaches to past medical crises, health experts said.
After a surge in H.I.V. infections in the 1990s, Brazil offered free and universal treatment and pushed the pharmaceutical industry to lower costs. It threatened to disregard a Swiss drugmaker’s patent for an H.I.V. drug in 2001, and did so in 2007, manufacturing its own generic version and greatly reducing the prevalence of H.I.V.After a surge in H.I.V. infections in the 1990s, Brazil offered free and universal treatment and pushed the pharmaceutical industry to lower costs. It threatened to disregard a Swiss drugmaker’s patent for an H.I.V. drug in 2001, and did so in 2007, manufacturing its own generic version and greatly reducing the prevalence of H.I.V.
In 2013, Brazil vastly expanded access to preventive health care in poor areas by hiring thousands of foreign doctors, most of them Cuban. And to combat the Zika outbreak in 2014, Brazil created genetically modified mosquitoes that helped decrease the insect’s population, a tactic that will soon be deployed in Florida and Texas.In 2013, Brazil vastly expanded access to preventive health care in poor areas by hiring thousands of foreign doctors, most of them Cuban. And to combat the Zika outbreak in 2014, Brazil created genetically modified mosquitoes that helped decrease the insect’s population, a tactic that will soon be deployed in Florida and Texas.
Brazil’s prior success resulted from investment in science and empowerment of scientists, said Tania Lago, a professor of medicine at Santa Casa University in São Paulo, who worked in the ministry of health in the 1990s.Brazil’s prior success resulted from investment in science and empowerment of scientists, said Tania Lago, a professor of medicine at Santa Casa University in São Paulo, who worked in the ministry of health in the 1990s.
“Now there’s been a rupture in the nation with its scientific community,” she said. “What saddens me is that we are and will continue to lose lives that could be saved.”“Now there’s been a rupture in the nation with its scientific community,” she said. “What saddens me is that we are and will continue to lose lives that could be saved.”
As countries started taking drastic measures to curb the spread of the virus in February and March, Mr. Bolsonaro played down the risks and encouraged public gatherings. Now, he is urging Brazilians to return to work even as the number of new cases and deaths are spiking.As countries started taking drastic measures to curb the spread of the virus in February and March, Mr. Bolsonaro played down the risks and encouraged public gatherings. Now, he is urging Brazilians to return to work even as the number of new cases and deaths are spiking.
This past week, the president issued an executive order classifying gyms and beauty salons as essential businesses that should reopen.This past week, the president issued an executive order classifying gyms and beauty salons as essential businesses that should reopen.
“Health is life,” he said. As with some of his other decisions related to the pandemic, it went against state and local measures, and caught the health minister by surprise.“Health is life,” he said. As with some of his other decisions related to the pandemic, it went against state and local measures, and caught the health minister by surprise.
As of Saturday, Brazil had 233,142 diagnosed cases of coronavirus and 15,633 deaths. But the actual death toll is likely to be much higher, according to death records compiled by Fiocruz, a government institute that studies health care trends.As of Saturday, Brazil had 233,142 diagnosed cases of coronavirus and 15,633 deaths. But the actual death toll is likely to be much higher, according to death records compiled by Fiocruz, a government institute that studies health care trends.
Between Jan. 1 and May 9, official government figures say 10,627 people died in Brazil of Covid-19, the disease caused by the coronavirus.Between Jan. 1 and May 9, official government figures say 10,627 people died in Brazil of Covid-19, the disease caused by the coronavirus.
During that period, an additional 11,026 people who were not diagnosed with the coronavirus died from acute respiratory infections.During that period, an additional 11,026 people who were not diagnosed with the coronavirus died from acute respiratory infections.
That number is several thousands more than the average number of deaths from respiratory ailments in recent years, said Marcelo Gomes, a researcher at Fiocruz. He said he suspected a significant percentage of those patients died from undiagnosed coronavirus infections.That number is several thousands more than the average number of deaths from respiratory ailments in recent years, said Marcelo Gomes, a researcher at Fiocruz. He said he suspected a significant percentage of those patients died from undiagnosed coronavirus infections.
Experts do not expect the epidemic to peak in Brazil for several more weeks. As of early May, it had the highest contagion rate of 54 countries studied by Imperial London College, which also found that existing containment measures in Brazil have failed to put transmission on a downward trajectory.Experts do not expect the epidemic to peak in Brazil for several more weeks. As of early May, it had the highest contagion rate of 54 countries studied by Imperial London College, which also found that existing containment measures in Brazil have failed to put transmission on a downward trajectory.
According to the Institute for Health Metrics and Evaluation at the University of Washington, the virus is on track to kill more than 88,000 people in Brazil by early August.According to the Institute for Health Metrics and Evaluation at the University of Washington, the virus is on track to kill more than 88,000 people in Brazil by early August.
Brazil’s Federal Council of Nursing said insufficient protective equipment and punishing workloads have exposed thousands of medical professionals to the virus, leaving hospitals understaffed.Brazil’s Federal Council of Nursing said insufficient protective equipment and punishing workloads have exposed thousands of medical professionals to the virus, leaving hospitals understaffed.
“Because salaries are low, most work in two places, some three,” said Manoel Neri, the president of the council. “This is a longstanding problem in Brazil.”“Because salaries are low, most work in two places, some three,” said Manoel Neri, the president of the council. “This is a longstanding problem in Brazil.”
The council said at least 116 nurses and medical technicians have died from confirmed or suspected coronavirus cases in recent weeks. Nearly 15,000 have developed symptoms, but many have been unable to get tested.The council said at least 116 nurses and medical technicians have died from confirmed or suspected coronavirus cases in recent weeks. Nearly 15,000 have developed symptoms, but many have been unable to get tested.
Jacqueline, a 37-year-old nurse in Rio de Janeiro who contracted the virus along with her husband, also a nurse, said fear is pervasive among her colleagues.Jacqueline, a 37-year-old nurse in Rio de Janeiro who contracted the virus along with her husband, also a nurse, said fear is pervasive among her colleagues.
“We feel exposed,” said Jacqueline, who asked to be identified by first name only because she fears reprisals from her employer. “You look around and people are crying because they’re fearful of taking the virus to our families.”“We feel exposed,” said Jacqueline, who asked to be identified by first name only because she fears reprisals from her employer. “You look around and people are crying because they’re fearful of taking the virus to our families.”
The political turmoil that has whiplashed the health ministry over the past few weeks has further hurt the country’s ability to prepare for the pandemic.The political turmoil that has whiplashed the health ministry over the past few weeks has further hurt the country’s ability to prepare for the pandemic.
Updated June 5, 2020 Updated June 12, 2020
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.
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.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.
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.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.
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.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.
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.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.
Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home.Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home.
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.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.
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.
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.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.
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.)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.)
Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications.Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications.
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.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.
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.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.
If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.
The health minister, Nelson Teich, resigned on Friday, just days shy of completing a month on the job.The health minister, Nelson Teich, resigned on Friday, just days shy of completing a month on the job.
Mr. Bolsonaro fired his predecessor, Luiz Henrique Mandetta, after the two clashed over the president’s disdain for quarantine measures.Mr. Bolsonaro fired his predecessor, Luiz Henrique Mandetta, after the two clashed over the president’s disdain for quarantine measures.
In an interview, Mr. Mandetta said Brazil’s “erratic” response to the pandemic left it ill-equipped to compete in a global scramble for ventilators, tests and protective equipment for medical personnel.In an interview, Mr. Mandetta said Brazil’s “erratic” response to the pandemic left it ill-equipped to compete in a global scramble for ventilators, tests and protective equipment for medical personnel.
“Our challenge is to expand health coverage while competing with the absurd spending power of the United States and Europe,” he said.“Our challenge is to expand health coverage while competing with the absurd spending power of the United States and Europe,” he said.
Flávio Dino, the governor of Maranhão State, said the federal government has been an obstacle as state officials have shopped for ventilators and put up field hospitals. The state capital, São Luís, was the first in the country to impose a strict lockdown this month, requiring everyone other than essential workers to stay home.Flávio Dino, the governor of Maranhão State, said the federal government has been an obstacle as state officials have shopped for ventilators and put up field hospitals. The state capital, São Luís, was the first in the country to impose a strict lockdown this month, requiring everyone other than essential workers to stay home.
“At the national level, there wasn’t a plan to prepare for this trying month of May,” he said. He called the firing of Mr. Mandetta a setback. “You don’t change the crew of an airplane mid-flight.”“At the national level, there wasn’t a plan to prepare for this trying month of May,” he said. He called the firing of Mr. Mandetta a setback. “You don’t change the crew of an airplane mid-flight.”
The impoverished State of Amazonas, in the north, has seen its hospitals overloaded and its cemeteries resorting to mass graves in order to cope with the deluge of bodies.The impoverished State of Amazonas, in the north, has seen its hospitals overloaded and its cemeteries resorting to mass graves in order to cope with the deluge of bodies.
Arthur Virgílio Neto, the mayor of Manaus, the state capital, has cried during televised interviews as he pleaded for federal assistance. Mr. Bolsonaro, with his disregard for social distancing and other preventive measures, has been part of the problem, Mr. Virgílio said.Arthur Virgílio Neto, the mayor of Manaus, the state capital, has cried during televised interviews as he pleaded for federal assistance. Mr. Bolsonaro, with his disregard for social distancing and other preventive measures, has been part of the problem, Mr. Virgílio said.
“People never stopped roaming the streets; there has been flagrant disregard for our decrees,” he said, blaming Mr. Bolsonaro. “He is against social distancing, and that explains part of the disobedience.”“People never stopped roaming the streets; there has been flagrant disregard for our decrees,” he said, blaming Mr. Bolsonaro. “He is against social distancing, and that explains part of the disobedience.”
Facing mounting criticism, the Bolsonaro administration, which declined to comment, launched a campaign this past week that highlighted the president’s concern over the economy, which is projected to contract by at least 5 percent this year.Facing mounting criticism, the Bolsonaro administration, which declined to comment, launched a campaign this past week that highlighted the president’s concern over the economy, which is projected to contract by at least 5 percent this year.
“Those lockdowns, they’re not the path — they’re the path to failure,” Mr. Bolsonaro said on Thursday, addressing supporters outside the presidential palace. He added, disparagingly, “It will turn into a country of misery, like a country in sub-Saharan Africa.”“Those lockdowns, they’re not the path — they’re the path to failure,” Mr. Bolsonaro said on Thursday, addressing supporters outside the presidential palace. He added, disparagingly, “It will turn into a country of misery, like a country in sub-Saharan Africa.”
Ms. Castro, the Harvard professor, said the government’s failure to mount an effective response is likely to lead to a series of outbreaks that will do more damage to the economy in the long run.Ms. Castro, the Harvard professor, said the government’s failure to mount an effective response is likely to lead to a series of outbreaks that will do more damage to the economy in the long run.
“How can you promote economic growth if your population is sick?” she said. “A sick work force can’t work.”“How can you promote economic growth if your population is sick?” she said. “A sick work force can’t work.”