As the second winter of the pandemic rolls in, the COVID-19 situation in Brazil is again deeply concerning, with national and international experts warning of a third devastating wave. The response remains fragmented and decentralised and the central authorities continue to disregard science, and the importance of masks and social distancing, in their health messaging.
Brazilians now account for over 500,000 COVID-19 deaths and the average daily COVID-19 fatality rate has crept above 2,000 people a day for the first time since May. Likewise, the number of new cases has also rise to more than 70,000 a day. This is not far from the highest average of more than 77,000 per day reached during the peak of the second wave in early May.
“In Brazil’s case, it is hard to say if we are starting a new wave, because the truth is that there has never been a substantial drop in cases since the beginning of the pandemic," says Antonio Flores, MSF infectious disease specialist. He explains that what we have seen so far are cycles—after a peak, there is a moderate fall, and then a stabilisation at a high plateau before cases start rising again.
“Throughout the pandemic, Brazil has been in almost continuous danger of having an acceleration of cases and deaths."
"It is hard to say if we are starting a new wave, because the truth is that there has never been a substantial drop in cases since the beginning of the pandemic."
The arrival of winter brings further complications. Usually, the cooler weather brings with it a rise in cases of the common flu and other respiratory diseases. As people become infected with these illness at health facilities, a health system that is already under pressure due to COVID-19 will be further strained.
Despite the challenges, as the virus continues to spread MSF teams across the country are finding new ways to help the most vulnerable communities in the most disadvantages areas of Brazil. The teams are based in the remote north and northeast of the country, where access to health services is more difficult, as consequence of a number of different factors.
Responding in Portel, Pará
On Ilha do Marajó (Marajo Island), MSF is supporting health authorities in the city of Portel, where, due to the extreme remoteness of the community and lack of infrastructure including roads, the system is struggling to face the COVID-19 pandemic.
MSF teams have run trainings in both primary and secondary level health facilities, as well as in the only hospital in the whole area, to improve patient flows, COVID-19 protocols, health promotion messages and mental health amongst the health staff.
“Our objective is to reach Portel’s most vulnerable and provide them with the health care they need and to strengthen the health system. We want local doctors and nurses to be prepared as much as possible for an influx of COVID-19 patients should the third wave hit the area”, said Juan Carlos Arteaga, MSF project coordinator in Portel.
The teams are also running mobile clinics to care for patients in the most remote areas of the region. They will provide COVID-19 antigen testing, primary health services, follow-up for recovered COVID-19 patients, mental health services and continue the health promotion activities in the area.
Responding in Fortaleza, Ceará
In the capital city of the state of Ceará, MSF staff is working in the communities of José Walter and Grande Bom Jardim where the community struggle to get the health care they need.
“In these communities' access to health care is notoriously difficult”, says Daniela Cerqueira Batista, MSF’s project coordinator in Fortaleza. We are in constant communication with community leaders and they are really happy to that we are offering services that they really need.”
MSF’s two mobile clinics provide health care close to home and aim to increase the number of high-quality services for the community. As in Portel, each day teams conduct rapid antigen testing for COVID-19, at home follow-up for COVID-19 patients with comorbidities, mental health services, support the COVID-19 vaccination registration programme and run health promotion activities.
The team is preparing also a comprehensive medical response in the state of Paraiba.
Responding in Bahia
MSF teams are working in the cities of Cocos, Xique-Xique and Riachão das Neves, whilst closely monitoring the COVID-19 situation in other municipalities. With a skilled and experienced team, they are supporting the municipal health secretariat´s health facilities to get them ready for the expected third wave. MSF medical staff are conducting trainings to improve COVID-19 protocols and patients´ flows along with mental health services for the staff working in those units. As in other areas of the country, COVID-19 has taken a terrible toll on the mental health of those who care for the most severely affected patients and deal with incredible amounts of deaths.
In order to build capacity in the fight against COVID-19, MSF is implementing a decentralized testing policy with antigen rapid testing and at home follow up of high-risk patients in order to facilitate the quick initiation of oxygen therapy. “We want to empower the local health system, so that they can give patients the highest quality of care possible”, said Fabio Biolchini, MSF head of mission in Brazil. “We are also supporting local authorities to deliver accurate health promotion messages to the communities, using science to explain how they can best take care of themselves and avoid the huge amount of misinformation in community.”
Meanwhile, the path of the pandemic remains uncertain in Brazil due to the lack of a centralised and coordinated response which has clearly compromised efforts to fight the disease.
“This lack of coordination and strategic actions by the authorities reflects in the absence of a sustained control of the epidemic," says Flores. "The virus has always been circulating freely."