COVID-19 outbreak in Brazil

More than a year into Brazil’s COVID-19 emergency, there is still no effective, centralised and coordinated public health response to the outbreak. The lack of political will to adequately respond to the pandemic has led to the unmitigated spread of COVID-19, killing Brazilians in their thousands. As of June, more than 500,000 people in Brazil have died from COVID-19. 

From January to April this year, more than 28,000 people died waiting for a bed in intensive care, with between 70,000 and 100,000 people falling ill with COVID-19 each day at the height of the outbreak. Brazil’s COVID-19 crisis is a humanitarian crisis of enormous proportions, with significant impacts on those most vulnerable. 

THE CURRENT SITUATION 

Twelve months into the pandemic, Brazil still has not developed a broad strategy for testing and contact tracing aimed at containing COVID-19. With Brazil's prestigious but battered universal health system near collapse, clear public health guidance—including the use of masks, social distancing, and the reduction of non-essential activities and mobility—is urgently needed to reduce coronavirus transmission.  

In hospitals across the country, a lack of oxygen and the sedatives used in intubation procedures are increasing the risks of patients dying from suffocation, unable to receive adequate treatment. There are also regular shortages of adequate personal protective equipment for staff.  

Doctors, nurses and other front line health professionals are beyond exhausted and many are suffering from psychological and emotional issues including burnout, anxiety and depression. Many are also falling ill with COVID-19. More than 700 health workers have died since the pandemic began, with more dying daily.  

Brazil does not have the volume of COVID-19 vaccines required to avert a catastrophe, and the Brazilian population remains fertile ground for the emergence of new variants of COVID-19. So far 92 variants have been identified across the country, including the highly contagious P1 variant, which is spreading throughout the region.  
 

With health staff falling ill and being diverted to care for patients with COVID-19, services like ante-natal care for expectant mothers, regular cancer screenings and emergency trauma care are being neglected. As a result, patients for non-COVID-19 concerns face long waiting times and sub-optimal care, as well as the increased risk of contracting the virus by being in healthcare facilities.  

THE IMPACT OF MISINFORMATION  

Fear of contracting the virus and the rampant spread of misinformation have led many in northern Brazil to rely on the ‘COVID kit’—a drug cocktail promoted by Brazilian authorities as both a preventative measure and treatment. The medication includes hydroxychloroquine (an anti-malarial medication), ivermectin (an anti-parasitic), and some antibiotics.  

As clinical studies have not shown any effectiveness of the kit in either preventing or treating COVID-19, those that take them have a false sensation of security, believing they are protected from the virus. This not only may lead to risk taking behaviour like ignoring social distancing, but when these patients fall ill with COVID-19, they tend to come late to health facilities, often already in severe or critical condition. 

“Some people say they are taking higher doses than prescribed, and for a longer period, believing that this way they are protected against the new variants,” says Jamila Costa, an MSF nurse responding in northern Brazil. “There are parents who give them to their small children. 

“Our duty is to keep working every single day so that preventive measures against the disease that actually work, like hand washing, using masks and social distancing, are understood and followed in the community.”

In locations where MSF works, the vast majority of patients in serious or critical condition were taking these medications when they fell ill. There are media reports of doctors being intimidated and threatened for refusing to prescribe such medications or speaking out about the mismanagement of the COVID-19 response in Brazil.  

“The COVID-19 response in Brazil needs to start in the community, not the ICU,” says Meinie Nicolai, MSF General Director. “Not only must medical supplies reach where they are needed, but the wearing of masks, physical distancing, strict hygiene measures and the restriction of non-essential movement and activities must be promoted and implemented in the community.”  

HOW MSF IS RESPONDING 

Since April 2020, MSF's dedicated COVID-19 teams have worked in eight Brazilian states and supported more than 50 health facilities, focusing on caring for the most vulnerable members of the community.    

We have expanded our focus to support health facilities that are fragile and do not have the capacity to provide care to the huge numbers of Brazilians who are falling ill.   

MSF is supporting local services to care for COVID-19 patients in northern Brazil, in the states of:  

• Rondônia – In mid-March we started activities in Rondônia’s capital, Porto Velho, with medical support and training in five emergency care units. Such facilities now keep patients, from moderate to critical, for long periods, as overcrowded hospitals cannot accommodate them. We also began working in the state’s second city, Ji-Paraná, where the local 75-bed COVID-19 facility is overcrowded, understaffed and poorly supplied.        
   
• Roraima – we are providing training to health professionals in Pacaraima and Caracaraí to improve care for patients.        
   
• Amazonas – we are providing mental support for health care workers from the biggest public hospital and an emergency care unit in Manaus.