SAO PAULO – Still far from the anticipated “peak” of the coronavirus but on the verge of the Southern Hemisphere’s winter, Brazil is heading towards a “perfect storm” of disease with the COVID-19 curve on the rise, the start of the flu season, the dengue season still under way and active outbreaks of other diseases that experts thought had been conquered, including measles.
While the intensive care units at local hospitals continue to fill up, President Jair Bolsonaro remains mired in a “political war” against the quarantine measures implemented by state governments and favors a return to normality.
Already having fallen in less than a month of that crusade are two health ministers – Luiz Henrique Mandetta, a staunch defender of quarantines, and Nelson Teich, who refused to recommend chloroquine for all coronavirus patients as the ultrarightist Bolsonaro had wanted.
The two men are physicians and now, with the coronavirus curve on an exponential increase, the health portfolio is in the hands – on an interim basis – of Eduardo Pazuello, an army general with no experience in the area.
As of Saturday, Brazil had registered a total of 233,142 confirmed coronavirus cases, surpassing both Italy and Spain, along with 15,633 deaths, thus proving itself to be one of the epicenters of the global pandemic.
The peak of the coronavirus wave here is expected in the coming weeks, although the virus will not be the only health emergency that Brazil’s fragile public health care system will have to confront.
The spread of the virus, which first hit Brazil in February, comes amid other infectious outbreaks that are already causing concern among health authorities.
The country is just now moving beyond the peak of the dengue curve, an illness transmitted by the Aedes aegypti mosquito, which is also the carrier of the Zika virus, yellow fever and chikungunya, which usually peak between April and May.
According to the Health Ministry’s latest bulletin, this year Brazil has experienced 676,928 probable dengue cases, a rate of 322 cases per 100,000 residents, and 265 people have died.
Starting in June, with the arrival of winter in Brazil, dengue cases inevitably subside, but those of the common flu and other respiratory diseases rise.
In 2019, Brazil, with its population of 210 million, registered 1,122 deaths from the three known types of influenza, according to official figures.
This year, the flu and dengue are coming in addition to COVID-19 and thus doctors face the problem of determining what a patient may be suffering from, since all three result in similar symptoms during the early days of infection.
“That combination is rather explosive,” Dr. Adriano Massuda, a professor of collective health at the private Getulio Vargas Foundation study center, told EFE.
Mauricio Lacerda, a researcher with the FAPESP foundation in Sao Paulo, works at the Sao Jose do Rio Preto Hospital and said that “the outlook is very bad” this winter.
“Here at the hospital we already have flu, COVID-19 and dengue patients, and we’ve had deaths from all three. It’s a very complicated situation” and the public health network is “too overloaded,” he told EFE.
To all this, one must add the outbreaks of the measles that continue all across the country.
So far this year, 2,910 measles cases have been reported, almost half of them in Para state, which is also one of those hardest hit by the coronavirus. Three people have died from the measles.
“The measles is returning to Brazil. There’s low immunization coverage and it can be one more problem (for us),” Massuda warned.
In 2019, 18,200 measles cases and 15 deaths were reported nationwide, 14 of the fatalities in Sao Paulo, which right now is Brazil’s epicenter for COVID-19.
The challenge for the SUS health care system, which includes the nation’s public hospitals on which 75 percent of Brazilians depend, will be enormous, and the situation will be even worse due to the chronic financing problem facing the sector.
Massuda said that the fiscal austerity policy, which was started during the 2016-2018 administration of Michel Temer and continued under Bolsonaro, has aggravated the situation.
According to reports by human rights organizations, since in late 2016 a controversial cap on budget expenditures was approved, Brazil has cancelled its investments of some 30 billion reais (about $5.17 billion) in the sector.
Although the problem dates back some time, according to those calculations, between 2007-2019 the lack of resources devoted to the health care sector has resulted in a reduction of 49,000 available hospital beds at intensive care units around the country.
“The laboratories of the public health system are dismantled and that’s not just from six months ago, it’s from 10 or 15 years ago. That set back the detection and diagnosis of the coronavirus and now hospitals are going to pay an enormous price,” Lacerda said.