https://www.economist.com/the-americas/2021/03/27/brazils-mismanagement-of-covid-19-threatens-the-world

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[20210327_AMP001_0]

Fighting the P.1 variant
Brazil's mismanagement of covid-19 threatens the world

Jair Bolsonaro has a lot to answer for

The AmericasMar 27th 2021 edition
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Mar 27th 2021

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SeRGIO OLiMPIO GOMES, better known as Major Olimpio, was a policeman
who entered politics 15 years ago. In 2018 he managed the campaign in
the state of Sao Paulo of Brazil's current president, Jair Bolsonaro,
and was elected to the national Senate. On March 18th this year he
died of covid-19, aged 58. He is the third sitting senator to have
died from the disease. Nearly 4% of the legislature's upper house has
perished in the pandemic.

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That has brought home to the political class a shock that millions of
Brazilians are now experiencing. The country is suffering a second
covid wave far worse than the first. Its recorded death toll,
averaging over 2,300 a day, is a quarter of the world's total. This
is despite the fact that Brazil has less than 3% of the world's
people.

The health system is in a state of "collapse" for patients with
severe cases of covid-19, says a bulletin published on March 23rd by
Fiocruz, a public-sector research institute. In 25 of the 27 states
more than 80% of intensive-care beds are occupied. Eighteen states
have shortages of drugs such as neuromuscular blockers, used when
patients are put on ventilators. In six states oxygen supplies are
dangerously low, according to the health ministry. The National Forum
of Governors warns that shortages threaten to cause "a collapse
within the collapse".

[20210327_a]

Bahia, a state in Brazil's north-east, is experiencing "pressure",
not complete failure, says its health secretary, Fabio Vilas-Boas.
But that is bad enough. The number of patients needing oxygen has
"exploded". Some hospitals are treating covid-19 patients in
emergency rooms because their intensive-care units (ICUs) are full.

Brazil's second wave is thought to be mostly caused by a variant of
the novel coronavirus, called P.1, which was probably born in the
Amazonian city of Manaus. More contagious than the original, and able
to reinfect people who have already had covid-19, P.1 has alarmed not
just Brazil but the rest of the world. It has been detected in 33
countries. Some vaccines are less effective against P.1 than against
other major variants of the virus in Europe and the United States.

The country's neighbours are slamming shut their doors. Peru and
Colombia stopped flights from the country. Just two of Brazilians'
top ten destination countries remain open to them. "If Brazil is not
serious, then it will continue to affect all the neighbourhood there
and beyond," warned Tedros Adhanom Ghebreyesus, the head of the World
Health Organisation.

But seriousness, like muscle blockers, is in short supply. Mr
Bolsonaro has touted quack cures, railed against lockdowns and tried
to thwart the publication of data. He has just bid farewell to the
third health minister (an army general) since the pandemic began.
Vaccines are not for him, Mr Bolsonaro has claimed. His government
was slow to order them, even though manufacturers such as Pfizer and
Janssen had tested them in Brazil.

Governors and mayors, who implement lockdowns, have largely followed
the president's lead. After clamping down at the beginning of the
pandemic most quickly eased up. But even when restrictions are in
place, Mr Bolsonaro's rhetoric can scupper their enforcement. In
Bahia's poor neighbourhoods life has continued as normal, at least
until very recently. "We can't impose on those who live in favelas
the obligation of being inside a hot small house," says Dr
Vilas-Boas. The state does not have enough police to ensure that bars
stay closed.

That a variant like P.1 was born in Manaus comes as no surprise, says
Natalia Pasternak, a microbiologist who leads Instituto Questao de
Ciencia, which advocates the use of science to shape policy. The
city's first wave was so severe that some thought it had reached herd
immunity. Residents thronged riverside beaches at the first
opportunity, giving P.1 a fast start in life. When it left the
forest, other parts of the country made it equally welcome. Although
Brazil does too little gene sequencing to know for sure how widely it
has spread, studies in Sao Paulo state identify the variant in 80-90%
of cases.

[20210327_A]

P.1 is frightening because it may be both more contagious than
earlier versions and able to reinfect people. One study suggested
that it could be up to twice as transmissible and could reinfect
25-61% of people who have had covid-19. P.2, a worrying variant from
Rio de Janeiro, is also spreading.

The shock of the second wave is changing people's behaviour.
Governors and mayors are now tightening restrictions and people are
obeying them more. From March 22nd a nightly curfew in Bahia begins
at 6pm rather than 10pm. Bahians have recently cut in half the
distance they travel, according to mobile-phone data. This is slowing
covid-19's spread. Dr Vilas-Boas estimates that the number of active
cases in Bahia has dropped from 21,000 to 17,000. The number of
patients waiting for beds in ICUs fell from 513 on March 12th to 280
ten days later.

This month the federal government finally agreed to buy Pfizer's
vaccine and the one-dose jab from Janssen. They will supplement the
AstraZeneca and Chinese CoronaVac vaccines already being
administered. Brazil has begun domestic production, too. Fiocruz has
delivered its first homemade doses of AstraZeneca; the Butantan
Institute in Sao Paulo has begun making CoronaVac. Some 8% of adults
have had a first jab. "For the first time," says Ms Pasternak, "I'm
hopeful."

On March 23rd, when the daily death toll reached a record 3,158, Mr
Bolsonaro went on television to boast of Brazil's vaccination
progress. Yet as long as social distancing is needed the president
will remain a menace to Brazilians' health. He has filed suits in the
Supreme Court against three states, including Bahia, that have
tightened lockdowns. His actions are bad for Brazil--and for the
world.#

Dig deeper

All our stories relating to the pandemic and the vaccines can be
found on our coronavirus hub. You can also listen to The Jab, our new
podcast on the race between injections and infections, and find
trackers showing the global roll-out of vaccines, excess deaths by
country and the virus's spread across Europe and America.

This article appeared in the The Americas section of the print
edition under the headline "Variants on a theme of disaster"

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