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Brazil reported another 881 deaths from coronavirus and almost 10,000 confirmed new infections on Tuesday, confirming its position as the world’s next big COVID-19 epicenter.
But, as President Jair Bolsonaro continues to dismiss the virus as “a little flu”, new research shows the coronavirus began spreading in the country months earlier than previously thought, and public health experts say the true scale of the crisis in the country is much, much greater than the official figures suggest.
The 9,258 new infections confirmed by Brazil’s Health Ministry on Tuesday mean the country has surpassed Germany in terms of infections and is on a par with France, a country seen as one of the worst-hit in Europe.
Brazil’s surging death toll, which now stands at 12,400, means it is now the sixth-worst hit country in the world.
A coronavirus mortality model from the University of Washington's Institute for Health Metrics and Evaluation (IHME) predicts more than 88,000 deaths from the coronavirus in Brazil by August.
But others believe it will be much higher.
“Brazil is probably the next epicenter of the pandemic in the world,” Luciano Cesar Azevedo, a physician treating COVID-19 patients in intensive-care units in São Paulo told the Atlantic this week. “I think Brazil is going to get close to 100,000 deaths.”
From the very start, Bolsonaro has been one of the world’s biggest coronavirus deniers.
Even when the death toll was mounting and the scale of the crisis was becoming obvious, Bolsonaro didn’t back down.
“So what?” Bolsonaro told reporters on April 29, when asked about that day’s record 474 deaths. “I’m sorry. What do you want me to do?”
Bolsonaro has responded to the crisis pushing for the economy to reopen. His latest effort was to issue a decree this week labeling gyms and hairdressers as “essential” services and allow them to restart their businesses.
So far ten governors have said they would defy that order. "Governors who do not agree with the decree can file lawsuits in court," Bolsonaro tweeted.
But public health and infectious disease experts say that despite the mounting death toll and surging infection rates, Brazil is still only at the beginning of its coronavirus crisis.
The real numbers
The president’s persistent downplaying of the threat from coronavirus is just part of the problem. Another concern is that no one really knows what the true scale of the outbreak is in Brazil.
In the last three months, Brazil’s Health Ministry says it has conducted nearly 338,000 coronavirus tests at official labs. There are another 145,000 tests under analysis or backlogged, it added.
But compare that to countries with comparable infection figures: Germany's certified labs tested more than 330,000 samples last week alone, and have capacity to test around 838,000 samples every week. France can test approximately 700,000 samples per week.
So Brazil’s true infection figure is likely much higher.
Azevedo says inadequate testing means the country’s infection total — which currently stands at 177,589 — is likely 10 times higher. Other experts say the total is even greater.
Last month a consortium of researchers from Brazil’s universities put the real figure at 12 times the official total, but new research published last week by the University of São Paulo Medical School put the infection rate at 15 times the official figure.
“Brazil is only testing people who end up in the hospital,” Domingo Alves, one of the authors of last week’s study told AFP. “It's hard to know what's really happening based on the available data. We don't have a real policy to manage the outbreak. The pandemic is passing through as it pleases.”
Further confusing the situation is new research from scientists at the Oswaldo Cruz Foundation that suggests one patient who died in Rio de Janeiro between 19 and 25 January had COVID-19.
Until now the first confirmed case of coronavirus was in late February with the first death not recorded until March 16. If the research from the Oswaldo Cruz Foundation is accurate, it will make it much more difficult — if not impossible — to understand how the outbreak spread across the country.
The scientists also say the evidence suggests person-to-person transmission began in early February, rather than late March when the government first acknowledged community transmission. During that time tens of thousands of Brazilians flooded streets across the country for the hugely popular carnival street parties.
Health Minister Nelson Teich declined to comment on the research on Tuesday, saying he needed more information. The report has been published online but not yet been peer-reviewed.
“Bodies pile up next to patients”
Another worrying sign for those tracking the disease’s spread in Brazil is an uptick in infections, hospitalizations and deaths among the country’s black population — a trend also seen in the U.S. and U.K.
Brazil’s black population is concentrated in the country’s poorest areas, including the favelas in São Paulo and Rio de Janeiro, where many lack even the most basic sanitation facilities and where social distancing and self-isolation are simply not possible.
In Manaus, an impoverished city of two million people buried deep in the Amazon rainforest, people of all backgrounds have been suffering.
According to data analysis by the New York Times, the city recorded about 2,800 deaths in April, about three times its historical average for the month. Such a spike is comparable to what happened in Madrid between mid-March and mid-April, when the Spanish city’s hospitals were overwhelmed by coronavirus patients.
Gravediggers in Manaus have had to stack coffins three deep in mass graves, because the city’s hospitals have been unable to obtain the necessary supplies due to a lack of support from the government and poor road and rail connections.
“Hospitals, which were already strained and severely under-resourced before COVID-19, have begun to implode in parts of the country,” Jocelyn Getgen Kestenbaum, an international-human-rights expert at Cardozo Law in New York, wrote in a recent look at Brazil’s crisis. “Videos circulating on social media have demonstrated the desperation of families seeking urgent care, while bodies pile up next to patients in understaffed hospitals in Manaus.”
Cover: Cemetery workers place coffins in a common grave during a funeral at the Nossa Senhora Aparecida cemetery, amid the new coronavirus pandemic in Manaus, Brazil, Monday, May 11, 2020. The new section of the cemetery was opened last month to cope with a surge in deaths. (AP Photo/Felipe Dana)