Dying in line: Brazil’s crunch for COVID-19 intensive care beds

By Stephen Eisenhammer

PIRATININGA, Brazil (Reuters) – José Roberto Inácio spent much of his life ferrying the sick and injured to the hospital in this quiet Brazilian town.

On Wednesday, March 10, the retired ambulance driver took the familiar route once more – as a passenger gasping for breath.

By the weekend, the 63-year-old’s kidneys were failing. He needed dialysis. He needed intensive care.

But at the small hospital where he was being treated even basic medical supplies, like a catheter, were lacking. He joined the list for a bed in an intensive care unit (ICU), but doctors told his family there were 70 people in this part of Sao Paulo state already in line.

Bauru, the nearest major town, only has 50 intensive care beds – and all were full.

Inácio died waiting.

“All his life he worked to save people, but in the hour that he needed help, there was nothing for him,” Inácio’s son Roberto, 41, told Reuters, eyes still blank with shock. “You watch a person dying, and you can’t do anything about it.”

Inácio was one of 3,251 people in Brazil killed by COVID-19 on March 23, then the highest daily death toll since the pandemic began. Around the world, nearly one in three COVID-19 deaths were Brazilian. Inácio was one.

“He’s become a statistic,” his son said.

As much of the world appears to be emerging from the worst of the pandemic, Brazil’s health system is buckling.

Across the country there are over 6,000 people waiting for an ICU bed, according to government data. In 15 of Brazil’s 26 states, ICU capacity is at or above 90% full, as the country’s P1 variant fuels a second wave far deadlier than the first.

Even in Sao Paulo, Brazil’s wealthiest state with a sophisticated public hospital network, scores are dying in line for intensive care.

Despite the crisis, President Jair Bolsonaro continues to ridicule stay-at-home measures. He rarely wears a mask and has said he does not plan to get vaccinated. He told Brazilians to “stop whining” about the number of dead, now over 300,000 – the world’s second-highest toll behind the United States.

Brazil, a major global economy once lauded for its public health victories, has also been slow to secure vaccines for its 210 million inhabitants. Less than 10% of adults have received a first dose and only 3% are fully vaccinated.

Epidemiologists fear the worst is yet to come.

“This is going to be devastating,” said Albert Ko, a professor at Yale School of Public Health with decades of experience in Brazil. “Unless there’s a change in federal and state government policies, towards implementing effective lockdowns, we’re looking at a real humanitarian crisis.”

SILENT BURIAL

A giant billboard of Bolsonaro greets visitors to Bauru, a town of 400,000 about a four-hour drive from Sao Paulo.

The mayor, Suéllen Rosim, has railed against lockdown measures and aligned herself with the far-right leader. Last month, she defied a state government order to close nonessential businesses, allowing many to remain open despite surging COVID-19 cases.

A court ruling finally forced her to comply, but she continues to argue lockdowns are ineffective despite overwhelming evidence they have worked across the globe.

“There’s no science that shows that if I lock everyone up at home, everything will get better,” she told Reuters. “Bars and restaurants have been shut for weeks and the numbers haven’t stopped going up.”

She blamed the state for a lack of ICU capacity.

In response, the Sao Paulo government said it was working to increase the number of hospital beds in Bauru and across the region. The state criticized the municipality, which it said did not fund a single intensive care bed.

“The town is also responsible for the increase of intensive care and should do its part,” the state said in a note to Reuters.

On Bauru’s front line, doctors are exhausted; understaffed and under-resourced against the relentless tide of infections.

“People have been talking for months about the risk of the public health system collapsing,” said Fred Nicácio, a doctor treating COVID-19 patients in Bauru. “Sadly, that moment has come.”

Ambulances dart across town carrying patients connected to green oxygen canisters, their belongings in black trash bags by their feet.

One patient in his 40’s, between concentrated breaths, said he now understood the virus was no joke, as medics wheeled him into the hospital.

Beds are so scarce in Bauru that desperate relatives are turning to the courts, hiring lawyers to secure injunctions that would force hospitals – public or private – to take in patients.

But lawyers cannot create ICU beds where there are none. Even private hospitals are struggling, sometimes begging the public sector to take patients needing intensive care off their waitlists.

Inácio’s son is haunted by the belief that his father’s death could have been avoided. If a vaccine had reached him in time, if his hospital had an extra catheter, if an ICU bed had become available.

Last Wednesday, one week after entering the hospital he knew so well, Inácio was buried.

Four men in white hazmat suits drove his body in a minivan the two blocks to the cemetery. They carted the wooden coffin between the rows of dead to a break in the red dirt.

No words were spoken. The only sound was the scratching of mortar and brick as the tomb was sealed.

From a distance, his son watched.

(Reporting by Stephen Eisenhammer; Additional reporting by Leonardo Benassatto; Editing by Brad Haynes and Jonathan Oatis)

Brazil vaccinations start as country faces vaccine ingredient shortfall

By Eduardo Simões

SAO PAULO (Reuters) – Brazil kicked off a nationwide COVID-19 immunization program on Monday by distributing doses of a vaccine from China’s Sinovac Biotech following an emergency use authorization, although the pace of vaccination will depend on delayed imports.

After weeks of setbacks, many Brazilians cheered the first wave of inoculations, from bustling clinics in Sao Paulo to a spectacular shot planned at the foot of the Christ Redeemer statue overlooking Rio de Janeiro.

The Health Ministry gave states the green light to start immunizing at 5 p.m. (2000 GMT). Although some began administering shots before that, the majority of Brazil’s 26 states had yet to receive vaccine shipments as of Monday evening, delaying the start of vaccinations for the elderly and frontline health workers.

Minutes after federal health agency Anvisa approved the Sinovac vaccine on Sunday, Monica Calazans, a 54-year-old nurse in Sao Paulo, became the first person to be inoculated in the country, as Sao Paulo Governor Joao Doria looked on.

President Jair Bolsonaro, a COVID-19 skeptic who has refused to take a vaccine himself, had faced fierce criticism for the lack of immunization in Brazil, which has lost more than 200,000 lives to COVID-19 – the pandemic’s worst death toll outside the United States.

On Sunday, Anvisa approved emergency use of the Sinovac vaccine and one from AstraZeneca Plc, although a plan to get 2 million doses of the AstraZeneca vaccine was hamstrung by a lack of export approval from India.

That was one of several hurdles threatening to slow Brazil’s already lagging immunization efforts, as local manufacturing partners for both vaccine makers wait on active ingredients from abroad in order to fill and finish doses for distribution.

The Butantan Institute run by Sao Paulo state needs another shipment of Sinovac’s ingredients by the end of the month in order to hit its target of 46 million doses by April, the head of the institute told a news conference.

The federally-funded Fiocruz biomedical center in Rio de Janeiro is still awaiting its first shipment of ingredients for AstraZeneca’s vaccine, pending Chinese export approval.

Health Minister Eduardo Pazuello scolded Doria on Sunday for what he called an illegal “marketing ploy” for allowing vaccinations to begin in Sao Paulo prior to the official rollout.

Bolsonaro, who had taunted Doria over the disappointing 50% efficacy of the Sinovac vaccine in Brazilian trials, added an indirect criticism on Monday.

“So it’s been approved for use in Brazil. It is Brazil’s vaccine. It doesn’t belong to any governor,” he told supporters outside the presidential palace.

(Reporting by Eduardo Simoes; Additional reporting by Lisandra Paraguassu and Sabrina Valle; Editing by Brad Haynes and Bill Berkrot)

‘Day of Fire’: Blazes ignite suspicion in Amazon town

By Stephen Eisenhammer

NOVO PROGRESSO, Brazil (Reuters) – A maverick journalist in this isolated Brazilian ranching town warned his readers last month that the surrounding Amazon was about to go up in flames.

Queimadas, or burnings, are nothing new in Novo Progresso, located on the frontier where Brazil’s farmland edges the Amazon rainforest in the northern state of Para. Locals say farmers annually use fire to illegally clear pastures or newly deforested areas.

But the Aug. 5 article in the online Folha do Progresso was eerily specific about an upcoming “Day of Fire.”

It said growers and ranchers were planning to set a coordinated series of fires in the forest and nearby land on Saturday, Aug. 10, inspired in part by President Jair Bolsonaro. Brazil’s right-wing leader has vowed to open the world’s largest rainforest to more development. Punishment of environmental crimes has plummeted on his watch.

When the day came, the number of fires tripled from the prior 24 hours. Government data recorded 124 blazes, compared to just six on Aug. 10 last year.

Bolsonaro’s office did not respond to a request for comment. In an Aug. 25 message on Twitter, Environment Minister Ricardo Salles said Bolsonaro had ordered a “rigorous” probe to “investigate and punish those responsible” for the Novo Progresso fires.

State and federal police have since descended on this rough-edged town of 30,000. Some residents are not pleased with the sudden attention. Most farmers approached by Reuters declined to be interviewed. Many dismissed the Folha do Progresso story as rubbish, the invention of a fabulist.

“For you outsiders, we’re all criminals here,” one rancher said, declining to give his name.

Adecio Piran, the reporter who wrote the article, told Reuters he temporarily went into hiding after receiving death threats. He stands by his story.

According to prosecutors investigating the case, Brazil’s government did not move aggressively to prevent the conflagration, despite forewarning.

Prosecutor Paulo Oliveira said he notified Brazil’s environmental agency, Ibama, about the Folha do Progresso article on Aug. 7. The agency responded on Aug. 12, two days after the “Day of Fire,” saying it lacked the police support needed to investigate the matter, according to copies of the correspondence between Ibama and Oliveira reviewed by Reuters.

Ibama did not respond to a request for comment.

Army troops were dispatched to the area weeks later. By last Wednesday, there were about 200 soldiers camping on a dusty patch of land used for country fairs on the edge of town.

As Reuters drove the long road into town on Aug. 30, smoke still hung heavy in parts. Charred tree trunks and ash littered the ground where jungle recently stood.

Brazil’s Environment Ministry declined to comment for this story. Salles, the minister, has said previously that overly restrictive environmental policies have incited rural dwellers to resort to illegal logging and mining to make a living.

The “Day of Fire” is part of a brutal wave of destruction in Brazil’s rainforest this year. Some 6,404.8 square kilometers (2,472.91 square miles) have been despoiled, double the area felled at this point last year and larger than the U.S. state of Delaware.

Images of the Amazon burning have sparked international condemnation of the environmental policies of Bolsonaro, who has dismissed those concerns as outsiders meddling in Brazil’s internal affairs.

Townspeople in Novo Progresso bristled with resentment at the arrival of federal police and the military. Cattle traders complained it was bad for business.

Madalena Hoffmann, a former mayor of Novo Progresso, said she did not know if the Aug. 10 fires were intentionally coordinated. She said deforestation has gone too far. But like many here, she blames the government for imposing environmental rules so complicated and strict that farmers feel they must break the law to ply their trade.

“Fundamentally it’s the government’s fault,” she said.

‘ABANDONED’

Novo Progresso dates to the early 1980s, when Brazil’s military dictatorship lured families here with the promise of land and opportunity.

The armed forces, where former Army captain Bolsonaro got his start, viewed the largely uninhabited Amazon as a vast, resource-rich asset vulnerable to invasion or exploitation by foreigners. The military built roads and encouraged settlement.

But by 1985, the dictatorship had fallen. The newly democratic government began what would become a very different policy towards the Amazon: conservation.

“We were abandoned,” said Moises Berta, a 59-year-old rancher. Sipping coffee under a dawning sky at a bakery popular with farmers, he said he moved to Novo Progresso as a young man in 1981 with hopes of starting a successful farm.

Berta said the government has left him and others in the lurch by failing to grant clear titles to lands they have worked for years. Possessing the title to one’s farm makes it easier to obtain financing and eventually sell it. Without it, ownership is difficult to prove, making illegal activity such as cutting down forest easier to get away with.

In Brazil, land ownership can be granted by demonstrating the property is being used constructively, is not owned by someone else, and is not located in a protected area – standards Berta says his holdings meet.

But 38 years after arriving, Berta still does not have the title for his ranch beside highway BR 163, a vital artery for transporting soy and cattle, despite repeatedly trying to register it with the federal government.

He might not have the rights to his land, but holding up his phone, Berta showed a document pertaining to four open cases against him from Ibama, the environmental watchdog. Asked what laws he had allegedly violated, he grinned. “I have no idea,” he said.

Ibama declined to comment on Berta’s cases, passing a request from Reuters to the Environment Ministry, which did not respond.

The town’s farmers union says 90% of farmers and ranchers here do not have their land formally recognized by the state. Locals say the process is complicated and that officials are unresponsive. Documents need to be presented in person at an office a five-hour drive away.

Incra, the government body responsible for issuing land titles, said in an emailed statement it was aware of the backlog in the Amazon and that “measures were being developed to promote the emission of the required titles.”

Farmers were further incensed by the 2006 creation of a vast reserve to the west of Novo Progresso called the Jamanxim National Forest, which they say has strangled their ability to expand. The federal government was trying to slow deforestation that had cleared much of the forest in neighboring Mato Grosso state and was heading north toward Novo Progresso along BR 163.

Complicating matters, nearly 500 farmers were already inside the reserve when it was created. Most refused to leave, creating a standoff that has yet to be resolved.

Many of the Aug. 10 fires occurred inside the Jamanxim National Forest, the most deforested reserve in Brazil this year, government figures show. Over 100 square kilometers of rainforest there have been cleared since January, an area nearly twice the size of Manhattan.

JOURNALIST IN DANGER

Agricultural interests support an amnesty that would see farmers inside the Jamanxim stay. They have found allies in the Bolsonaro administration.

On Sunday, at a nearby country fair, Special Secretary for Land Affairs Nabhan Garcia told farmers they would get their titles. The administration, he added, was reviewing the “embarrassment” of conservation areas and indigenous lands expanded under previous governments.

State police have so far interviewed about 20 people in connection with the “Day of Fire,” a person with direct knowledge of the case told Reuters. No one has been charged or arrested. State police did not respond to a request to confirm the information.

Prosecutors say they suspect organizers used Whatsapp to coordinate fires along BR 163 to show public defiance of environmental regulations. The Jamanxim forest blazes, they say, were likely the work of land grabbers.

“That’s a coordinated invasion to force the area into farmland,” a second law enforcement source told Reuters. The people requested anonymity as they are not authorized to speak to the media.

Piran, the journalist believes he is still in danger. A pamphlet denouncing him as a liar and extortionist who lit the fires himself has circulated around town. While no longer in hiding, he still avoids going out at night. Police have asked state prosecutors that he be enrolled in a witness protection program.

(Reporting by Stephen Eisenhammer, additional reporting by Amanda Perobelli; Editing by Brad Haynes and Marla Dickerson)