Explaining Brazil’s COVID disaster

Brazil is the only country with a population of over 100 million to have a universal, free health system. Over the last 30 years this system has allowed an overall reduction of inequality in terms of access to health care. We might therefore have expected that the country would be able to avoid the worst consequences of the COVID-19 pandemic. However, on a worldwide scale, Brazil is the country most affected, with 9,5% of total infections and 10,4% of deaths, while its inhabitants make up only 2,7% of the world’s population. Researchers at Harvard University and at the University of Sao Paulo have recently published epidemiological data to help understand the propagation of SARS-CoV-2 across the country between the 23^rd of February and the 10^th of October 2020. 

Their main observation was that the infection’s spread had been particularly rapid and the number of deaths high, with significant discrepancies depending on regions. It is not possible to explain everything as a result of one factor, but rather as a confluence of several elements. Firstly, the virus must have been in circulation for more than a month before being detected, due to the lack of infrastructure permitting identification of new pathogens, and to inequalities in access to health care. In addition, Brazil has very large urban conglomerations that are interconnected via transport or commerce. These links were not subject to restrictions during the epidemic’s peaks. Then there were the many local disagreements between states and central government, meaning that observation of sanitary measures was weakened, with little overall strategy. Finally, while certain regions such as Ceara stayed strong and united in the face of the crisis, other more prosperous areas such as Rio de Janeiro were unable to limit the virus’ spread.

This health crisis necessitated a rapid response from the state, with an  even-handed and well-coordinated regional implementation. Another complicating factor was the emergence of a variant in December 2020, which seems to be between 1,4 and 2,2 times more transmissible, and which is now the dominant strain throughout the country. By the 11^th of March 2021, Brazil had already reached 40% of the total number of COVID-19-related deaths in 2020.