In the huge intensive care unit (ICU) of the Emilio Ribas Institute for Infectious Diseases in São Paulo, anger spreads among doctors when asked about their President’s comments. “Revolting,” says one. “Irrelevant” declares another.
Dr. Jacques Sztajnbok is more moderate. “It’s not a flu. It’s the worst thing we’ve ever faced in our professional life.” Her eyes are slow and narrow when I ask if she cares about her health. “Yes,” he says twice.
The reasons why are clear in the overwhelming silence of intensive care. The coronavirus kills behind the veil of a hospital curtain, in a suffocating silence, so distant and alienated from the global upheaval and the noisy political divisions it has inspired. But when it takes a lifetime, it is intimately terrifying.
The first noticeable break in calm is a flashing red light. The second, a doctor’s headdress, who moves up and down just above a privacy screen, while his stiff arms provide harsh and ruthless chest compressions to a patient.
The patient is 40 years old and her medical history has meant for days that the odds of her survival are bad. But the change, when it comes, is sudden.
Another nurse arrives. In this intensive care, the medical staff pauses in an external room to get dressed and washed, but only a few moments before running inside. In the corridor outside, a doctor fumbles, clumsily pulling on his suit. These moments have come countless times in the pandemic, but today it is no longer easy. This intensive care is full and probably the peak in São Paulo is probably two weeks away.
Through the glass, the famous staff shakes tightly and goes around the patient’s head; to replace the pipes; move posture; to change positions and relieve each other from the grueling task. Their ruthless compressions on the patients’ sternum are all that keeps her alive.
Sweat on the forehead emerges to stop in the cooler air of the corridor. A sliding glass door slams – a rare noise – while another rushes in. For 40 minutes, the focus continues silently continues. And then, without audible warning, it suddenly stops. The lines on the heart rate monitors are flat, permanently.
Coronavirus has so pervasively damaged our lives, but its way of killing remains so often hidden within the confines of ICUs, where only valiant health workers see trauma. And for the staff here, it feels closer every day.
Two days before our visit, a nurse colleague Mercia Alves, 28 years old, lost. Today, they are together with the glass of another isolation room, inside which is a doctor in their team, intubated. Another colleague tested positive that day. The disease that has filled their hospital seems to be moving on them.
Emilio Ribas hospital is full of bad news – with no more sleeping space before the peak peaks, and staff are already dying from the virus – but it is the best equipped in the city of Sao Paulo. And this is a dark omen for the coming weeks of Brazil. Its largest city is the richest, where the local governor insisted on a blockade and face masks. Yet the death toll is still close to 6,000 and the over 76,000 confirmed cases are chilling indications of what – even in the probably most prepared place in Brazil – is about to arrive.
Wealth does not concern health Bolsonaro, who recently started calling the war against the virus a “war”. But on May 14, he said, “We have to be brave to deal with this virus. Are people dying? Yes, they are, and I regret it. But many more will die if the economy continues to be destroyed because of these [lockdown] measures.”
Invasive disease in favelas
On the other side of the city, there is no debate in the favelas. Having almost nothing is trivial and some time ago it brought its form of isolation from the rest of the city. But the priority here has long been clear: survival.
Renata Alves laughs, shakes her head and says “it’s irrelevant”, when asked about Bolsonaro’s opinion, the virus is just a “cold”. His business is serious and hourly.
Around her, the urgent tasks of staying alive are buzzing. In one room, rows of sewing machines are arranged, in which women are taught how to get back on their streets and start creating masks from everything they can find. In another, 10,000 meals are brought, prepared and then shipped again, in small numbers, to streets unable to put food on their tables in the block.
Alves, a volunteer health worker with the G10 Favela aid group, heads for one of the worst-affected areas of the suburb of Paraisopolis. Its narrow streets and narrow alleys explain why the disease here is so rampant.
And Alves realizes that he only knows half the picture of a potential 100,000 patients. Only when someone has three symptoms are they allowed to offer them a Covid-19 test, and that too is paid for here by a private donor. Many cases are not detected.
“Mainly the test is done when the person is already in an advanced stage of the disease,” he says, while heading to Sabrina’s house, an asthmatic isolation with his three children in three small rooms. Doctors use a wooden swab to check the back of the throat with a torch and greet his bored and bewildered children before moving on.
“Cases can be difficult,” Alves tells me. “An obese woman needed eight people to bring her into our ambulance. And a man with Alzheimer’s … we had to ask the family if we could physically get him away from his home. It’s difficult.” The woman survived, the man died.
High above the crowded street – crowded when everyone seems to go out to meet the garbage truck – is Maria Rosa da Silva. The 53-year-old says she thinks she got the virus by going to the market here, even if she wore a mask and gloves. So it is “locked up”, three floors on its tree-lined terrace, without railings. Social distancing seems possible here only if you do it vertically.
“People like me in the risk group are dying,” he points out. “Even yesterday the owner of the pharmacy died. Many are losing their lives because of someone’s carelessness. If it is for the good of society, we must do it.”
Social responsibility in these dangerous and poor roads has also led to the construction of an isolation center near an abandoned school. The government ceded the building to a privately funded project that now has dozens of patients inside. It’s ready, with sparkling uniform dormitories monitored by CCTV cameras, for many more.
Other signs of readiness are less comforting. On the hills above Sao Paulo, the Vila Formosa cemetery is full of mourning and yawns in anticipation – flanked by endless empty and fresh tombs. It appears that a funeral takes place every 10 minutes and this also does not dent in the many new holes dug in the red dust.
Brazil had an advantage: for at least two months it has seen the coronavirus tragedy sweep the world.
But the incontrovertible evidence in the horror world of the disease has instead led to conflicting messages from the government. And the death toll and the dataset of new cases – horribly as it is – probably don’t reflect the whole tragedy already underway.
What has already happened elsewhere – and has sent warning flares across the planet – is happening here, the same, and it could be even worse.