Brazil and Covid, a tragedy in pictures

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By Marcelo Eduardo Bigal*

Despite the pain and loss caused by this epidemic, what we are faced with is a simple decision. We can proceed rationally and value life, or persist in a genocidal route, fighting for chloroquine, camphor, intrarectal ozone

The deconstruction of science is carried out in Brazil in such a brutal and articulated way that we are affected by a feeling of dismay, of being living through a blindness epidemic, as I recently wrote this site. This week, when asked yet again about my opinion on chloroquine in the treatment of COVID-19, I had the impression of living in a parallel universe, where the voice of science is not heard. I decided, therefore, to refrain from scientific arguments and decided to show, through images, the surreal brutality of the Brazilian tragedy where three epidemics are intertwined: COVID-19, misinformation and, finally, ignorance, and lack of empathy/ contempt.

Overview

Starting with the basics. The Brazilian population, currently estimated at 212,559,000 people, accounts for 2.7% of the world's population. We should therefore expect that we would account for 2.7% of the number of cases and deaths, and that, efficiently and taking advantage of the privilege of having a single health system, we would be better than average. However, we account for 15.2% of the world's cases (5.6 times more than the world average) and 13.8% of deaths (5.1 times more than the world average).

The severity of the crisis is even more evident when we compare it with other countries in South America, where we are the most economically important country. We account for around 49% of the South American population, but 63,8% of cases and 63.7% of deaths (30% higher than expected by the population just for these two parameters). Note that South America is one of the most affected regions, with 4 countries among the 10 most affected (Brazil, Peru, Chile and Colombia) and, even so, our performance is well below average.

The same tendency is observed when comparing Brazil, the 9th largest economy in the world, with similar countries such as France (7th), Italy (8th), Canada (10th) and Russia (11th). We account for 41% of the population, but 67% of cases (63% increase) and 53% of deaths (29% more than expected).

Tests

In epidemics, sometimes all the best efforts still fall short. But Brazil fails in the most basic. One of the best efficiency metrics for controlling an epidemic focuses on the number of tests per diagnosed case (which shows the effort in identifying contacts). The other countries with a similar GDP (and also with a public health service, such as Brazil), perform between 5 times (France) and 7 times more tests (Canada) per diagnosed person than Brazil.

And the situation is similar when we compare Brazil with the 20 countries with the highest number of cases. In number of tests per confirmed cases we are below, in addition to the obvious developed countries, also countries like Pakistan (69% more), Bangladesh (11% more), Peru (25% more). The following graph shows the proportion of tests per diagnosis that each of these countries performed in relation to Brazil. Only two did less, Argentina and Mexico. Most have done much more. Some do not even fit in the chart, such as England, which performs 1206% more tests than Brazil per diagnosed case.

Evolution of the Epidemic

The two graphs below are emblematic. Brazil has just reached 3 million cases. It took 112 days to reach the first million, 30 days to reach the second million, and 23 days to reach the third.

The concept seems to have been created in Brazil that the epidemic will naturally decrease in intensity. This is based on the fact that other countries have flattened the curve. But flattened by acting. What we see in Brazil is the anti-flattening of the curve. We are adding cases with increasing speed, not decreasing speed. And also dead. Where do you see improvement? It took 66 days for the first 25 deaths to occur, and since then another 25,000 have occurred every 25 days. Despite underreporting, official data show that in Brazil one person dies every 86 seconds by COVID.

Curve flattening

Brazil did not pass a year in the “Economy of Microbes” course. The deconstruction of information has led to the concept that we must resume economic activity at any cost. But in order to resume economic activity (and this also applies to the return to schools and normality in a broader sense), the epidemic must first be overcome. In the graph below I present the experience of New York, Italy and Canada, two of them brutally affected (New York and Italy). It should be noted that, despite the huge success, these venues continue to take every precaution. New York has not reopened theaters and many other activities. Canada will not have full face-to-face classes and has its borders closed.

But what happens when we add Brazil to the graph (below, in green)? Nothing can be more illuminating. This, for me, is the graph that best illustrates the mediocrity of our current thinking. To return to a minimum of normality (commerce, schools), the epidemic must first be controlled. We can fight this until the end of time, and take all the chloroquine in the world (which, by the way, if it worked, would have improved our mortality curves). As long as we do not act with seriousness and decency, there will be no normalcy on our horizon.

Leadership

It is worth reflecting on our own guilt in this situation. We trivialize pain, we relativize the importance of knowledge. Some examples for reflection.

The Ministry of Health in Canada is led by Dr. Theresa Tam, specialist in childhood infectious diseases. Born in China, she was a co-leader of a study in 2006 that focused on preparations needed to prevent epidemics after SARS. According to the WHO, it predicted the COVID epidemic with extraordinary accuracy. Prior to that, she had led efforts in Canada to curb the narcotics use epidemic. She led the response against SARS, H1N1, Ebola, and represents the country at the WHO. She warns against the risks of relying on the effectiveness of vaccines under development, to the detriment of more obvious actions.

The US, which has performed as disastrously as Brazil, is not in a worse situation thanks to the performance of Dr Anthony Fauci, who has the courage and credentials to oppose Donald Trump. He has been director of the Health agency since 1984. He led action against the Ebola and Zika epidemics. He has advised six presidents and was the chief architect of the AIDS emergency plan that saved millions of lives and for which he is considered a legend by patients and support organizations.

Brazilian health coordination is led by General Pazuello. According to Wikipedia, the general served in the coordination of Army troops at the 2016 Olympic Games and, since February 2018, coordinated Operation Acolhida, which takes care of refugees from Venezuela in Roraima, in addition to previously serving as Secretary of Finance in the Government of the State of Roraima during the period of federal intervention. On January 8, 2020, he left the coordination of the operation to command the 12th Military Region, in Manaus. Gifted with logistical and operational experience, he has extensive military training and extensive inexperience in healthcare.

Despite the pain and loss caused by this epidemic, what we are faced with is a simple decision. We can proceed rationally, like many countries, and value life, either out of humanism or economic interest. Or persist in a genocidal route, fighting for chloroquine, camphor, intrarectal ozone. Disputing the obvious. Speaking of the flu. Not wearing masks. Not doing a coordinated isolation. And, paradoxically, waiting for a vaccine, a great advance in science. We still don't know if it will work well and for a long time. But that's another story. You can always chloroquinize a vaccine!

*Marcelo Eduardo Bigal is a neurologist and researcher, with a doctorate in neurosciences from USP. He has 320 articles published in international scientific journals, and has published five medical books. He is CEO of a Boston-based biotechnology company dedicated to medical development in the field of immunology.

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