By ANA MARIA GR ODA & SONIA LEITE*
The COVID-19 pandemic in Brazil: in search of meanings in the midst of tragedy
At the time we write this text, the number of deaths caused by the COVID-19 pandemic (a disease caused by the new coronavirus) already exceeds 160 thousand people in Brazil, and the number of cases of infection in the world reaches more than 5 million. Worldwide, there are more than 1 million deaths and 33 million cases, in 188 countries (Coronavirus Resource Center, 2020). By way of comparison, the atomic bombs dropped on Hiroshima and Nagasaki in 1945 claimed around 250 victims, a total that includes those killed instantly in both cities and those who died as a result of burns and radioactive poisoning. , 2020). The fact is that the effects of situations of mass destruction (pestilence, wars, etc.) are not limited to the moment of the tragic event, but always extend beyond the disaster, affecting, as a rule, a few generations over time. In the case of the current pandemic, in addition to the presence of emotional, health, social, cultural, political and economic consequences in our daily lives, survivors of severe forms of COVID-19 may have physical sequelae (such as pulmonary fibrosis, heart failure, kidney and neurological problems) and mental (depression, various manifestations of anxiety, post-traumatic stress, among others) (Allegrante et al., 2020; Pfefferbaum & North, 2020).
When we become aware of this numerical reality, we are initially taken by horror, but then, paradoxically, a kind of numbness crosses us, because most of the time the numbers themselves do not tell us anything. They confront us with the unnamable.
We have great difficulty in dimensioning quantities due to the fact that we are beings of words, senses and affections. To go beyond mere numerical astonishment, it is necessary to insist on interpretation, on the production of meaning, even when we are confronted with the affects of pain, sadness and hopelessness. Facing affections is fundamental because they are the support of what is most human in us. Human, all too human. In this sense, it can be said that those killed by the pandemic are numerous but innumerable, that is, far from being restricted to numbers in the impressive statistics, they must be recognized in their unique biographical experiences, as proposed by the collaborative project Memorial Inumeráveis, created by artist Edson Pavoni (https://inumeraveis.com.br).
Being numb in the face of an unnameable real can lead to indifference. Indifference towards death goes hand in hand with disregard for life. And, on the other hand, the appreciation of life, as a radical existential experience, is always intertwined with the recognition of the presence of death in all its aspects. The pandemic, with its devastating effects, calls us to this recognition so that life can be revalued. Life, not just from the point of view of human existence, but from the very preservation of life in all its aspects on planet Earth.
But what does the virus teach us?
As indicated by Boaventura de Sousa Santos (2020) in his book The cruel pedagogy of the virus, a pandemic affects everyone in general, however, there are groups that, due to their previous vulnerability, are affected more radically. Disaster situations make these groups more visible by reinforcing injustice, discrimination and social exclusion.
The pandemic gives us an exemplary lesson on the social determinants of health and the importance of public policies that guarantee the minimum of a welfare state. It is a fact that health, unfortunately, is not an equally distributed good, but dependent on socioeconomic and educational level, gender, skin color, ethnicity. These inequalities imply different conditions in health and quality of life, in addition to producing large differences in life expectancy, as well as in the way people die, including violent deaths.
As we well know, the 2019-nCoV pandemic found Brazil and its age-old structural inequalities, with a large number of people living in inadequate conditions, without basic sanitation and without access to water and electricity, in precarious and crowded housing, and still with high prevalence of chronic diseases, such as hypertension and diabetes, in addition to the so-called neglected diseases, such as tuberculosis, and reemerging zoonoses, such as yellow fever and dengue (Andreazzi et al., 2020).
We are a country built on hidden bodies and, in that sense, the pandemic reveals everything we didn't want to know about everyday reality. A reality historically marked by the trauma arising from exclusion and violence against Indians, blacks and shirtless people. Contradictorily, we are a collective body that lives under the aegis of denial that, most of the time, does not recognize itself in the other that exposes our original cultural marks. A collective body that repudiates the differences that indicate the diversity that constitutes the nation, and that placidly accepts the profound social inequalities present in daily life. In this sense, we are a country of a majority of excluded people, in eternal social abandonment.
With this ground prepared, it is not surprising what several studies have shown: the risk of both contracting the virus and dying from COVID-19 is greater among the poorest. A study in the city of São Paulo indicated that, between March and June 2020, residents of peripheral neighborhoods of the city had a 50% higher risk of dying from COVID-19 than residents of areas of high socioeconomic status, and such risk continues to increase as the pandemic progresses (Bermudi et al., 2020). In the same sense, the results of a broad ongoing national study, Epicovid19-BR (Evolution of the Prevalence of Infection by COVID-19 in Brazil) indicate: as pointed out by epidemiologist Pedro Hallal (2020), the poorest present twice the risk of infection compared to the richest, and indigenous people have a five times greater risk of infection than whites. In view of this, we cannot fail to emphasize that indigenous peoples have been vilified due to the negligence of government authorities, which have not only failed to provide humanitarian aid, but have also abandoned them in the face of violence by land grabbers and squatters and by the State itself. With regard to black people, although information on race/skin color is flawed or incomplete in many statistics, the worst previous health and housing conditions, in addition to less access to health services, means that these people are overrepresented in the hospital mortality statistics due to COVID-19 (Baqui et al., 2020), once again making evident the social exclusion of Afro-descendants.
Unlike Schindler's list — which saved Jewish workers from the clutches of the Gestapo — Boaventura de Sousa Santos's list (2020), present in the aforementioned book, also indicates a huge group of people who, due to their conditions prior to the pandemic, present the greater risks not only of contracting the disease, but of dying, increasing the huge contingent of deaths that continues to grow every day.
They are: the informal workers, currently dominant all over the world, due to the neoliberal policies that have been advancing in the last decades, workers who need to earn day by day to survive day by day; street workers, who are the uberized, the couriers who make it possible to quarantine others and who often cannot protect themselves from the pandemic; the homeless who occupy the viaducts, tunnels, subway stations or simply the sidewalks, which lead us to question what quarantine is for those who don't even have a home. At the beginning of the pandemic, someone commented, sadly, that he was wearing a mask on a street with several homeless people when one of them asked: “What is going on? Why are people walking around in masks?”
And the list goes on: refugees and immigrants, who live in places where the risk of spreading the virus is even greater; people with disabilities, with mobility difficulties, discriminated against due to their special needs and dependent on someone to help them; the elderly, often deposited in homes and nursing homes, ranging from luxury to garbage, and who end up suffering from increased isolation, in addition to the greater risk of contagion; and women who suffer from the dizzying increase in domestic violence during quarantine.
In the face of complex health and socioeconomic scenarios, choosing the best government strategies to face the COVID-19 pandemic, at each stage, has not been an easy task anywhere in the world, taking into account the meager, albeit growing, scientific knowledge about the new coronavirus, its rapid spread and the potential risk to life for part of those infected (Barreto et al., 2020). In terms of prevention, at the moment there are no drugs that can prevent infection and vaccines are still promising. Thus, behavioral measures — personal and environmental hygiene (washing hands, wearing masks, respiratory etiquette, cleaning surfaces) and social distancing (physical distance between people, avoiding travel, working from home) —are the strategies consensually recommended by international scientific entities. (Allegrante et al., 2020).
In Brazil, implementing and maintaining such measures has proven to be an extremely difficult challenge. Here, notable efforts have been made by health professionals and scientists who seek to offer support to public managers in this difficult task, on several fronts, highlighting the essential response of the Unified Health System in assistance and public universities in the search. However, with regard to the actions of the federal government, we are faced with the appalling situation of having the third Minister of Health in the midst of a pandemic, and with facts broadcast daily that denounce the militarization of the portfolio and the lack of coordination of combat actions to the pandemic. As if that were not enough, we read news every day about the adventures of a President of the Republic who minimizes the pandemic, disrespects hygiene rules, mocks the number of dead, does not recognize the pain of the bereaved (The Lancet, 2020), in addition to feeding fantasies of magical prevention and cure, disregarding science and perpetrating what is called necropolitics.
In this truly maddening context, at a time that brings us pain, helplessness and perplexity, the pedagogy of the virus summons us, above all, to the work of producing meaning and inventing new forms of care and social ties. It is necessary to insist on the bonds of solidarity, bearing in mind the differences that make up our collective daily life.
Thus, departing from the thematic axis Pandemic, psychopathology and subjectivity, proposed by the publishers, the authors invited to this special issue of Latin American Journal of Fundamental Psychopathology provide us with excellent work, reflecting on various aspects of the COVID-19 pandemic, from clinical, social, cultural, historical and psychopathological perspectives.
*Ana Maria GR Oda, psychiatrist, is editor in charge of Latin American Journal of Fundamental Psychopathology.
*Sonia Leite, psychoanalyst, is editor in charge of Latin American Journal of Fundamental Psychopathology.
Originally published as the September Editorial of Latin American Journal of Fundamental Psychopathology, Pandemic, Psychopathology and Subjectivity, 23(3), 457-671, September 2020. Link: https://www.scielo.br/scielo.php?script=sci_serial&pid=1415-4714&lng=pt.
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