In the huge Intensive Care Unit (ICU) at Emilio Ribas Infectious Disease Institute in São Paulo, anger is swirling among doctors when asked about their president’s comments. “Revolting,” says one. “Irrelevant” explains another.
Dr. Jacques Sztajnbok is more restrained. “It’s not a flu. It’s the worst we’ve ever encountered in our professional lives.” His eyes slowly and narrowly, when I ask if he is worried about his health. “Yes,” he says twice.
The reasons why are clear in the overwhelming silence of the ICU. Coronavirus kills behind the veil of a hospital curtain, in a stifling silence that is so remote and alien to the global upheaval and noisy political divisions it has inspired. But when it takes a life it is intimately frightening.
The first noticeable interruption in calm is a flashing red light. The other, a doctor̵
The patient is in his 40s, and her medical history has for several days meant that the odds of her survival are poor. But the change, when it comes, is sudden.
Another nurse runs in. At this ICU, the medical staff pauses in an outer chamber to dress and wash, but only moments before he competes. In the corridor outside, a doctor fumbles and pulls clumsily in his dress. These moments have come countless times before in the pandemic, but this day will not be any easier. This ICU is full, and still the peak in São Paulo is probably two weeks away.
Through the glass, the dressed staff glimpses closely and circles the patient’s head; replacing pipes; to change posture; to change position and free each other from the exhausting task. Their unforgiving compression on the patient’s sternum is all that keeps her alive.
A doctor shows up, sweats on his forehead to pause in the cooler corridor. A sliding glass door slams – a rare sound – when another rushes in. For 40 minutes, the silent frenetic focus continues. And then, without audible warning, it suddenly stops. The lines on the brain screens are flat, permanent.
Coronavirus has so profoundly damaged our lives, but its way of killing so often remains hidden in the ICU’s borders, where only brave healthcare professionals see trauma. And for the staff here, it feels closer daily.
Two days before our visit, they lost a nurse colleague Mercia Alves, 28 years in the job. Today, they stand together by the glass in another isolation room, inside who is a doctor in their team, intubated. Another colleague tested positive that day. The disease that has filled their hospitals seems to be moving in on them.
Emilio Riba’s hospital is full of bad news – with no more bed space before the peak reaches, and staff already dying of the virus – but is the best equipped city of São Paulo has. And that’s a dark harbinger for Brazil’s weeks to come. The largest city is its richest, where the local governor has insisted on a lockdown and face masks. Still, the number of deaths is almost 6,000 and the more than 76,000 confirmed cases are chilly indications of what – even probably the best prepared place in Brazil – will come.
Wealth not health finds Bolsonaro, who has recently begun calling the fight against the virus a “war.” But on May 14, he said: “We must be brave to face this virus. Do people die? Yes, I am and I regret it. But many more will die if the economy continues to be destroyed because of these [lockdown] measures. “
Disease cruel in favelas
Across the city, in the favorites, there is no debate. Having almost nothing is common and has taken its own form of isolation from the rest of the city recently. 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.” Her business is serious and every hour.
Around her are the urgent tasks of staying alive. In a room, there are rows of sewing machines, where women learn to go back to their streets and start making masks of everything they can find. In another, 10,000 meals are brought in, cooked and then sent out again, in small quantities, to streets that cannot put food on their own tables in lockdown.
Alves, a volunteer health care worker with the G10 Favela relief group, leads to one of the most affected areas in the suburb of Paraisopolis. Its narrow, dense streets and alleys explain why the disease here is so widespread.
And Alves realizes that she only knows about half the picture among potential 100,000 patients. Only when someone has three symptoms is she allowed to offer them a Covid-19 test, and even it is paid here by a private donor. Many cases go undetected.
“Most often, the test is done when the person is already in an advanced stage of the disease,” she says as she walks into Sabrina’s home, an asthmatic isolation with her three children in three small rooms. Doctors use a wooden stick to check the back of her neck with a flashlight and greet her bored, confused children before moving on.
“Fall can be tough,” Alves tells me. “One obese woman needed eight people to take her to our ambulance. And a man with Alzheimer’s … we had to ask the family if we could physically remove him from his home. It’s hard.” The woman survived, the man died.
High above the crowded street – exciting when everyone seems to come out to meet the garbage truck – is Maria Rosa da Silva. The 53-year-old says she thinks she got the virus from going to the market here, even though she wore a mask and gloves. So she is “locked in”, three floors up on her lush terrace, without railings. Social distance seems only possible here if you do it vertically.
“People I die in the risk group,” she emphasizes. “Even yesterday, the owner of the pharmacy died. Many people lose their lives because of someone’s carelessness. If it is to the benefit of society, we must do it.”
Social responsibility in these dangerous and poor streets has also led to an isolation center being built nearby from a deserted school. The government handed over the building to a privately funded project, which now has dozens of patients inside. It is ready, with sparkling uniform dormitories monitored by CCTV, for many more.
Other signs of readiness are less comforting. In the mountains above São Paulo, the Vila Formosa cemetery contains grief and yawning in anticipation – lined with endless empty and fresh graves. A burial seems to occur every ten minutes and even that means that it is not possible to break the many new holes dug in the red pond.
Brazil had a head start – at least two months saw the coronavirus tragedy sweep the world.
But the undeniable evidence around the world about the horror of the disease has instead resulted in mixed messages from the government. And the death and the set of new cases – terrible as they are – probably cannot reflect the entire tragedy that is already going on.
What has already happened elsewhere – and sent warning signals around the planet – happens here, as well, and could very well be worse.