In the huge intensive care unit (ICU) of the Emilio Ribas Institute of Infectious Diseases in São Paulo, anger swirls among doctors when asked for comments from their president. “Revolting,” said one. “Not relevant,” said another.
Dr. Jacques Sztajnbok is more sober. “It is not a flu. It is the worst thing we have ever known in our professional life.” His slow, narrow eyes, when I ask him if he’s worried about his health. “Yes,” he says twice.
The reasons for this are clear in the overwhelming silence of the ICU. The coronavirus kills behind the curtain of a hospital curtain, in a suffocating calm, so distant and foreign to the global upheavals and the noisy political divisions that it has inspired. But when it takes a life, it’s intimately horrible.
The first notable break in calm is a flashing red light. The second, a doctor’s cap, rising and falling just above a privacy screen, while his rigid arms provide hard and unforgiving chest compressions to a patient.
The patient is in her forties and her medical history has meant for days that the chances of her survival are bad. But the change, when it comes, is sudden.
Another nurse arrives. In this intensive care unit, the medical staff take a break in an outdoor room to dress and wash, but only a few moments before returning. In the corridor outside, a doctor is groping, awkwardly putting on his robe. These moments have come countless times before in the pandemic, but today it doesn’t get any easier. This intensive care unit is full and the peak of São Paulo is probably in two weeks.
Through the windowpane, the staff in dresses are jostling closely and go around the patient’s head; to replace the tubes; change posture; to change position and relieve each other of the exhausting task. Their relentless cuts to the patient’s sternum are all that keeps her alive.
A doctor emerges, sweating on his forehead, to pause in the cooler air in the corridor. A sliding glass door slams – a rare noise – while another rushes. For 40 minutes, the quietly frantic concentration continues. And then, without an audible warning, it suddenly stops. The lines on the heart monitors are flat and permanent.
The coronavirus has damaged our lives so deeply, but the way it kills so often remains hidden in the confines of intensive care, where only hardworking healthcare workers see the trauma. And for the staff here, it feels closer every day.
Two days before our visit, they lost a nurse colleague Mercia Alves, 28 years of work. Today, they stand together by the glass of another isolation room, inside which is a doctor of their team, intubated. Another colleague was positive that day. The disease that has invaded their hospital seems to have spread to them.
Emilio Ribas Hospital is full of bad news – without additional bed space before the peak and the staff is already dying of the virus – but is the best equipped in the city of São Paulo. And it’s a dark warning sign for the coming weeks of Brazil. Its largest city is the richest, where the local governor insisted on a lock and masks. Still, deaths are still close to 6,000 and the more than 76,000 confirmed cases are frightening indications of what – even probably the best prepared place in Brazil – is to come.
Wealth, not health, worries Bolsonaro, who recently started calling the fight against the virus a “war.” But on May 14, he said, “We have to be brave to deal with this virus. Do people die? Yes, they are, and I regret it. But many more will die if the economy continues to be destroyed because of these [lockdown] measures.”
The disease is rife in the favelas
Throughout the city, in the favelas, there is no debate. Having almost nothing is commonplace and has brought its own form of isolation from the rest of the city some time ago. But the priority here has long been clear: survival.
Renata Alves laughs, shakes her head and says “it is not relevant”, when asked the opinion of Bolsonaro, the virus is only a “cold”. His business is serious and hourly.
Around her, the urgent tasks of staying alive hum. In one room, rows of sewing machines are arranged, where women learn to go back to their streets and start making masks from whatever they can find. In another, 10,000 meals are brought, prepared, and shipped again, in very small numbers, to the streets unable to put food on their own tables during isolation.
Alves, a volunteer health worker with the G10 Favela aid group, travels to one of the most affected areas in the suburbs of Paraisopolis. Its narrow, dense streets and alleys explain why the disease is so prevalent here.
And Alves realizes that she only knows half the picture among a potential of 100,000 patients. It is only when someone has three symptoms that they are allowed to offer them a Covid-19 test, and even this is paid for here by a private donor. Many cases go undetected.
“Most of the time, the test is done when the person is already at an advanced stage of the disease,” she says, as she heads for the house of Sabrina, an isolated asthmatic with three children in three lowercase letters. rooms. Doctors use a cotton swab to check the back of her throat with a flashlight, and greet her bored and disoriented children before continuing.
“Cases can be difficult,” Alves tells me. “An obese woman needed eight people to transport her to our ambulance. And a man with Alzheimer’s disease … we had to ask the family if we could physically remove him from his home. C ‘is difficult.” The woman survived, the man died.
Maria Rosa da Silva is over the crowded street – distressed when everyone seems to go out to meet the garbage truck. The 53-year-old says she thinks she caught the virus while going to the market here, even though she was wearing a mask and gloves. It is therefore “locked up”, three floors on its green terrace, without railings. Social distancing only seems possible here if you do it vertically.
“People like me in the risk group die,” she said. “Even yesterday, the owner of the pharmacy passed away. Many lose their lives due to someone’s negligence. If it is for the good of society, we must do it.”
Social responsibility in these dangerous and poor streets has also led to the creation of an isolation center near a deserted school. The government ceded the building to a privately funded project, which now has dozens of patients inside. He’s ready, with uniform sparkling dorms monitored by CCTV, for many more.
Other signs of preparation are less comforting. In the hills above São Paulo, the cemetery of Vila Formosa overflows with mourning and yawns in expectation – bordered by endless empty and fresh graves. A burial seems to occur every 10 minutes and even this does not make a dent in the many new holes dug in the red dust.
Brazil was one step ahead – for at least two months it saw the tragedy of the coronaviruses sweep the world.
But the overwhelming evidence in the world of the horror of the disease has instead given mixed messages from the government. And the death toll and the dataset of new cases – as horrible as they are – probably do not reflect the entire tragedy already underway.
What has already happened elsewhere – and sent flares around the planet – is happening here, all the same, and may well be worse.