As Brazil faces a second winter of the pandemic, the COVID-19 situation in the country remains deeply concerning, with national and international experts warning of a devastating third wave. The response remains fragmented and decentralized—compromising efforts to fight the disease. National authorities continue to disregard science and the importance of masks and social distancing in their health messaging.
COVID-19 has now killed 500,000 Brazilians. The average daily COVID-19 fatality rate has crept above 2,000 people a day for the first time since May, and the number of new cases has risen to more than 70,000 per day. This is not far from the highest average of over 77,000 reached during the peak of the second wave in early May.
“In Brazil’s case, it is hard to say if we are starting a new wave because, the truth is, that there has never been a substantial drop in cases since the beginning of the pandemic,” said Doctors Without Borders/Médecins Sans Frontières (MSF) infectious disease specialist Antonio Flores. “The virus has always been circulating freely. Throughout the pandemic, Brazil has been in almost continuous danger of having an acceleration of cases and deaths.”
The impending arrival of winter brings further complications. The cooler weather often brings a rise in cases of the common flu and other respiratory diseases. As people become infected with these illnesses, a health system that is already under pressure due to COVID-19 will be further strained.
Despite the challenges, as the virus continues to spread, MSF teams across the country are finding new ways to help vulnerable communities in the most disadvantaged areas of Brazil. Teams are based in the remote north and northeast of the country, where accessing health services is difficult.
Reaching vulnerable communities in Portel, Pará state
On Ilha do Marajó (Marajo Island), in the state of Pará, MSF is supporting health authorities in the city of Portel, where, due to the extreme remoteness of the community and lack of infrastructure including roads, the system is struggling to face the COVID-19 pandemic.
MSF teams have run trainings in both primary and secondary health care facilities, as well as in the only hospital in the area. The trainings cover how to improve patient flow to prevent the spread of the virus in health centers, COVID-19 protocols, health promotion messages, and support for mental health among health staff, who are struggling to cope with the situation.
“Our objective is to reach Portel’s most vulnerable and provide them with the health care they need and to strengthen the health system,” said Juan Carlos Arteaga, MSF project coordinator in Portel. “We want local doctors and nurses to be prepared as much as possible for an influx of COVID-19 patients should the third wave hit the area.”
MSF teams are also running mobile clinics to care for patients in the most remote areas of the region, providing COVID-19 antigen testing, primary health services, follow-up for recovered COVID-19 patients, mental health services, and health promotion activities.
Connecting people to care in Fortaleza, Ceará state
In Fortaleza, the capital city of the state of Ceará, MSF staff are working in the communities of José Walter and Grande Bom Jardim where people struggle to get the health care they need.
“In these communities, access to health care is notoriously difficult,” said Daniela Cerqueira Batista, MSF project coordinator in Fortaleza. “We are in constant communication with community leaders, and they are really happy to that we are offering services that they really need.”
MSF’s two mobile clinics provide health care close to people’s homes and aim to increase the number of high-quality services for the community. As in Portel, each day teams conduct rapid antigen testing for COVID-19, provide at-home follow-up for COVID-19 patients with comorbidities, offer mental health services, support the COVID-19 vaccination registration program, and run health promotion activities.
Working with local health centers in Bahia state
In the state of Bahia, MSF teams are working in the cities of Cocos, Xique-Xique, and Riachão das Neves, while closely monitoring the COVID-19 situation in other municipalities. With a skilled and experienced team, MSF is supporting the municipal health facilities to get them ready for the expected third wave. MSF medical staff are conducting trainings to improve COVID-19 protocols and patient flows, along with strengthening mental health services for the staff working in those units. As in other areas of the country, COVID-19 has taken a terrible toll on the mental health of those who care for the most severely affected patients and deal with the overwhelming number of deaths.
Outside of health facilities, MSF is implementing a decentralized testing policy with antigen rapid testing and at-home follow-up of high-risk patients in order to facilitate quick treatment for those who need it.
“We want to empower the local health system so they can give patients the highest quality of care possible,” said Fabio Biolchini, MSF head of mission in Brazil. “We are also supporting local authorities to deliver accurate health promotion messages to the communities, using science to explain how they can best take care of themselves and avoid the huge amount of misinformation that’s circulating in communities.”
Currently, MSF is responding to the COVID-19 pandemic in Para, Ceara, and Bahia states—and is preparing a comprehensive medical response in Paraiba state. Since the start of the pandemic, MSF teams have worked in a total of 11 Brazilian states, focused on caring for the most vulnerable members of the community and supporting health systems that are fragile and do not have the capacity to provide care to the massive numbers of Brazilians falling ill and dying of COVID-19.