Covid-19 is out of control in Brazil. So why are some officials easing restrictive measures?

Last week, Brazil saw its deadliest day since the start of the pandemic, with 4,195 people killed in just 24 hours. The state of Sao Paulo and the city of Rio de Janeiro rank among the worst in the country for Covid-19 deaths. Yet both plan to ease movement restrictions starting on Monday.

Sao Paulo will reopen state schools, sports events, and construction stores. Rio de Janeiro will allow bars and restaurants to operate again, overturning restrictions that have been in place since March.

Sao Paulo authorities justify the reopening by pointing out that occupancy rates in intensive care units in the state have fallen from crisis-level 90.5% to 88.6%. “This measure clearly shows that the effort made in recent weeks is beginning to give results,” said Vice-Governor Rodrigo Garcia on a press conference on April 9.

But daily numbers are still very grim: On Friday alone, the state registered over 20,000 new cases.

Meanwhile, in the city of Rio de Janeiro, ICU occupancy rates are higher at 92%, but Mayor Eduardo Paes nevertheless has decided to ease restrictions. “This is an answer for anyone who thinks that restrictions are of no use by preventing parties and crowds. Our reality does not allow lockdown”, Paes said in a press conference held on Friday, adding that shop owners and the general population suffer economically from such measures. Still, he said, “This is no time to relax.”

Medical staff members transport a patient on a stretcher at the Pedro DellAntonia Sports Complex field hospital as coronavirus cases soar on March 11, 2021 in Santo Andre, Brazil. The state of Sao Paulo has reached over 80% occupancy in intensive care units and has declared a red alert as the spread of COVID-19 has accelerated in Brazil in recent weeks. State Health Minister Jean Gorinchteyn announced that they are already recruiting health professionals for reinforcement and working in 140 extra ICUs to prevent the collapse of the health system. 38 patients with COVID-19 have already died on the waiting list for ICU's beds in the state in the first ten days of March.

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Easing restrictions is the opposite of what many institutions and medical specialists say Brazil needs: a national and coordinated lockdown. At the moment Brazil has only fully vaccinated 2.8% of its population – just over 6 million people, in a country of 210 million.

Currently, Brazil’s public and private health systems are under immense pressure, with ICUs in at least 17 states overwhelmed with over 90% occupancy. Intubation medication and oxygen have repeatedly run low at points during the pandemic. On Thursday the National Council of Municipal Health Secretariats declared that about a fifth of all the country′s cities were at risk of running out of medical oxygen over the next ten days.

Only a lockdown can prevent April from becoming “even worse” than March – the country’s most fatal month of the pandemic so far, with 66,573 deaths recorded – according to the Oswaldo Cruz Foundation (Fiocruz), a public biomedical research center that is currently working with vaccine-maker AstraZeneca.

“Lockdowns are a bitter remedy, but they are absolutely necessary in times of crisis and collapse of the health system like the one the country is experiencing now. Just this will prevent more deaths and effectively save lives,” wrote Fiocruz scientists in a recent report.

The United Nations office in Brazil has also asked for the country to impose movement restrictions, warning that an accelerating death rate and absence of a national coordinated plan are “leading the country to a catastrophe.”

Brazil has never had a real lockdown

Since the pandemic began, Brazil has seen a patchwork of local restrictions on movement or activity, but they never really amounted to an effective broad lockdown, neuroscientist Miguel Nicolelis told CNN.

Nicolelis, a prominent Brazilian scientist, created one of the nation’s first scientific committees to study the coronavirus and develop tactics to counter the disease, and has advised on regional Covid-19 strategies. He and other medical experts and civil society groups are part of Brazil’s “April for Life” campaign, which is calling for the federal government to impose an immediate nationwide lockdown.

“Lockdown is when you restrict the flow of people – streets, roads, flights, in addition to achieving strict social isolation. That has never been achieved widely in Brazil, we had only a few exceptions,” said Nicolelis. “In general, we had the application of a few restrictive measures with low levels of adherence from people.”

April for Life estimates that a strict national lockdown for 30 days, with strict rules on the movement of people, could save 22,000 lives.

“If you look at the Brazilian curves in Rio de Janeiro and even in S?o Paulo, you see peaks and valleys. Death spikes, then they temporarily close a few things and you see a small fall, but the fall is not sustainable. In the end, you do not curb the transmission of the virus efficiently, but instead, you make an environment for new variants to arise,” said Nicolelis.

He says that Brazil needs greater federal leadership; an accelerated vaccine rollout; and a federally enforced national lockdown in which only essential services are allowed and most movement is banned.

“The virus is a collective organism, and it is only possible to fight it collectively. It is of no use to close one city if we are to leave the rest open, you need coordinated action, otherwise, the virus will keep growing back,” he says.

RIO DE JANEIRO, BRAZIL - SEPTEMBER 06: An aerial view of people enjoying the weather at Copacabana Beach on September 6, 2020 in Rio de Janeiro, Brazil. Residents of Rio de Janeiro and tourists disrespected the rules of the city and occupied the sands of the beaches. A municipal decree cleared beach vendors and permitted bathing in the sea. However, the use of chairs and tents on the sand is still prohibited. (Photo by Buda Mendes/Getty Images)

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Yet Brazilian authorities have resisted adopting such measures to contain the spread of the virus. The country’s federal government, led by President Jair Bolsonaro, has in fact shown a fierce opposition to imposing any restrictions, out of concern for the economy.

“Whoever closed the markets and shops and obliged the people to stay at home, it wasn’t me,” Bolsonaro said on Saturday, during a visit to the periphery of Brasilia, dismissively referring to mayors and governors who have adopted local restrictive measures.

“I have the power of by signing a document to decree a lockdown in the whole country, but this will not be made, and our army will not go to the streets to impose people to stay at home,” the maskless President declared.

His newly appointed Health Ministry, Marcelo Queiroga, has also rejected the idea. “The (president’s) order is to avoid the lockdown,” Queiroga said on April 3.

Local lockdowns have worked

Three hours drive from Sao Paulo, Edinho Silva is one of few mayors in Brazil who have gone against the tide.

He imposed a full lockdown in the city of Araraquara, closing commerce including supermarkets and public transport, and forbidding the circulation of people for 10 days in February – a decision that prompted death threats against him.

He took the dramatic step after seeing hospitals in the agribusiness-oriented town start to fill up. The city of 250,000 people, was the first in the state of Sao Paulo to see its health system collapse under the weight of new Covid-19 cases, forcing it to transfer severe cases out of packed ICUs and into other cities.

“(Locking down) was a tough decision that required sacrifices, especially from small and medium businessmen, because there is no financial aid for them in Brazil. But with the contamination curve we had, I had nothing else to do,” said Silva.

Shortly after, he started to receive death threats from Bolsaro supporters, Silva told CNN. “Does anyone know where Mayor Edinho lives? I just want a (fight) round with him. Then I am going to stab him from the bottom to top,” one man said on social media, according to Silva. Police are now investigating the threats.

Despite the personal risks, Silva’s strict approach seems to have worked.

Since the end of the 10 day lockdown, some restrictions have remained on the city, including a night curfew from 9pm to 5am and limited hours for bars and restaurants — and Araraquara’s Covid-19 case numbers and deaths have steadily dropped.

For three consecutive days last week, Araraquara registered no deaths due to Covid-19. It’s a small sign of hope, but one that stands out amid Brazil’s accelerating coronavirus crisis.

“Lockdown is not a choice, it is imposed by reality,” says Silva. “If you don’t adopt it, you’ll pile up coffins, there’s no other way.”

Correction: An earlier version of this story misspelled Araraquara.