On the opposite end of the country, more than 1,000 miles away, Santa Catarina state health secretary André Motta had a similar warning: “We are reaching capacity!” And in the northeast: “Our health system will reach capacity and Brazil will be in chaos in two weeks,” Bahia state Gov. Rui Costa said.

While much of the world is using restrictions and vaccines to begin to tame the coronavirus, Brazil’s outbreak is worse than it’s ever been. Deaths have hit a new high, averaging 1,208 per day over the last week. Public hospital occupancy is peaking. Health systems in more than half the country’s 26 states are at or near capacity. And a highly transmissive and potentially more dangerous variant is spreading across the country.

From the earliest days, the severity of Brazil’s outbreak has set the country apart from its peers. Under the chaotic leadership of President Jair Bolsonaro, the country has been consumed by internal divisions, set upon by medical quacks, unable to pull itself out from the abyss. More than a quarter million Brazilians are now dead, a toll surpassed only by the United States. Now the country’s vaccination campaign is bogging down in shortages and delays.

“In this scenario, if nothing is done, by March people will both be fighting for both hospital beds — and graves in the cemetery,” said Domingos Alvez, the director of the Health Intelligence Laboratory at the University of São Paulo in Ribeirão Prêto. “We are going to need to open new graveyards to bury the bodies.”

Health analysts warn the global implications are significant. Brazil has shown a capacity to spawn new, potentially more dangerous mutations of the coronavirus. The variant known as P.1, which was discovered earlier this year, has stampeded the Amazonian city of Manaus, leading to more deaths in January and February than in all of 2020.

“If Brazil does not control the virus, it will be the largest open laboratory in the world for the virus to mutate,” said Miguel Nicolelis, an epidemiologist and neuroscientist at Duke University. “It could not only be the epicenter of the pandemic, but the epicenter of the dissemination of more lethal and infectious variants. It’s in the interest of the entire planet.”

Nicolelis was visiting his mother in his native Brazil when the coronavirus arrived. He believed he’d be more of a help here than in the United States, so he decided to stay and advise. He’s been studying the numbers ever since. Now the moment he long feared and predicted has arrived: “All regions are synchronized.”

When the virus hit Brazil last year, it targeted the cities first, then spread to the rural areas. That delay was a crucial break for Brazil. Health care systems are heavily concentrated in the state capitals. So by the time people from rural communities began flooding city hospitals, the facilities had had time to regroup following the initial surge of urban patients.

But the mass gatherings during the country’s November elections, then the holiday parties, and finally Carnival — they all put much of the country on the same ascent, pushing medical systems all over the country to the brink.

“It’s the first time in Brazilian history that two-thirds of the medical systems in the Brazilian capitals are collapsing at the same time,” Nicolelis said. “And I’m not talking about Manaus. I’m talking about São Paulo. São Paulo. The wealthiest city in the Southern hemisphere. It may have two weeks until it collapses.”

Nicolelis and Alvez both urged an immediate nationwide lockdown for three weeks to avert a humanitarian catastrophe. “We are not going to be able to manage the bodies,” Nicolelis said. “We can either right the country, or it will go downhill. And this time, I guarantee the abyss will be bigger than Brazil.”

But a coordinated nationwide effort to control the virus appears unlikely.

Bolsonaro, who has from the beginning urged Brazilians to all but ignore the pandemic, has sought in recent days to minimize the shortage of hospital beds, criticized new restrictions being imposed by local officials and fretted over the side effects of using a mask.

“They could harm children,” he said late last week. “The side effects of masks are beginning to appear.” He said they included irritability, headaches and difficulty concentrating.

Some cities have imposed new restrictions: A curfew in Brasilia, the closure of nonessential businesses in Porto Alegre. Health analysts say they’re woefully insufficient. But leaders have been extremely hesitant to fully shut down. Unemployment is peaking. The pandemic has plunged millions of Brazilians into poverty. The emergency cash payments the federal government offered last year have now been cut off. In Brazil, a country of vast inequality and social instability, locking down without additional benefits could generate hunger and violence.

Lígia Bahia, a public health professor at the Federal University of Rio de Janeiro, said the tragedy of Brazil has been the triumph of doubt over reason, politics over science.

“We’ve lost,” she said. “The scientists, we’ve lost. It ended up creating all of this polarization.”

But she said there was time for the government and the people to act. Brazil once had one of the strongest vaccination programs in the developing world. It has the capacity to vaccinate millions of people every day. A population largely willing to receive it. And the vaccine is here.

Bahia worries however, about what the coming weeks will bring.

“It will get worse certainly,” she said. “There will be no letup.”



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