New era of uncertainties: COVID-19 and its impact on Brazil

Introduction.

The Americas today is with no doubt the new epicenter of the novel Covid-19 pandemic, upending the lives of many it has changed dramatically the lives of those who are less protect under a failed and archaic system that for many years tends to favor only the rich few. This pandemic is as much a health crisis as a social and economic threat, creating extremely challenging situations, particularly amongst the most vulnerable.

Since the beginning of the pandemic, Latin America alone counted for more than 11 million cases and some 400,000 deaths due to Covid-19 which is with no doubt alarming ^[1]. Countries like - Brazil, Peru, Colombia, Mexico, and Argentina – are amongst the most affected in the region. As of October, Brazil had over 5 million confirmed cases and more than 150 thousand deaths related to Covid-19 ^[2]. Such high numbers can demonstrate that the country’s health system is struggling to cope with the demand.

In addition to a large number of deaths and sick victims of the new coronavirus, which is advancing rapidly and filling ICUs, Brazil is also going through repeated political crises. Every day, President Jair Bolsonaro (without a party) is at the center of controversy and clashes. In the past months, since the beginning of the pandemic, Bolsonaro has scorned the severity of the disease, disapproved or dismissed ministers, attacked the other powers of the Republic, governors, and mayors, and continued to refuse to comply with the preventive measures recommended by the World Health Organization which led to a rise in the number of cases throughout Brazil. President Bolsonaro was highly criticized by other world leaders and his measures to tackle not just the pandemic but also the economic crisis that the country is facing led to the discernibility of Brazil in the international arena which made many international investors lose interest in the country and bringing Brazil to an even deeper recession.

Unemployment

The decrees of calamity, emergency, and panic started a week after the pandemic in the country. It is statistically and comprehensively proven that crime and mortality rates increase with financial crises and governments are the ones responsible to mitigate such effects. However, Brazil failed to admit that the pandemic would hit the country and its economic system which led to a social crisis that took many Brazilians unprepared.

Unemployment was already high in Brazil in the first quarter of this year when the new coronavirus pandemic was only beginning to affect the national economy. According to the Brazilian Institute of Geography and Statistics (IBGE), the unemployment rate went from 11% at the end of 2019 to 12.2% in the quarter ended in March 2020 ^[3]. This means that around 1.2 million people have joined the unemployment queue only in the past three months, but analysts say that number is still rising due to the Covid-19 crisis.

Also, according to The National Household Sample Survey (PNAD in Portuguese) about 2.8 million (or 3.4% of the employed population) were away from work due to social distance in September ^[4]. The population outside the labor force (who were neither working nor looking for work) was 73.6 million people. In this population, people who said that they would like to work were about 25.6 million (or 34.7% of the population outside the labor force). To prevent the collapse of the economic system in the country and to aid millions of Brazilians that lost their jobs and could not support their families the Federal Government decided to launch a Social Program aimed at helping those who did not have any income due to the pandemic. On April 2 by Law 13.982 was launched the main economic support program for the population during the pandemic of the new coronavirus. The aid consists of an amount of R $ 600 (approx.100USD) paid by the government to help low-income workers affected by the crisis. However, since it was launched, the program has received many critics from Brazilian citizens who argue that the amount offered by the government is way below the minimum wage in the country. Another factor is that emergency aid has also experienced errors of different types. First, there were technical problems involving all stages of the initial benefits application.

Among the problems, the crash of the Caixa Econômica Federal ^[5] application through which registration takes place, the delay in analyzing orders, and receiving messages that do not reflect the exact point of the user process which resulted in the delay of payment for several weeks or months.

Education

If in Brazil before the pandemic about 20.3% of children and adolescents aged 4 to 17 years have their right to education violated where illiteracy and school backwardness affect 53% more boys than girls ^[6] then during the Pandemic these numbers rose and according to PNDA 6.3 million students did not have school activities or were out of school in September alone. UNICEF estimates that in Latin America and the Caribbean, more than 154 million children ^[7], about 95% of students enrolled in the region, are temporarily out of school due to Covid-19.

Several countries including Brazil have started to implement distance learning modalities, including courses on digital platforms. However, these modalities are not guaranteed across the region, and not all families have access to them, especially the most vulnerable. It is a priority to provide accessible content on radio and television for low-income children, at risk of exclusion, without internet access, with disabilities, in addition to migrants and indigenous communities. Based on UNICEF’s survey of 2019 in Brazil, 4.8 million children and adolescents, aged 9 to 17, do not have access to the internet at home. They correspond to 17% of all Brazilians in this age group and are greater in rural areas, where the percentage of those who do not access the network reaches 25% ^[8]. Therefore, I argue that today over 4 million children and adolescents do not have the opportunity to study remotely in Brazil due to social inequality.

The National Education Council (CNE) in Brazil to mitigate this issue launched a program that aimed in helping students all over Brazil by creating a non-classroom activities program that can be offered digitally or not. For example, through video classes, content organized on virtual teaching and learning platforms, and through social media, among others. They can also be offered through television or radio programs; the adoption of printed teaching materials and distributed to students and their parents or guardians; and for the guidance of readings, projects, research, activities, and exercises indicated in didactic materials ^[9]. However, this system lacks planning and logistics where in many cases the teachers are responsible for organizing, printing, and distributing these materials.

Health

Another sector that was hit Brazil greatly since the pandemic started was the Unified Health System (SUS) that underwent a decisive test in the coming months. Today more than 80% of the Brazilian population depends exclusively on SUS, (150 million people) for health care treatments and support. The growth in the number of confirmed cases of Covid-19 has put pressure on the existing care structure, mainly its Intensive Care Unit (ICU).

The country has about 55 thousand ICU beds, half in the public sector (SUS), and a half in private hospitals. The problem is that only 25% of the population has access to supplementary health care, which accounts for half of the beds ^[10]. The other 75% of patients, who use SUS, keep the other half. The World Health Organization (WHO) and the Ministry of Health indicate that there should be one to three beds for every ten thousand inhabitants. Considering all the ICU beds in Brazil, there are two beds for every ten thousand inhabitants. In São Paulo, the government has already announced the installation of 1,400 additional beds and other states are also strengthening its service structure. Even so, there is a strong fear that ICU beds will be lacking. The North and Northeast regions may be unassisted. The average occupancy rate in private ICUs is around 80%. In public hospitals, this rate is an impressive 95%, according to the Associação Medicina Intensiva Brasileira (AMIB) ^[11].

The SUS also demonstrated flaws incompleteness by not offering the number of COVID-19 tests necessary, especially in the poorest areas of the municipalities, such as the peripheries, inland and rural municipalities, and shelters for migrants and refugees. The data collected by the Municipal Health Secretariat of São Paulo (SP) illustrate this point. According to them, the neighborhoods with the highest record of deaths have few confirmed cases of COVID-19 (due to the scarcity of tests), while the wealthiest regions of the city, with greater access to tests and treatments (private and public), accumulate many confirmed cases and fewer deaths.

A solution found by the government to increase the number of tests in the country was to allow pharmacies to test individuals.

The publication of Resolution of the Collegiate Board of the National Health Surveillance Agency (RDC / Anvisa) No. 377, published on 04/28/2020, pharmacies are authorized, by Anvisa and on a temporary and exceptional basis, to use the “rapid tests” (Immunochromatographic assays) for Covid-19 ^[12].

The Ministry of Health spent less than a third of the R $ 39.3 billion released to fight the coronavirus through provisional measures. Since the beginning of the coronavirus crisis, President Jair Bolsonaro has issued eight provisional measures with specific resources for the Ministry of Health. The interim Eduardo Pazuello, who participated in a remote public hearing of the mixed commission stated that the portfolio has so far paid R $ 10.9 billion (1,9 billion USD) by Resolution 969/2020 ^[13], - equivalent to 27.2% of the total. The MPs provide actions such as purchasing PPE, tests, monitors, and lung ventilators; rental of ICU beds; medication production; remuneration and temporary hiring of health professionals; and emergency financial assistance to holy houses and philanthropic hospitals.

Currently, the Ministry of Health is working on two central issues in the country: the capitals of the southeast, such as São Paulo and Rio de Janeiro, with high and growing cases of the new disease, and states in the north and northeast regions, which have none less than the necessary number of ICU beds per 100 thousand users, according to a study published by Cebes (Brazilian Center for the Study of Health). The chaos in Brazilian public health aggravated by the pandemic affects not only the population but also health professionals. The lack of PPE (personal protective equipment) has led to an increase in cases of contamination by coronavirus among doctors, nurses, and others. Thus, according to information from the Ministry of Health, Brazil already accounts for more than 31,700 infected health professionals. Of these, 34.2% are nursing technicians or assistants, 16.9% nurses, and 13.3% doctors.

Conclusion

Thus, in the midst of global chaos, Brazil faces great difficulty in being able to mobilize the resources necessary to exercise equity, since the country, as well as the world, is in need of joint efforts. Even so, within the limitations imposed, small reflexes of a social justice policy can be found by prioritizing urgent cases and by decentralizing the public health system. The Government failures do not focus only on the negligence and belligerent stance of the President of the Republic, Jair Bolsonaro. The conduct of state actions by its commanders and the attempt to manage the crisis also helped to place the country in second place behind only the United States. Public health in Brazil is an old problem that was aggravated by the coronavirus pandemic. In this way, the wealthiest portion of the population has access to private health services while the majority depends on the public service, facing queues, crowded hospitals, and limited structure and the same can be applied to other social services such as education.