Analysis: Brazil projects third wave of Covid-19 as states let their guard down despite warnings

RIO DE JANEIRO, BRAZIL – The arrival of a third wave is not a question of “if”, but rather “when”, according to researchers. Low vaccination and relaxation of restrictions are pointed out as factors for a new peak in the country, with over 70% of the population susceptible to becoming infected by the virus.

Brazil is experiencing in April the most dramatic moment of the Covid-19 pandemic. In just four months, 2021 has now become the most lethal year since the start of the health crisis that has killed almost 400,000 people – 3,086 of whom in the past 24 hours, according to data from the National Council of Health Secretaries (CONASS) released on Tuesday, April 27.

Last week there was a small respite, with the drop in the number of confirmed cases and deaths in the country caused by the novel coronavirus. But experts say it is still too early to celebrate, and that the arrival of a third wave is not a question of “if”, but rather “when”, especially as states begin to relax the restrictive measures behind the reduction in numbers.

With Mother’s Day coming up on May 9th – one of the main dates for stores and a time for socializing and gatherings – there is concern over a rise in cases and deaths such as seen after the year-end holidays in 2020.

The relaxation of restriction measures, as has occurred in São Paulo, where restaurants, beauty salons, and gyms have been allowed to reopen since the weekend, is viewed as reckless by doctors and researchers. “April, which is not even over yet, is now the most lethal month in the pandemic. And regardless of that we are reopening activities again,” says Rafael Lopes Paixão da Silva, member of the Covid-19 BR Observatory.

According to the researcher, “if the measure is working, it needs to be maintained for some time to have a safety margin.” But this is not the case: “Governments see a slight drop in hospital occupation and start releasing activities again; this is desperate.” Epidemiologist Paulo Lotufo agrees. “There is a basic mistake, which is to use as an indicator [of reopening of activities and trade] the ICU occupancy rate. This is not an epidemiological indicator, it is an administrative indicator,” he says.

The prognosis for the country is bleak: “[The numbers] should drop a little further, and then there will be a new rise. The question is what the magnitude of this rise will be. No one imagined, for example, that this second peak would be as sharp as it was [this year the country has recorded more Covid-19 deaths than in 2020]. If things continue as they are, a third wave is possible in July,” says Lotufo, citing the crowds that should occur due to Mother’s Day combined with the easing of isolation.

Lotufo’s statement may sound alarmist, but it is shared by other pandemic scholars. “There is no reason for relief. The drop in numbers seen in the past week is a natural process of an epidemic; it is true for dengue and many others. But we still have very high levels. If we relax too much, this drop may become a plateau, and there may even be a reversal of the decline,” says Fiocruz (Oswaldo Cruz Foundation) researcher Leonardo Bastos.

He says it is not possible to specify how low the numbers will drop before stabilizing. “And then the relaxation [of restriction measures] or new variants can lead to a new outbreak. It’s not a question of ‘if’ but rather ‘when’ it will happen. It can be a small wave or a big wave, national or focused on a few states. It depends greatly on the reality of each place and the policies that have been adopted. Or which were not.”

Delay in the vaccination of priority groups

The slow progress of the vaccination process in the country is another factor that can make a third wave as lethal as or more than the second one. Last week,  Minister of Health Marcelo Queiroga stated that immunization of priority groups will only be completed in September. The initial forecast, made by his predecessor Eduardo Pazuello, was to complete this stage in May.

“If we had greater speed in vaccination we would see a next wave with a much lower number of deaths and hospitalizations. And if the most vulnerable population [included in the priority group] were protected, the likelihood of seeing many deaths and serious cases would also drop,” says Bastos, from Fiocruz.

But even if the schedule of the priority groups had been maintained, it would not be enough to stop a new wave. “Vaccinating priority groups   by itself is not enough, you reduce deaths but don’t eliminate them, and it doesn’t prevent a collapse of the health system,” says Isaac Schrarstzhaupt, Coordinator in the Covid-19 Analysis Network. “The strategy needs to be twofold. Vaccinate and reduce the transmission rate. It is possible to avert a third wave with non-pharmacological measures [vaccines], although in Brazil this has not been done,” he says. He mentions New Zealand as an example, where closing and restriction measures are implemented as the transmission rate increases.

The shortage of immunizers will rely on yet another unanticipated factor during the second wave. “The expectation for more vaccines is getting smaller and smaller. With the explosion of cases in India, they will now stop exporting their immunizers and supplies to other countries, and will even go into a process of mass vaccines purchases. I don’t see much of a way out,” says epidemiologist Lotufo.

“We have a very low standard of vaccination. Ideally, we should have between 25% and 30%, then we would have a much better accommodation,” he says. “If you analyze the lethality of the disease, which is around 1% and has killed almost 400,000 people, there must be almost 40 million people who have already been infected, that is, 25% of Brazilians have now had the disease. So almost three quarters of the population are still susceptible to contracting the virus. That’s a lot of people.”

Government guidelines regarding vaccination are also conflicting: initially the Ministry of Health had determined not to reserve the second dose, given that according to the initial planning -and which has been revised downwards numerous times- supplies would be enough for the states.

Now, as several capitals are forced to suspend the vaccination of both first and second doses due to a shortage of immunizers, the portfolio has reversed its position: Minister Queiroga said that the new recommendation is that a reserve is kept back for the second dose, given the delays in the supply of raw materials and immunizers.

Source: El Pais