As Brazil’s Middle Class Exit from Quarantine, Private Hospitals Grow Crowded

RIO DE JANEIRO, BRAZIL – She has been almost six months locked inside her home in Brasilia. Since the start of the novel coronavirus pandemic, in March, through October, retiree Vânia Carvalho de Mendonça, 71, did not set foot outside her doorstep.

“It was my husband who did the shopping in the market”, she says. In October the health crisis situation in Brazil seemed to be improving, with the number of deaths and cases decreasing weekly. Her grandson’s birthday -Vânia hadn’t seen him for almost a year – led her to end her quarantine.

She hopped on a plane and traveled to São Paulo to attend the celebrations. She attended a dinner at her son’s friends’ house with eight other adults and seven children. Days later, the elderly woman was in the intensive care unit of the Albert Einstein hospital, in the south zone of the capital city of São Paulo, receiving oxygen, a situation that stretched for five days.

Vânia’s case is no exception. More and more Brazilians from classes A and B who were quarantined at the start of the pandemic, relying on the privilege of the home office, are reaching the psychological limits of being locked inside their homes. The improvement in the number of infections and deaths by Covid-19 and the relaxation of restrictions by the public power, which freed the opening of bars and restaurants, caused many in isolation to take to the streets across Brazil, often lacking proper caution – such as wearing masks.

In a way, history repeats itself: the novel coronavirus came to Brazil brought by middle-class tourists returning from their vacation in Europe, and now, once again, finds fertile ground in this same population. “It is possible to say that the start of this new increase in the number of cases once again began with class A and B, just as it did in March. But it was soon followed by a generalized growth in all layers of the population”, says Sidney Klajner, president of Albert Einstein Hospital.

One of the consequences of this reopening was the increase in the number of cases of the disease, which directly reflected in the occupancy of beds in the private and public health system. In Albert Einstein, for instance, where Vânia was treated, the daily average of people admitted with Covid-19 in the ICU in October and November was 28. In the first days of December this number is now around 50 (the hospital states that it does not work with occupancy rates, because it reallocates beds according to demand).

“We had to almost double the number of Covid-19 beds,” says Klajner. A similar situation was observed in other private hospitals. On December 7th, Sírio Libanês Hospital announced a contingency plan to cope with the increased demand for beds for novel coronavirus patients, and at HCor, the rolling average of hospitalizations for the disease – which considers seven-day intervals – jumped from 17 in mid-October to 51 last week.

Already recovered from the shock, Vânia laments the event. “I regret having contracted the virus. I was careful for months and a little outing led to this. But emotionally I needed to go out. And the children kept asking, you know? ‘Grandma, come see us! Then you get carried away by this emotional aspect,” she says.

The symptoms of the disease began to manifest days after dinner at her son’s friend’s house. “I was feverish, had headaches and body pain, I didn’t even have the strength to talk. And then came the shortness of breath, which led me to be hospitalized,” she says. Of the eight adults present at the meeting, six tested positive for the disease, all with mild symptoms and no need for hospitalization.

With the end-of-year festivities approaching, there is concern from authorities that the numbers of the disease in the country will explode, given the increase in gatherings and meetings of friends and families to celebrate Christmas and New Year.

“I think people need to consider what’s best: to refrain from being with their relatives once in the year, for a moment, and be able to enjoy these moments in the near future, or run the risk of dying and it’s all over,” Vânia says.

Public system also under pressure

The private network is not alone in experiencing an increase in the number of Covid-19 hospitalizations. Emílio Ribas Hospital, nationally recognized in the area of infectology, had 100% of its beds occupied at the start of December.

On December 9th the rate stood at 90%. There was also an increase in hospitalizations in other public units: the Emergency Care Unit in Campo Limpo, in the far south of São Paulo, for instance, saw a 65% increase in the number of people with Covid-19.

Despite the rise in the number of cases, the City Hall reported on Friday that the network occupancy rate stood at 57% and 91% in the units contracted. “The whole network is experiencing a significant increase, both in the public and private systems,” says Ana Freitas Ribeiro, coordinator of the Epidemiology Service at the Emílio Ribas Hospital’s Infectology Institute.

In addition to the end-of-year parties, she believes that the imminence of a vaccine has also led to many people lowering their guard with respect to care against the disease. Moreover, the relaxation of quarantine, with the opening of bars, brought more young people to the streets, without the proper social distancing.

This is what occurred with the Curitiba attorney Paulo Kroeff Baggio Silva, 30. He worked in home office from March to early September. “I would go out only for the basics, the market, such things”, he says. Little by little, there was a “somewhat subtle relaxation”, which followed the reopening of stores and the drop in the ICU bed occupancy rate.

It all started with a “little meeting” with a few friends in his home, followed by an occasional lunch out. And culminated with a trip to the Balneário de Camboriú, in Santa Catarina. “There it was as if there was no pandemic. Parties and everyone with no masks.” In early November the first symptoms of a mild flu came, followed by the loss of taste and smell. Silva had contracted Covid-19. He recovered within a few weeks, with no need for hospitalization.

But this behavior of exposing himself to unnecessary risks could be mitigated by government measures.

“We point the finger at those who go to parties. Of course, it’s dangerous. But you don’t see the authorities saying which lower-risk activities can be done. I’m not going to convince a young man going to a club that he can’t go, it’s unrealistic. But what if I tell him that he can meet friends at a park, which is safer?”, says Vitor Mori, member of the Covid-19 Observatory.

He calls for a “damage reduction” policy on the part of governments. “You don’t need to be totally safe, staying home locked up 24 hours a day, or to be totally unsafe, going to parties,” he says.

Social Classes in Brazil

Brazilian society often relies on social classes when segmenting the demography of their population. Social classes in Brazil originated in the early 50’s, when the country experienced an economic boom that would last until the late 70’s. There are still huge differences between rich and poor, which is the reason why social classes have such relevance for segmenting demography in Brazil.

There are several different concepts of social classes in Brazil, but the one that is most widely adopted by the market classifies society in letters from A to E. This definition is based, overall, on the household’s gross monthly income, based on the official minimum salary equivalent, as follows:

Class A: above 20 minimum salaries or R$20,900 (around US$4,000)
Class B: between 10 and 20 minimum salaries
Class C: between 4 and 10 minimum salaries
Class D: between 2 and 4 minimum salaries
Class E: below R$ 2,090 (two minimum salaries)

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