Brazil is likely to pass the awful mark of 500,000 COVID-related deaths in the next two days. Only the United States has a higher number of dead across the world.
Currently averaging 2,500 deaths a day, Brazil’s P1 variant has long been identified as a highly virulent cause for concern, prompting travel bans to most countries.
But researchers in Sao Paulo, one of the worst-hit cities in the country, say the P1 variant has started infecting and killing pregnant women and their unborn children in startling numbers.
Currently 42 pregnant women die every week from COVID-19; many more women are being intubated and their premature children delivered by caesarean section without consultation with obstetricians, according to medical researchers at the Brazilian Obstetric Observatory.
Dr Rossana Pulcineli Vieira Francisco from the observatory said: “The virus transmissibility is higher with this variant and I think the big problem is that the health system for maternal care in Brazil is very bad.
“In some states the patient starts treatment in one hospital, a general hospital, and when her condition starts to worsen, and she needs to deliver the baby, she will be transported while intubated because they’re not at the right hospital to do the delivery.”
This, she believes, is part of the reason Brazil is seeing a higher rate of maternal mortality.
She says obstetricians and intensivists should be working together to find the right outcomes for mother and child, otherwise it will be very difficult to stop maternal mortality during COVID.
“I think we have more cases because of the variant, and because our maternal health system is very fragile, we have this result.”
I asked her if it’s a perfect storm.
“Yes”, she replied, “and I think our only chance to stop this is the vaccine.”
The data from her and her colleagues’ research reveals that last year 10 pregnant women were dying each week from COVID-19.
This year, with the emergence of the new variant, the new figure is more than 40 per week.
Poor medical care and facilities already contributed to a high death rate for pregnant women in Brazil of 55 per 100,000 women. In Britain the figure is just 9.7.
But Dr Francisco says their research so far indicates that with COVID-19 as a factor the new number could double to over 100 per 100,000 by the end of the year.
The high overall transmission of the P1 variant (it accounts for nine in 10 coronavirus cases in Sao Paulo) combined with an overwhelmed health service, puts pregnant women at extreme risk.
The practice of intubating pregnant women and delivering the baby while the mother is in a highly stressed condition is criticised by the researchers as a “bad outcome” for both the mother and her child.
For their part, doctors working in overstretched public hospitals prioritise the life of the mother over the child and without extensive experience of intubating anyone, let alone pregnant women, they have little choice but to deliver the baby while saving the mother.
In Jardim Almeida Prado, a poor neighbourhood in the south of the city of Sao Paulo, Thais Ferreira de Lomes looks down at her tiny three-month-old baby Ezequiel, who has just been released from hospital.
Ezequiel was born 12 weeks prematurely, after Thais was intubated.
Previously fit and healthy, like most people, Thais and her family thought she was in no danger when the first symptoms of COVID developed, but they were wrong.
When her kidneys failed, the doctors said she wouldn’t live to see her third child.
She’s still scarred by her near-death experience – her uncle had died of COVID when she first got sick.
“It was great to come home, see my family, and know that God gave me the opportunity to live again,” she tearfully told me.
“Seeing so many people dying, so many people dying like my uncle died with COVID. Many people are dying with COVID.”
Even though she is over the worst of her experience, she is scared for her and her children’s futures, and worries Ezequiel might still get coronavirus.
“Even today I’m afraid because he’s tiny, he was born prematurely. I told my mother-in-law that it’s hard for me to look at him and not think that something might happen.”
At the Graiau Hospital, the maternity ward and its premature babies section where Ezequiel was cared for, are currently free of COVID cases, but doctors and nurses have no expectation that it is going to stay this way – other hospitals in the city are still treating infants with COVID-19 and their sick mothers.
Dr Patricia Sella, the medical coordinator for gynaecology – and the doctor who treated baby Ezequiel – says she has no doubt that the P1 variant, sweeping across the country, is infecting young pregnant women like she hasn’t seen before.
“In 2021 we observed an increase in pregnant women affected by COVID, likely because of the new strain.
“In 2020, in our hospital mainly, we had a very small number of pregnant women with COVID, but this year we have at least one pregnant woman hospitalised with COVID every week,” she explained to me, standing in the hospital’s neonatal intensive care unit.
She puts this down to the high infection rate of the P1 variant.
“So, actually, I think that with the change in the strain, we saw that the inflammatory process, [and] the vasculitis caused by the virus is much greater, right, and that ended up changing, bringing it to pregnant women.
“[Pregnant women] already have decreased lung compliance due to the pregnancy itself and the evolution of the pregnancy. With the COVID infection, this ends up getting worse.
“What we observed is that this strain ended up infecting pregnant women who do not have any other pre-existing conditions, so they do not have hypertension, and do not have diabetes during pregnancy. We observed that there was an increase and an increase in severity of the cases.”
In the middle-class suburb of Jardim America, Douglas Silverio proudly shows off the latest addition to his family, three-month-old Maria Helena.
She has two elder brothers Pedro, five, and Bento, three, who run around their home playing with toys while their grandmother prepares lunch.
She now lives with the family because her daughter and the children’s mother, Vanessa, is dead; killed by COVID-19.
Vanessa was just 33 when coronavirus struck.
Within five days she deteriorated and was intubated, and Maria Helena was delivered by caesarean section, coincidentally on her dad’s birthday.
Vanessa never recovered.
“I told my sons, ‘let’s say goodbye to her’.
“Pedro, who is five years old, cried too, and he said, ‘goodbye mother, you are going to heaven’.
“The youngest one did not understand what happened. And it was crazy, that was a crazy time, because we had prayed a lot for the baby, a lot of prayers from our family, but I was not ready to bury my wife in this process.”
On the day Douglas held mass for his wife’s death, baby Maria Helena was released from hospital.
He wants everyone to fear COVID and to listen to the warnings about the disease.
“I miss my wife. And she was my friend, we had a lot of plans together.
“I get scared when I see on the streets some pregnant women without masks. I say to them please take care of yourself.”
The entire medical profession in Brazil now acknowledges that the only way to fight the virus and to stop the country being a petri dish for creating COVID-19 variants that will continue to threaten the world, is for the country’s vaccination programme to speed up and reach all members of society.
The rollout is currently very slow and so far has only started to include 56-year-olds in Sao Paulo.
Many in the profession directly blame the country’s president, Jair Bolsonaro, for the country’s poor response to the pandemic.
He still refuses to take the vaccine, has continuously played down the danger of coronavirus and still discourages the use of face masks anywhere.
The identification of the virus as a specific threat to young pregnant women has set off the alarm bells here that COVID-19 variants are attacking younger and younger members of society, who were previously thought to be relatively safe from serious illness.