H5N1

Ethnic and regional variations in hospital mortality from COVID-19 in Brazil: A cross-sectional observational study

Via The Lancet Global Health: Ethnic and regional variations in hospital mortality from COVID-19 in Brazil: a cross-sectional observational study. The summary:

Background 

Brazil ranks second worldwide in total number of COVID-19 cases and deaths. Understanding the possible socioeconomic and ethnic health inequities is particularly important given the diverse population and fragile political and economic situation. We aimed to characterise the COVID-19 pandemic in Brazil and assess variations in mortality according to region, ethnicity, comorbidities, and symptoms. 

Methods 

We conducted a cross-sectional observational study of COVID-19 hospital mortality using data from the SIVEP-Gripe (Sistema de Informação de Vigilância Epidemiológica da Gripe) dataset to characterise the COVID-19 pandemic in Brazil. In the study, we included hospitalised patients who had a positive RT-PCR test for severe acute respiratory syndrome coronavirus 2 and who had ethnicity information in the dataset. 

Ethnicity of participants was classified according to the five categories used by the Brazilian Institute of Geography and Statistics: Branco (White), Preto (Black), Amarelo (East Asian), Indígeno (Indigenous), or Pardo (mixed ethnicity). We assessed regional variations in patients with COVID-19 admitted to hospital by state and by two socioeconomically grouped regions (north and central-south). We used mixed-effects Cox regression survival analysis to estimate the effects of ethnicity and comorbidity at an individual level in the context of regional variation. 

Findings 

Of 99 557 patients in the SIVEP-Gripe dataset, we included 11 321 patients in our study. 9278 (82·0%) of these patients were from the central-south region, and 2043 (18·0%) were from the north region. 

Compared with White Brazilians, Pardo and Black Brazilians with COVID-19 who were admitted to hospital had significantly higher risk of mortality (hazard ratio [HR] 1·45, 95% CI 1·33–1·58 for Pardo Brazilians; 1·32, 1·15–1·52 for Black Brazilians). Pardo ethnicity was the second most important risk factor (after age) for death. Comorbidities were more common in Brazilians admitted to hospital in the north region than in the central-south, with similar proportions between the various ethnic groups. States in the north had higher HRs compared with those of the central-south, except for Rio de Janeiro, which had a much higher HR than that of the other central-south states. 

Interpretation 

We found evidence of two distinct but associated effects: increased mortality in the north region (regional effect) and in the Pardo and Black populations (ethnicity effect). We speculate that the regional effect is driven by increasing comorbidity burden in regions with lower levels of socioeconomic development. 

The ethnicity effect might be related to differences in susceptibility to COVID-19 and access to health care (including intensive care) across ethnicities. Our analysis supports an urgent effort on the part of Brazilian authorities to consider how the national response to COVID-19 can better protect Pardo and Black Brazilians, as well as the population of poorer states, from their higher risk of dying of COVID-19.

Social divisions drive astronomical COVID-19 rate in Chile

Via NPR's Goats and Soda blog: Social Divisions Drive Astronomical COVID-19 Rate In Chile. Chile's COVID-19 case count is here. Excerpt:

Chile looked as if it were well prepared to deal with the new coronavirus. 

It's a rich country — classified as high income by the World Bank. Life expectancy is roughly 80 years — better than the United States'. It has a solid, modern health care system, and when the outbreak began spreading, officials made sure they had plenty of ventilators and intensive care beds at the ready.  

But the virus exploited the cracks in Chilean society. The country now has the highest per capita infection rate of any major country — 13,000 cases for every 1 million people. That's more than 10 times the rate in neighboring Argentina and twice the rate in Brazil.  

Like many well-to-do countries, Chile saw its first cases of COVID-19 among its elite — people who'd recently traveled to Europe and the United States. That was in April. The government quickly rolled out a plan to provide testing and treatment. Health officials quarantined hard-hit neighborhoods. Residents had to apply for a pass online before they could go out of their homes even to buy groceries. In late April, things were going so well that Chile was starting to talk about reopening. 

"And then May started bringing more cases and more cases. Currently we have, in my opinion, more cases than we are able to handle," says Thomas Leisewitz, a physician in Santiago. Leisewitz is a professor at Pontificia Universidad Católica de Chile and heads up strategic development at Red de Salud UC Christus, a nonprofit Catholic health care network. 

Since May, the number of cases has been rising steadily, with the country recording at one time 5,000 to 6,000 new cases a day in June. The virus spread out of the affluent parts of Santiago to low-income neighborhoods where many residents don't have the luxury of being able to work from home.  

And the high numbers are not just a reflection of an efficient testing infrastructure. Chile's per capita testing rate is lower than most European nations' and almost half the rate in the United States. 

So how did this particular virus come to spread incredibly rapidly in wealthy, well-prepared Chile? 

Andrea Insunza, a journalist in Santiago, says the reason is something unrelated to the virus itself. That something is social inequity. 

"In Chile, there are two countries," says Insunza, who runs the center for investigative journalism at Universidad Diego Portales. "There's a country for people like me. I have a good education. I have a good salary, and all my social security is privatized."  

By this she means she has access to high-quality private hospitals and clinics. 

But there's another Chile.  

"And that Chile is poor and you depend on the public health [system]," says Insunza. 

Last October, violent street protests erupted in Santiago over a fare hike on the subway of 30 pesos, or less than 5 U.S. cents. The protests became about far more than the price of a subway ride. 

Chile is one of the most unequal countries in Latin America, according to the World Bank. The elite, the top 10%, controls more than half the country's wealth. And while extreme poverty has been driven down significantly over the last decade, the social unrest in October centered on the frustrations of lower- and middle-class Chileans who view their economic opportunities as unfairly limited. 

Insunza says part of the frustration is driven by the elite often not even seeming to recognize their privileged lifestyles. 

"Santiago, it's a very segregated place," Insunza says. "You can actually live your whole life and not see poverty. Never."  

Chile's initial plan to deal with the coronavirus outbreak — which at first affected mainly the elite in Santiago — failed to recognize that the affluent have maids, gardeners and cooks who might also get infected.  

The country's response went well in those early weeks. Case numbers were holding steady. The fatality rate was low. 

Then the virus started spreading in lower-income neighborhoods and quickly got out of control.

Hollowed-out public health system faces more cuts amid COVID-19 pandemic

Many thanks to Lauren Weber for sending this major report by Kaiser Health News and The Associated Press: Hollowed out public health system faces more cuts amid virus. Here's an excerpt and then a comment, but you should just click through and read the whole long, grim story. Don't let it depress you, but do let it enrage you.

The U.S. public health system has been starved for decades and lacks the resources to confront the worst health crisis in a century. 

Marshaled against a virus that has sickened at least 2.6 million in the U.S., killed more than 126,000 people and cost tens of millions of jobs and $3 trillion in federal rescue money, state and local government health workers on the ground are sometimes paid so little, they qualify for public aid.  

They track the coronavirus on paper records shared via fax. Working seven-day weeks for months on end, they fear pay freezes, public backlash and even losing their jobs.  

Since 2010, spending for state public health departments has dropped by 16% per capita and spending for local health departments has fallen by 18%, according to a KHN and Associated Press analysis of government spending on public health. At least 38,000 state and local public health jobs have disappeared since the 2008 recession, leaving a skeletal workforce for what was once viewed as one of the world’s top public health systems. 

An Associated Press-KHN investigation has found a skeletal workforce facing more possible county budget cuts. KHN, also known as Kaiser Health News, and AP interviewed more than 150 public health workers, policymakers and experts, analyzed spending records from hundreds of state and local health departments, and surveyed statehouses. On every level, the investigation found, the system is underfunded and under threat, unable to protect the nation’s health.  

Robert Redfield, the director of the Centers for Disease Control and Prevention, said in an interview in April that his “biggest regret” was “that our nation failed over decades to effectively invest in public health.”  

So when this outbreak arrived — and when, according to public health experts, the federal government bungled its response — hollowed-out state and local health departments were ill-equipped to step into the breach.

Over time, their work had received so little support that they found themselves without direction, disrespected, ignored, even vilified. The desperate struggle against COVID-19 became increasingly politicized and grew more difficult. 

States, cities and counties in dire straits have begun laying off and furloughing their limited staff, and even more devastation looms, as states reopen and cases surge. Historically, even when money pours in following crises such as Zika and H1N1, it disappears after the emergency subsides. Officials fear the same thing is happening now. 

“We don’t say to the fire department, ‘Oh, I’m sorry. There were no fires last year, so we’re going to take 30% of your budget away.’ That would be crazy, right?” said Dr. Gianfranco Pezzino, the health officer in Shawnee County, Kansas. “But we do that with public health, day in and day out.”

This is not just a Republican failure; the Democrats are equally to blame. Both parties, since about 1980, have presided over an enormous project of social engineering: the transfer of wealth from working people and the middle class to the 0.1%.

"Government is the problem" was Reagan's mantra, and as people began to notice that their incomes couldn't quite cover all their bills any more, they were taught to blame government spending for their suddenly heavy taxes. (Never mind that Americans were already among the most lightly taxed citizens of any industrialized country.)

 

So tax cut after tax cut came from Republican and Democratic administrations alike, on all levels of government. Somehow the taxes were always too burdensome, the government spending too wasteful. Universal health care was for those overtaxed "socialist" Europeans and Canadians, and a little grudging support for public health came only to provide symptomatic relief—to provide a Band-Aid, not to prevent the cut in the first place.

 

"We're all in this together" rings hollow in a country that's been taught for 40 years that everyone is personally responsible for his or her success or failure, health or sickness. And now that the consequences of 40 years of wealth transfer are manifest, 126,000 rugged American individualists are dead, 2.6 million have been sickened (so far), and everyone but the 0.1% have been further impoverished. (The 0.1% have been doing just fine, thanks.)

 

It will take more than yet another transfer of power from Republicans to Democrats to roll back COVID-19. It will take a rollback of 40 years of systemic theft from the 99%.

'Like leaning into a left hook': COVID-19 calamity unfolds across divided US

Via The Guardian: 'Like leaning into a left hook': coronavirus calamity unfolds across divided US. Excerpt from a very depressing report:

A disaster is unfolding in Montgomery, Alabama, where Martin Luther King preached and where Rosa Parks was arrested for refusing to give up her seat on the bus. Hospitals are running short of drugs to treat Covid-19, intensive care units are close to capacity, and ventilators are running short. 

Between 85% and 90% of the very sick and dying are African American. 

Amid this gathering storm, the city council met to decide whether to require people to wear masks, a basic protection the US Centers for Disease Control and Prevention (CDC) strongly recommends. Doctors lined up to plead their case. 

“This is beyond an epidemic in this area,” said the pulmonologist Bill Saliski. “Our units are full of critically ill covid patients. We have to slow this down.” 

His colleague, Nina Nelson-Garrett, described watching undertakers carrying out corpses, 30 minutes apart. 

“Something as simple as a mask can save someone’s life,” she said. 

Dr Kim McGlothan recounted how she was frequently stopped by white people asking, “Is the media sensationalizing this, is it really as bad as they are making out?”  

McGlothan told the council: “People don’t believe the hype. Until you mandate masks, we won’t be able to stop this – we just won’t.”  

Then a black resident stood up. Six of his relatives had died from Covid-19. His brother was on a ventilator. “This is not about masks,” he said. “The question on the table is, ‘Do black lives matter?’ I lost six of my family to Covid. How would it feel if it was your family?”

The council debated for two hours. White council members asked if young children could get carbon monoxide poisoning from masks – no, the doctors firmly told them – and spoke portentously about individual rights.  

“At the end of the day,” said councilman Brantley Lyons, “if a pandemic comes through, we do not throw our constitutional rights out the window.”  

When the vote was called, it divided on largely racial lines. Black members voted for masks, in order to prevent more families losing six loved ones. White members voted against masks, to preserve the fundamental right not to attach a cloth to your face.  

In a 4-4 tie, the ordinance failed. As he left the chamber, Dr Saliski uttered just one word: “Unbelievable.” 

Unbelievable accurately describes America today. The country is on the brink of a huge surge of Covid-19, as the virus tears through the heartlands while the president praises himself for having done “a great job” and blithely predicts the scourge will “fade away”. 

Ask Alabama whether the virus is fading away. Or Arizona, Florida, South Carolina or Texas. The disease is venting its fury on these states, which all reopened their economies – with Donald Trump’s avid blessing – before the contagion was contained. 

“Opening while cases are increasing is like leaning into a left hook,” said Tom Frieden, a former CDC director. “You are basically asking to get hit – and that’s what these states did.” 

Alabama is enduring a pummeling. It has recorded 32,000 cases and its curve is on a steep upward path. 

The Republican governor of Texas, Greg Abbott, who ushered in one of the earliest and most aggressive reopenings, insisted a few days ago that his state “remains wide-open for business”. Yet he has been unable to ignore reality: that the virus has spread its lethal tentacles to every corner of the state overwhelming hospitals to the point that Houston medical centers are running out of ICU beds. Now, once again, Texas’ bars are closing. One town, near Houston, has even brought in a curfew.  

The Lone Star state recorded 6,584 cases on Wednesday alone – a heart-sinking figure that makes its curve look almost vertical. 

Florida’s malaise would be wryly amusing were so many lives not at stake. On 20 May the conservative magazine the National Review ran the gloating headline: “Where Does Ron DeSantis Go to Get His Apology?” The article scolded liberal critics of the Republican governor’s lax approach to coronavirus – he famously allowed beaches to remain open in spring break and has permitted shops and restaurants to get back to business – for having got it wrong: there was no spike in Florida.  

On 20 May, Florida’s daily infection load stood at 527 new cases. Five weeks later, it reported a record 8,942 on Friday and broke the record again on Saturday with 9,585.

The COVID-19 Catastrophe: Richard Horton's short, angry, and powerful book

The Tyee has published my review of Richard Horton's new book The COVID-19 Catastrophe: What's Gone Wrong and How to Stop It Happening Again: Only a Newly ‘Vigilant Society’ Can Stop the Next Pandemic. Excerpt:

Feeling a bit under the weather, you go to your doctor. He knows your medical history, he checks your symptoms, he comes up with a diagnosis, and then he chews you out for behaving precisely as you’re not supposed to, thereby making yourself sick. What’s worse, you’re now a menace to the health of everyone around you. If you don’t shape up, you’ll ship out — in a body bag.  

That’s the structure of this short, angry, and powerful book, written while the author was in lockdown in the U.K. Richard Horton is a doctor, but for a quarter-century he has been editor-in-chief of The Lancet, flagship of a fleet of important medical journals. As such, he has monitored global health through outbreaks of Ebola, SARS, MERS, cholera, H1N1 influenza, Zika, and the steady, deadly background noise of malaria, measles, and other diseases. 

While locked down and dealing with a flood of incoming reports on COVID-19, Horton has also managed to write a clear, concise account of our own incompetence and folly — both in preparing for a pandemic everyone knew was coming, and in responding to it once it arrived. While politicians and bureaucrats take much of the blame, so do scientists. And so does everyone else. 

 His summary of the emergence of COVID-19 covers the key points and the questions they raise. If the first cases were noted at the beginning of last December, why wasn’t World Health Organization notified until New Year’s Eve? And once notified, why didn’t WHO respond more quickly, and why didn’t it engage health scientists from around the world in learning about the new virus from their Chinese colleagues? 

Slow and confused 

The world’s response to clear signs of impending disaster was woefully slow and confused. Governments, especially those of the U.K. and the U.S., come in for Horton’s condemnation: “The science and politics of COVID-19 became exercises in radical dehumanization.… At press conference after press conference, government ministers and the medical and scientific advisors described the deaths of their neighbours as ‘unfortunate.’ But these were not unfortunate deaths. They were not unlucky, inappropriate, or even regrettable. Every death was evidence of government misconduct — reckless acts of omission that constituted breaches in the duties of public office.… Missed opportunities and appalling misjudgments were leading to the avoidable deaths of tens of thousands of citizens.”

COVID-19 has widened America's vast racial wealth gap, study finds

Via The Guardian: Coronavirus has widened America's vast racial wealth gap, study finds. Excerpt:

The coronavirus pandemic has proved a bonanza for billionaires and further widened the enormous racial wealth gap in the US, according to a new report released Friday. 

In the 12 weeks between 18 March and 11 June, the combined wealth of all US billionaires increased by more than $637bn to a total of $3.581tn, more than the entire wealth of the US’s 59 million Latinx population combined and equal to three-quarters of all Black wealth, according to an analysis by the Institute for Policy Studies (IPS). 

The report is called: White Supremacy is the Pre-existing Condition: Eight Solutions to Ensure Economic Recovery Reduces the Racial Wealth Divide. 

The top five billionaires – Jeff Bezos, Bill Gates, Mark Zuckerberg, Warren Buffett and Larry Ellison – saw their wealth grow by a total of $101.7bn, or 26% between 18 March and 17 June. They captured 17.4% of the total wealth growth of all 600-plus billionaires in the last three months. The fortunes of Bezos and Zuckerberg together grew by nearly $76bn.  

Over the same period, 44 million Americans lost their jobs and filed for unemployment insurance. The numbers have declined from a one week peak of 6.6 million in April but are still historically high. More than 3 million people have filed for unemployment in the last two weeks alone. Latinx and African American people have been hit hardest by the layoffs.  

The share of households of color with zero or “negative” wealth, meaning their debts exceed the value of their assets, is much higher than the share of white households. According to the report, 37% of black families and 33% of Latino families have zero or negative wealth, compared to just 15.5% of white families. Black Americans have a homeownership rate of just 44%, compared to a white homeownership rate over 70%.  

Darrick Hamilton, one of the report’s authors and the executive director of the Kirwan Institute for the Study of Race and Ethnicity at Ohio State University, said: “Today’s racial wealth divide is an economic archeological marker, the result of the multigenerational history of white supremacy running from the African slave trade, Jim Crow, separate and unequal, predatory lending, and other forms of systematic discrimination in wealth-building opportunities.” 

Even before the pandemic, the racial wealth gap had expanded. Racial wealth inequality increased by more than $40,000 from 1983 to 2016, according to a previous IPS report, Ten Solutions to Bridge the Racial Wealth Divide.  

“In 1983, white median wealth was $110,160, while black wealth was $7,323, and Latino wealth was $4,289. By 2016, white median wealth had increased by $36,000 to $146,984, while Latino median wealth increased by only a couple thousand to $6,591. 

“Black wealth declined by about $4,000, to a mere $3,557,” the report found. 

Hamilton said the racial wealth gap had been worsened by government efforts to address the 2008 financial crisis – bailing out banks and propping up the stock market – and that the federal response to the coronavirus pandemic needed to address systemic issues with racial inequality. 

“Surging billionaire wealth contrasting with a worsening racial wealth divide undercuts the solidarity and unity required to overcome the health and economic challenges of this pandemic,” he wrote.

Navajo Nation: The people battling America's worst COVID-19 outbreak

Via BBC News: Navajo Nation: The people battling America's worst coronavirus outbreak. Excerpt:

When Valentina Blackhorse tested positive for coronavirus, she texted her sister and told her not to worry.  

A former pageant queen, Valentina was known for her love of her Native American Navajo heritage, her passion for helping others and her playful sense of humour. She doted on her one-year-old daughter, Poet, and worked as a government administrator, with dreams of leading her people some day as Navajo president. 

When coronavirus reached the reservation on which she lived, Valentina warned her family to stay indoors and take precautions. Weeks later her boyfriend Bobby fell ill and she tended to him at their home in Kayenta, a small town near the sandstone buttes of Arizona's Monument Valley. 

She'd lived with rheumatoid arthritis her whole life, but soon her joint pain started to feel different, and breathing wasn't so easy. She took herself for a test and the results came back a week later, confirming her fears. The next day, when Valentina's breathing got worse, Bobby rushed her to a health clinic. She died hours later, aged 28. 

"She overcame a lot of things in her life," said her sister, Vanielle. "I thought she was strong enough to pull through." 

Valentina was one of the youngest victims of coronavirus in the Navajo Nation, a Native American reservation grappling with what is America's worst outbreak.  

Since Covid-19 was first reported in the Nation on 15 March, infection rates per capita have grown to be the highest in the country when compared with any individual state.  

As of 14 June, 6,611 cases have been confirmed. More than 300 people have died after contracting the virus as well - a toll higher than 15 states.  

The Navajo Nation is the largest reservation of its kind, in both size and population. More than 173,000 people live within its borders, in pockets of communities spread across the deserts and canyons of Utah, Arizona and New Mexico. If it were a state, the Nation would be larger than 10 others. 

The Navajo - or Diné, as they call themselves - have lived in the region for centuries, but the Navajo Nation is an American construct. After US expansion forced thousands of Navajo to leave their homes, America carved out a stretch of land where they could maintain some sovereignty. In return, the federal government pledged to support its people with funding for education, healthcare and other services. The Navajo have contributed much to America's development. Perhaps most famously, Navajo soldiers invented a military code, based on their language, that kept American communications secure during World War Two. 

But as coronavirus has swept through the reservation, it has underscored many of the social and economic inequalities that continue to affect the tribe - all contributing to one another, and all making the outbreak worse. 

"If we had better resources, maybe [Valentina] would still be alive," said Vanielle.

Many residents struggle with money. The reservation's unemployment rate is approximately 40%, and a similar number live below the poverty line, earning less than $12,760 (£10,191) a year. 

These factors exacerbate health problems among the Navajo and a third of the population suffers from diabetes, heart conditions and lung disease. In some cases, people have fallen ill after years of radiation exposure from hundreds of abandoned uranium mines dotted around the desert.  

Severely limited access to healthy food also plays a role. The Navajo Nation spans 71,000 sq km (27,413 sq miles) but has only 13 grocery stores, forcing many residents to drive for hours to towns outside the reservation with better facilities. It is common for people from different households to travel in one vehicle during these excursions because they are unable to afford petrol, further heightening their risk of catching coronavirus.

'The country is adrift': Echoes of Spanish flu as Brazil's COVID-19 catastrophe deepens

Via The Guardian: 'The country is adrift': echoes of Spanish flu as Brazil's Covid-19 catastrophe deepens. Excerpt: 

As a child growing up in 1940s São Paulo, Drauzio Varella remembers his grandmother’s tales of how the Spanish flu ravaged the blue-collar immigrant community they called home.  

“So many people died that families would leave people outside on the pavements, and early each morning the carts would come by to collect them and take them off to burial in mass graves,” remembered Varella, who would go on to become Brazil’s best-known doctor. 

More than a century after the 1918 calamity, South America’s largest country is again being shaken by a devastating pandemic, and Varella is in disbelief.  

“Nobody thought this could happen. Perhaps they imagined it theoretically – that some kind of virus might come along,” said the 77-year-old oncologist, author and broadcaster. “But even when this virus did show up, we didn’t think it would cause a tragedy of such proportions.”  

The precise magnitude of Brazil’s Covid-19 tragedy remains unclear – but the story told by official statistics grows more wretched by the day. 

On Friday, Brazil overtook Britain as the country with the world’s second-highest death toll: 41,901 deaths since the first fatality was confirmed in São Paulo on 17 March.  

A University of Washington projection indicated another 100,000 Brazilians could die before August, possibly placing Brazil ahead of the US as the country with the most deaths. 

As the catastrophe deepens there is growing anger at the conduct of president Jair Bolsonaro, whose jumbled and dysfunctional handling of a pandemic he has called a “fantasy” has made Boris Johnson’s widely panned response look sober and efficient.  

“This is the worst public health crisis we’ve faced – and it has come at a time when we have the worst government in the world,” said Daniel Dourado, a public health expert and lawyer from the University of São Paulo who believes thousands of lives could have been saved by a swifter and less erratic response. “The country is adrift.” 

There are uncanny and painful parallels between the impact of the Spanish flu – which historians say killed between 35,000 and 100,000 Brazilians – and the harm coronavirus is now inflicting.  

Claudio Bertolli Filho, the author of a book on the 1918 pandemic, said Brazil’s then leaders had initially played down the unknown influenza – just as Bolsonaro has dismissed coronavirus as a “bit of a cold”. 

Then, too, authorities tried to hide the true scale of the disaster – just as Bolsonaro’s health ministry has been accused of doing – until, like now, the determination of Brazilian journalists made that impossible. 

Then, like now, doctors pushed untested and potentially dangerous remedies, just as Brazil’s populist leader has promoted the use of hydroxychloroquine despite limited scientific evidence of its effectiveness. Bertolli Filho said one São Paulo quack was famed for injecting Spanish flu patients with mercury. “He killed lots of people – and yet despite this many believed.” 

As the Spanish flu ripped through cities, from Recife to Rio, religious leaders also touted miracle cures just as powerful televangelists today promise followers Covid-19 salvation with holy water and supernatural seeds.  

And in 1918, as now, the mysterious malady prompted an explosion of rumour and conspiracy, including claims German submarines had secretly spread the infirmity along the Brazilian coast. (In fact, it arrived on an English merchant ship called the Demerara).  

But perhaps no parallel is more cruel than the way in which both catastrophes obliterated the idea pandemics chose victims indiscriminately. 

Bertolli Filho said the 1919 death of Brazil’s president-elect, Rodrigues Alves, from the Spanish flu was widely cited as proof epidemics were equal opportunity.

In fact, cemetery records showed most of São Paulo’s 5,000 dead hailed from working class, industrial districts such as Mooca, Ipiranga, and Brás, where Varella’s grandmother watched the corpse collectors at work. Today, the areas suffering most are blue collar communities such as Brasilândia, Freguesia do Ó and Capão Redondo where many do not have the luxury of social distancing or working from home.

COVID-19 in Brazil on Saturday: 21,704 new cases, 892 new deaths

A screenshot taken at 8:23 p.m. Pacific time of the ministry of health's Coronavírus Brasil page:

Click or tap through and study the rest of the page: the daily rise in cases and deaths, and especially the worsening of the pandemic in São Paulo state. Wikipedia tells us that São Paulo generates a third of Brazil's GDP, and is richer than Argentina, Uruguay, Paraguay, and Bolivia combined. Its population is 46 million, about 10 million more than Canada's. 

 

I briefly visited its capital, also São Paulo, in 2002. I gained an impression of a megalopolis of enormous freeways, choked with traffic, where motoqueiros—couriers on motorcycles—wove in and out and died at the rate of about one a day. Overhead, helicopters ferried the rich, who couldn't afford to be stuck in traffic, to downtown rooftop helipads. Lula was about to become president in a computerized election.

 

The economic damage COVID-19 is doing to São Paulo must be immense, and Jair Bolsonaro's stupid efforts to save the Brazilian economy are only making matters worse. I doubt that even Lula, if he were released from jail and restored to power, could save the country.

Covid-19 in Latin America: A pandemic meets extreme inequality

Via the World Bank: Covid-19 in Latin America: A pandemic meets extreme inequality. Excerpt:

In late May, the World Health Organization declared that Latin America has become the new epicenter of the Covid-19 Pandemic. It has already been noted that the region’s high levels of inequality have limited the effectiveness of various containment policies, thus contributing to this sad distinction. In this post we look at the reverse direction of causation and ask what effects the pandemic is likely to have on the region’s entrenched inequalities.  

We argue that the impact of the pandemic will itself be highly unequal in Latin America : both in terms of health and economic outcomes, and along income, spatial, gender and racial dimensions. Worse yet, this will be true both in the short-term, during the current “lockdowns”, but also in the medium and longer-term. Nonetheless, the policy responses in some countries suggest that there may be a silver lining: the crisis might provide an opportunity for rethinking the region’s structurally unequal social contract.    

In the short-term, inequalities in how individuals can cope with stay-at-home orders are particularly striking in the region. Living conditions – including access to such basic amenities as piped water and adequate sanitation facilities – are highly unequal.  The homeless and those living in cramped and precarious housing in urban slums, without access to water and sanitation, face huge difficulties in implementing social distancing and maintaining the higher levels of personal hygiene that are now required. ...

Almost one in three Bolivians has no access to piped water at home. Fully half of Brazilians have no access to improved sanitation – a sadly remarkable number. Large numbers of Hondurans and Peruvians are also deprived of access to these basic services.  These deprivations mean that those who were worst-off to begin with are also most vulnerable to the virus.   

This also implies that Covid-19 will not be color- or race-blind in Latin America. Afro-descendants are over-represented among slum dwellers in Brazil, Colombia, and many other countries. Infection and death rates will almost certainly be higher for black Latin Americans than for whites, much as in the United States. Indigenous descendants are also more vulnerable in a number of Andean countries, and in the Brazilian Amazon.   

A second pre-existing inequality that is likely to make the underprivileged more vulnerable to the pandemic is that between formal and informal workers in the region. According to the ILO’s definition, the informal sector accounts for 34% of the GDP in the region, with 53% of total employment being informal: ranging from 23% in Uruguay to above 80% in Bolivia. Perhaps most vulnerable among the informal labor force are self-employed or own-account workers, who typically account for between 20% and 40% of the labor force in Latin America, or even higher in countries such as Bolivia and Colombia.