The fourth wave of the pandemic in Brazil is taking place amid an explosive combination of factors: stagnation in vaccinations, an end of the COVID-19 health emergency, increasing spread of the most infectious and vaccine-resistant BA.4/5 Omicron subvariants, the abandonment of the most basic mitigation measures, such as mask wearing in closed places, and the arrival of winter.
On Tuesday, Brazil registered a moving average of 147 deaths and 40,174 cases, an increase of 21 percent and 10 percent, respectively, from two weeks ago. Besides the huge under-reporting, six of the 27 Brazilian states didn’t release any pandemic data.
For Lucas Ferrante, researcher at the National Institute for Amazonian Research (INPA), with whom the WSWS spoke last Saturday, this situation has turned Brazil into a “time bomb” that could lead to a new health collapse in the coming weeks.
Studies led by Ferrante showed that the late 2020 reopening of schools in Manaus, the capital of Amazonas state, triggered the emergence of the Gamma variant, responsible for two-thirds of COVID deaths in Brazil. Today, particularly after all Brazilian states have ended mandatory mask wearing in classrooms, the role of schools as vectors of virus transmission is more than clear.
The past few weeks have seen numerous outbreaks among entire school communities across the country. “Schools and universities are the fastest accelerating ways for viral transmission,” Ferrante explained. “Today we are replicating this in a much more catastrophic scenario, with no mask wearing, overcrowded classrooms and low air circulation, as well with a more resistant variant and low vaccine protection.... We will experience an explosion of cases and mortality, including in children.”
Outbreak of other infectious diseases and fourth wave in Brazil
The widespread reopening of schools late last year, when attendance of students in unsafe schools became mandatory, and the abandonment of mitigation measures in Brazil have led to unseasonable outbreaks of other infectious diseases.
Last December, amid the beginning of the third wave caused by the BA.1 Omicron subvariant, Brazil experienced an outbreak of influenza A and B that flooded hospitals. Then, since March, with the beginning of the school year and the end of mask mandates in classrooms, there has been an increase in cases of acute bronchitis, caused by the respiratory syncytial virus (RSV), which has filled pediatric ICUs since the beginning of May all over the country.
However, Ferrante pointed to data from mid-May, when the Brazilian corporate media was still wondering whether Brazil would have a fourth wave, which showed that “respiratory syncytial virus is predominant only in children under 9 years old.” Now, according to him, “we are seeing the very low test positivity rates for influenza A and B, stabilized syncytial virus and COVID-19 increasing exponentially in all age groups, especially in children and in middle-aged adults.”
Indicating that early June data from the Brazilian epidemiological institute FIOCRUZ showed a “strong sign of growth in the trends of Severe Acute Respiratory Syndrome (SARS) cases”, Ferrante added: “this increase in SARS every epidemiological week is COVID-19. We are in the midst of a wave of COVID-19 caused by a variant whose vaccines still have an efficacy to protect, however we are entering a phase in which new variants already introduced in Brazil will start to become prevalent and the vaccines don’t perform as well against those variants.”
The danger posed by BA.4/5 Omicron subvariants
Unlike many countries, which have experienced the outbreak of only the BA.2 Omicron subvariant, such as the UK in April, Ferrante pointed out that the more infectious and vaccine-resistant BA.2 and BA.4/5 Omicron subvariants are spreading across the country at the same time.
“Genomic sequencing has shown that the BA.1 Omicron subvariant has been replaced by BA.2. So, we are having a ‘turnover’ of subvariants,” Ferrante explained. “However, we have already registered Omicron BA.4 and BA.5.” In early June, data from Instituto Todos pela Saúde showed that BA.4/5 already accounted for 44 percent of positive samples in Brazilian private laboratories.
For Ferrante, this situation is worrying, as in late May a pre-print study was published with the results of “a clinical trial of the efficiency of vaccines against the different variants that are circulating. [It] showed that the vaccines have a lower protection against BA.4 and BA.5.”
He explained: “This image shows the family tree of the different variants of the coronavirus. In gray, I have the original pandemic variant, and this same variant was used so that we could produce the vaccines. The problem is that the new variants are moving genetically away from the variant that caused the pandemic and was used for us to make the vaccines.
“In other words, we are losing that ‘link’ between the vaccines that we are using and the variants that are circulating, so we are experiencing a loss of efficiency of the vaccines right now.”
According to the study mentioned by Ferrante, this makes BA.4/5 “4.2-fold more resistant [to sera from vaccinated and boosted individuals than BA.2] and thus more likely to lead to vaccine breakthrough infections.”
Caption: Family tree of the novel coronavirus. The further the new variants deviate from the original one (WA1), the more likely they are to be more resistant to available vaccines (Source: Wang, Q. et al. “SARS-CoV-2 Omicron BA.2.12.1, BA.4, and BA.5 subvariants evolved to extend antibody evasion”)
Stagnating vaccination rates in Brazil tend to make the spread of the more transmissible and vaccine-resistant BA.4/5 variants even greater. Ferrante noted that because of the “slowdown of vaccination in Brazil and the lower efficiency of the vaccines against the new variants, the population today is less protected.” Today, Brazil has 46 percent of the population with a booster shot, which can more effectively neutralize the Omicron subvariants.
Ferrante projected two scenarios: “either we’re going to see Omicron BA.2 explode along with BA.4 and BA.5, causing a further collapse of the health care system, or we’re going to have the peak of this wave decline a bit, we’re going to loosen up the measures even more, and then we’re going to quickly see the two much more transmissible variants, BA.4 and BA.5, become prevalent... And the worst thing is that this is going to happen at the beginning of the school return next semester. This is going to be catastrophic for Brazil, we are going to have a new collapse of the health system, the pandemic is not over, and we have a situation about to explode ... at the same time in several urban centers in Brazil.”
The end of the COVID-19 health emergency in Brazil
Contradicting the claims of fascistic President Jair Bolsonaro’s government, Ferrante stated, “We are far from the end of the pandemic.” In addition to more vaccine-resistant variants, he added, “those who have had natural contact with the virus cannot generate lasting immunity, they can even become infected by the same variant, and reinfection is always more severe.”
On April 22, the Bolsonaro government decreed an end to the COVID-19 health emergency, effectively declaring the pandemic over. According to Ferrante, “We have just dismantled the only mechanism we had to lend quicker assistance of the population in the face of the upsurge of the pandemic, and we are already seeing an upsurge of the pandemic that is being ignored by the government.”
He continued, “We had a major collapse of the health system even in the midst of a health emergency, and even then, the Brazilian government was not able to have an efficient opening of beds and produce enough medical supplies to avoid a catastrophe.”
Another artifice used by the federal and local governments to “end the pandemic” by decree is the blackout of COVID-19 data since last December, with an increase in under-reporting.
Pointing to the situation in Manaus, which he has been following closely since the beginning of the pandemic, Ferrante said, “We have already noted this in the third wave in Manaus, when we had eight times more deaths than officially reported. In an election year, what we see is a public policy of concealing deaths.”
Today, under-reporting can “be higher, perhaps up to 15 times, according to some estimates,” he said. Regarding the total number of deaths, which is approaching 670,000, Ferrante’s studies “show that Brazil has already surpassed 1.2 million COVID-19 deaths.”
With the end of the health emergency in Brazil, there is also increasing uncertainty regarding COVID-19 vaccinations next year. Bolsonaro himself is proud of not having taken the vaccination and has boycotted it since the first vaccines were available, including that of children, leading to one of the world’s highest rates of infant deaths.
Ferrante warned that without other mitigation measures, “we need an annual or biannual vaccination for the entire population.” But he continued: “worryingly, the health ministry updated the national immunization plan (NIP), and next year it is studying to make booster shots available only for health professionals and the elderly over the age of 60. In other words, educational professionals, children, and the rest of the population will be left out of the NIP against COVID-19, which is very serious. This will lead to an alarming resurgence of the pandemic, so that we will return to the same level that we had at the beginning of the pandemic in 2020.”