BRAZILIA, Brazil — It began with the elderly. When an Amazonian variant appeared, a broader range of Brazilians started dying. Then those in their 40s, 30s and even 20s succumbed. Now, in an even more chilling development — with possibly global implications — COVID-19 is killing pregnant and post-partum Brazilians, leaving newborn orphans.
As the disease’s toll on the young surges, overwhelming hospitals, roughly 500 such deaths have occurred in the first four months of this year, according to a group that monitors mothers and babies in Brazil. That’s more than the toll of the previous nine months: 30 a week, compared with 10.
“Brazil already had a structural problem with women’s reproductive health care,” said Debora Diniz, a researcher at Brown University in Rhode Island who has spent the past few months tracking COVID-19 and pregnancy in Brazil. “The pandemic overloaded the health system. There’s now a risk of a generation of orphans.”
The stages of Brazil’s battle with COVID-19 have often been a harbinger for the pandemic elsewhere. The emergence of a more contagious variant that’s now invading the rest of Latin America, a shift to the young such as that happening in the U.S. and the oxygen shortages that are plaguing India were all seen earlier in this nation of 212 million.
It could be the same for COVID-19 and pregnancy. A study published on Jama Pediatrics last month found that COVID-19 in pregnancy “was associated with consistent and substantial increases in severe maternal morbidity and mortality and neonatal complications,” especially if mothers have co-morbidities or present with symptomatic cases. The study, which involved 18 rich and poor countries, found that women who tested positive delivered earlier and had higher rates of pregnancy-induced hypertension.
The second wave of the virus hit Brazil hard as lax social distancing mixed with the new variant, sending transmission rates soaring. With a daily death toll that routinely tops 3,000, the pandemic has galloped past milestones of 200,000, 300,000 and now 400,000 dead, second only to the U.S. The mortality rate has surged to 4.5%, more than double that of last year, according to local research institution Fiocruz.
Last month, Brazilian health authorities issued a rare plea for women to delay pregnancy: “With maternity hospitals in disarray, postponing should be considered,” the health ministry said.
The warning came too late for Adriely Carneiro de Santana. She was 26 last year when she found out she’d be having a daughter. Novel coronavirus was new.
Adriely lived with her husband Fabio in the same house as her mother in Olinda, a city in the northeast. She’d had health battles before: chikungunya in 2017 and dengue in 2019, both mosquito-borne. So when coronavirus hit, she locked herself at home.
A month before her October due date, she was hospitalized with a urinary tract infection. Because of high blood pressure, doctors induced labor. The baby, Aylla Vitoria, was born healthy, but Adriely was weak and needed an ICU bed, which the hospital didn’t have. She was transferred and put in a room with other patients. Four days later, she had trouble breathing. She was transferred again, to a COVID-19 hospital where she was finally tested: positive. She died two weeks later, never having held her baby.
“My daughter got COVID in the hospital,” Edilene Carneiro said. “She was already weak, but she might have survived if she’d been put in an isolated room.” The 53-year-old hairdresser is helping raise her granddaughter.The government has moved pregnant women into the priority category for vaccinations, but a widespread shortage of shots has states suspending immunizations every few weeks. Brazil has deployed 51 million vaccines so far, enough to cover 16% of the population with one dose and to fully inoculate about 8%.
Officials are also considering a cash-handout program to help the orphans, people familiar with the matter said.
While elsewhere in the Americas pregnant women contract COVID-19, far fewer of them die. The highest case count is in the U.S., according to the Pan American Health Organization. Brazil also lags Peru, Argentina, Chile, Colombia and Mexico. But its fatality rate is almost 10 times the number for the Americas.
Underreporting and a lack of data makes the problem harder to track. Brazil's health ministry doesn't break down the figures in its website, and didn't reply to requests for an official number. Observatorio Obstetrico Brasileiro COVID-19, the group that follows the issue in Brazil, says 4,031 pregnant women or women who gave birth were infected with coronavirus just in the first four months of 2021, with 494 deaths.
Several hospitals turned into COVID-19 treatment centers, which left future mothers more fragile, said Rossana Francisco, a professor at Sao Paulo University Medical Department and a member of the group. When pregnant women started to show up sick, hospitals sent them to units specializing in prenatal care. It became harder to get the proper treatment.
An additional problem, she said, is that there isn’t a clear protocol on how to handle a pregnant woman with COVID-19. Doctors have concerns, for example, about laying these patients in a prone position, which is common for those being treated for the disease. Pregnant women also have more oxygenation problems and usually need intubation earlier than other COVID-19 patients, but it is not unusual for doctors to delay that procedure out of concern for the babies.
“Pregnant women do not get COVID-19 more easily, but their infection is more serious,” Francisco said.
The decision to add pregnant women and new mothers to the priority vaccination group comes too late and should be a warning for others, says Fatima Marinho, an epidemiologist and senior adviser at Vital Strategies.
“The Brazilian government neglected pregnant women from the start of the pandemic,” she said.©2021 Bloomberg L.P. Distributed by Tribune Content Agency, LLC