Ana Coelho da Cunha rose early on the last Wednesday of February, picked out a smart outfit and spritzed herself with a favorite perfume. It was a special day: The 85-year-old was getting vaccinated.
Relief spread through the matriarch’s tight Brazilian family, who had waited months for the shot, watching enviously as richer nations launched inoculation campaigns amid delays to their own country’s coronavirus vaccine rollout. For the first time in a year of the pandemic, her 10 children and 22 grandchildren could see a way out: an end to the enforced distance, to the canceled feasts of pork bean stew, to the constant fear.
“Everyone was so excited,” said her granddaughter Lidiane, who was largely raised by “Dona” Ana – as everyone has long called the feisty octogenarian. “It looked like things were about to change.”
Instead, the fate of the Cunha family shows in chilling detail the danger still faced by those in most of the developing world, where vaccines – or the raw materials to produce them – are trickling into countries still facing a raging virus.
Dona Ana, a widow, required constant care. Four of her children looked after her, taking turns to stay at the big yellow-white house the family had built half a century ago in the suburbs of Belo Horizonte, a vibrant city in Brazil’s southeast founded by a wayward gold prospector.
“She’s well, happy to be vaccinated.”
They had tried to hire a nurse for her, but she refused. She wanted her family close.
Concern had grown with the rising wave of infections in Brazil, which by last June had become the world’s deadliest outbreak after the United States, and has in recent months been stalked by a new, highly transmissible variant that has increasingly struck down younger generations of Brazilians.
But now, finally, Dona Ana was being given the Chinese-developed CoronaVac, one of two dominant COVID-19 vaccines in Brazil. After the shot, she gave thanks to God.
That evening on a family WhatsApp group, another granddaughter asked about Dona Ana, “the powerful, vaccinated one.” Her eldest son, José Gonçalves, replied, “She’s well, happy to be vaccinated.”
Two days later, Dona Ana’s second-eldest daughter, Ivanilda, was at her mother’s house cleaning. It was unseasonably cold, and when she had finished, she coughed.
The 64-year-old thought little of it, putting it down to the chilly weather and dust from the house – she’d always struggled with allergies. She spent the weekend with her mother and then handed off the caretaker duties to her older brother José Gonçalves on the following Monday.
Lack of vaccines
In rich nations such as Britain, the United States and Israel, droves of the newly vaccinated are celebrating their newfound freedom at barbecues and soccer matches and wondering when they should get a booster shot.
But in Brazil, the toll of COVID-19 keeps rising, with more than 500,000 dead. Fewer than 12% of Brazilians are fully vaccinated, with about 30% receiving a first dose. Across Latin America, which now accounts for nearly half of all worldwide coronavirus deaths, the proportion of inoculated people is lower still.
Other parts of the world are also struggling, most notably India, where around 17% of the population has had an initial shot amid a terrible assault by another variant.
In the face of rising vaccine inequality, the World Health Organization is calling ever more loudly for rich nations to free up supplies to Brazil, India and other countries. There is some support from the European Union and from the United States – which donated 3 million doses of the Johnson & Johnson shot to Brazil this week – but for now, life remains edgy in countries with slower vaccine rollouts and virulent variants.
“If one of them catches it, it will spread and it will be a tragedy. And that’s exactly what happened.”
As someone in her 80s in a relatively young population, Dona Ana was near the front of the queue in Brazil, but still her jab came nearly three months after the United Kingdom started its vaccination campaign.
In Brazil, cities have been forced to halt inoculations because of a lack of doses as delays plague shipments of active ingredients from China. The country’s Senate is investigating accusations of negligence and mismanagement in the government’s handling of the pandemic and the securing of vaccines. Last year, for example, approaches from Pfizer Inc. to sell its vaccine to Brazil were repeatedly unanswered.
Brazil’s Health Ministry declined to comment to Reuters on specific points of criticism, including the repeated overtures by Pfizer. It said Brazil was making every effort to increase vaccinations with the aim of inoculating every eligible adult by the end of the year.
President Jair Bolsonaro has been widely criticized by public health experts for his staunch opposition to lockdown measures and his frequent refusal to wear a mask. He has dismissed the virus as just a “little flu” and threatened to use security forces against state governors who imposed local restrictions to try and halt its spread. He has derided those who stay at home to avoid the virus as “idiots.” In recent weeks, thousands have taken to the streets to call for Bolsonaro’s impeachment.
The presidency didn’t respond to repeated requests for comment about Bolsonaro’s handling of the pandemic. The Health Ministry said it was providing “unqualified support to states and municipalities” in the fight against COVID-19 and continues to stress the importance of preventive measures such as wearing a mask.
As the variant took hold in Brazil, Lidiane watched helplessly from her home in Canada, an exchange with her husband rising incessantly to the forefront of her mind.
“If one of them catches it, it will spread and it will be a tragedy,” she recalled him warning early last year.
“And that’s exactly what happened.”
A little cough
The virus broke into the Cunha household the same way it has so often around the world, disguised as the mundane.
On that day in late February, Ivanilda blamed the change in the weather for why she felt a little off.
“It just didn’t occur to me that it could be…,” Ivanilda said before trailing off, leaving the virus unsaid.
Over the weekend at her mother’s house, her cough got worse and she ran a low fever, but she remained adamant it was no more than a normal cold – and told her family so. Between looking after her mother and staying at home, she’d barely been out in months.
On Monday, José Gonçalves, 67, came to take over and Ivanilda went home. At Dona Ana’s house, the siblings shared the same room as they came and went, caring for their mother. This time was no different, and José Gonçalves slept in the same bed his younger sister had just used. He looked after his mother, as he had done for several years. As the oldest son, much of the burden fell on his slim but sturdy shoulders.
On Wednesday morning, after another brother had come to take over, José Gonçalves went home. His wife, Maria, gave him a hug and a kiss as he came through the heavy brown wood door, happy he was back.
Within a few hours, everything had changed. Ivanilda had tested positive for the coronavirus.
Her test result descended on the family like a thick cloud. Maria was sitting on the sofa in their living room, the TV on, when her husband told her.
“What has she done?” Maria remembers him repeating over and over again. “What has Ivanilda done?”
But for a while, nothing happened. Ivanilda was in bed at home, but José Gonçalves felt completely fine, and their mother too. They took a test just to be sure.
POSITIVE. They waited for sickness to come.
Across Brazil, a brutal second wave was crashing, pushing hospitals to the breaking point and crowding the country’s cemeteries. Intensive-care wards were filling up with patients of all ages, struggling to breathe.
On March 11, the day after she had been scheduled to receive her second dose, Dona Ana collapsed at home. Doctors won’t vaccinate those already infected with the virus because it is ineffective, and staff told her she would have to wait a few weeks until the infection had cleared before getting her second jab.
Real-world studies have shown CoronaVac to be very effective at preventing hospitalization and death from two weeks after both doses are given. But Dona Ana appears to have been exposed to the virus just a few days after her first shot, likely leaving her with minimal protection.
A preliminary study released in Brazil last month also found the Chinese vaccine to be less effective against symptomatic infection in older people, particularly those over 80. The institute responsible for the production of the vaccine in Brazil, Butantan, issued a statement saying it was normal for studies to find differing efficacies and that mortality data showed Coronavac was saving lives among the country’s older population.
José Gonçalves, who had gone to be with his mother after they both tested positive, carried her to the car and drove to a nearby private hospital that accepted her medical insurance. The place was overrun with the sick and the dying, and the nurses told him the hospital couldn’t provide his mother with the degree of care she needed. They asked him to stay and help. José Gonçalves spent the night by his mother’s side, knowing all the while he was carrying the virus too.
The next day, he went home. His daughter Lidiane suspects he was already starting to feel sick, though he told her he was fine. On March 14, he too was taken to the hospital with dangerously low oxygen levels in his blood. It quickly became clear he needed intensive care, but there were no beds available.
Hospitals were so stretched they were running out of basic sedatives needed to ease patients on to ventilators. But doctors had little choice, and on March 15, José Gonçalves was intubated on a temporary unit.
His family spent the next days calling hospitals, fighting for a real ICU bed as his condition worsened, his kidneys showing signs of failure. José Gonçalves was luckier than many. On March 18, he was transferred to a full-fledged ICU bed at another hospital. His private healthcare meant he’d gotten a bed when many were still waiting and dying in line.
Ivanilda was already on a ventilator too, fighting for her life. For others, the light was already fading.
Dona Ana died on Sunday, March 21. Her family had worried all that day, calling the hospital repeatedly for news, scared of the silence. That evening the hospital finally telephoned, confirming their fears. Her last words, spoken to a nurse in a glimmer of wakefulness, was a plea to see her family: “I want to die at home.”
Three generations cut down
In Brazil, families often step in where the state does not, whether that’s a lift to soccer or school because of a lack of public transport or caring for one another because of gaps in the health system. Many Brazilians prefer it that way too, choosing the personal over the impersonal. Several generations often live together, or just a few blocks away.
The members of the Cunha family understand that their closeness cost them dear. But most don’t see how they could have acted any other way. Dona Ana refused a private nurse. She needed to be looked after; her children had little choice but to help.
They say they place the blame far more on the country’s stuttering vaccination campaign than their own failures to maintain social distance. A few weeks earlier, and Dona Ana would have been fully inoculated – potentially saving herself and stopping the virus’ progression. In the U.S. or the UK, Ivanilda and José Gonçalves would also have been vaccinated before the virus hit the family. But vaccinations have stalled repeatedly in Brazil, with the rate of inoculations falling in May compared to April as delayed imports led to a shortage of shots. Towns across the country have been forced to delay second doses as the supply ran low.
The Health Ministry did not comment on the Cunha tragedy. It told Reuters earlier this month that it continues to ramp up inoculations.
The day after José Gonçalves was transferred to the ICU, his wife, Maria, was taken to the hospital too. Their daughter Regiane, 37, stayed by her side, fearful for her mother. Maria urged Regiane to leave, reminding her that she had a young child who needed her, but her daughter refused.
“I won’t abandon you, Mother,” Maria, 65, remembers her daughter saying to her repeatedly.
Along the other branch of the family, a similar pattern was playing out.
Ivanilda’s positive test result had come too late to isolate and protect her husband, José Pedro. After Ivanilda was intubated, his sickness worsened and their daughter, Erika, who lived on the same plot of land, cared for him, bringing him food and medicine.
Erika, a fit 40-year-old, feared for her parents but didn’t give too much thought to herself. She wore a mask and tried to keep her distance, but when she tested positive too, she was hardly worried. She used it to her advantage at first, moving in with her father. “I never had any health issues. I thought I’d pass through this, no problem,” she said.
But her cough got so bad, she could hardly breathe. Her father had already been taken to the hospital, and a few days later Erika followed. On March 25, the day after Erika was hospitalized, she was put on a ventilator. Her father died the same day.
When Erika awoke from her induced coma nine days later, she had no idea her father was dead. Afraid the news would harm her recovery, the family kept it from her for weeks.
Scientists don’t know why the variant appears to be hitting younger people harder. Some believe it is predominantly down to behavioral factors, with younger people taking fewer precautions and more of them catching the virus as a result. But increasingly Brazilian doctors also think there is something about the variant’s makeup that is affecting young people more than the previous iteration of the virus that spread through the country last year.
The demographic of those in intensive care in Brazil has changed dramatically. In March, hospital data showed that for the first time, the majority of those in ICUs were 40 or younger. The Health Ministry has also noticed an increased risk to expectant mothers, advising women to avoid getting pregnant for now, if possible.
As more family members were hospitalized, Maria’s condition was improving. Doctors called her resilience “a miracle.” On April 1, she messaged the family on WhatsApp to say she would be leaving the hospital the next day. Her children sent delighted messages back, but Regiane was silent. “That’s when I knew something was wrong,” Maria said.
Days earlier, Regiane had been taken to the hospital with dangerously low oxygen levels. She was overweight and suffered from thrombosis, but the family was shocked at the damage the virus was wreaking on someone so young. Maria, still recovering and on oxygen at home, asked the family not to share any bad news with her. But the silence, she recalled, told her everything she didn’t want to know.
“I never had any health issues. I thought I’d pass through this, no problem.”
On April 3, her husband, José Gonçalves, died of a cardiac arrest after nearly three weeks on a ventilator. The bed the family had secured for him in intensive care had helped him live longer, but it had not been enough. They still wonder whether the outcome could have been different if he’d gotten an ICU bed immediately.
Regiane hung on for another month. But by the end of April, she had developed a generalized infection and was no longer responding to heavy antibiotics. She died on May 1, the third generation of the family to have a life taken by COVID-19 in the span of just six weeks.
Maria has barely left her home since she returned from the hospital to an empty house. Her psychologist recommends that she go for walks, but she struggles to find the strength, paralyzed by fear, knowing the virus is still out there.
Ivanilda still hasn’t spent a night at home, staying instead with her daughter. She says she’s too afraid of the memories that come when she’s alone. She asks how God could have allowed this to happen.
She has apologized to the family.
“The time that I caught it, that the others caught it as well, suggests that it was caused by me, started with me.” Her mind spins through possibilities of where it might have happened. Maybe when she took her husband to the hospital for a checkup, perhaps through a neighbor.
She has lost her husband, her brother, her niece and her mother. “My mother for me was everything,” she said. “She was everything to me, and she continues to be everything to me.”
Loss Upon Loss
By Stephen Eisenhammer
Photos: Washington Alves
Photo editing: Sergio Moraes
Video: Moises Silva
Video editing: Sebastian Rocandio, Megan Revell
Art direction: Catherine Tai
Edited by Kari Howard