The COVID-19 pandemic in Brazil: searching for meaning in the midst of a tragedy

At the time of writing, the number of deaths caused by the COVID-19 pandemic (the disease caused by the new coronavirus) exceeds 142,000 in Brazil, and the number of infection cases is nearly 4,8 million. There are more than 1 million deaths around the world, and 33 million cases in 188 countries (Coronavirus Resource Center, 2020). By comparison, the atomic bombs dropped in Hiroshima and Nagasaki in 1945 claimed about 250,000 victims, a total which includes those who died instantly in both cities and those who died later due to burns and radioactive poisoning (UOL, 2020).

The point is that the effect of instances of mass destruction (pests, wars, etc.) is not limited to the tragic event itself, but always extends beyond the disaster, affecting, as a rule, some generations over time. With the present pandemic, besides the emotional, sanitary, social, cultural, political, and economic consequences, the survivors of severe forms of COVID-19 can suffer from long-term physical (pulmonary fibrosis, cardiac insufficiency, kidney, and neurological problems) and mental effects (depression, various anxiety disorders, post-traumatic stress disorder, among others) (Allegrante et al., 2020; Pfefferbaum, & North, 2020).

When we become aware of the reality of the numbers, we are at first overwhelmed by the horror, but, soon after, paradoxically, a kind of numbness runs through us, because the numbers in themselves do not tell us anything. They make us face the unspeakable.

We find it very difficult to make sense of quantities because we are creatures of words, meanings, and affects. To overcome the astonishment caused by the numbers, we should insist on interpreting and producing meaning, even when we are confronted with the affects of pain, sadness, and hopelessness. We must face this affects because they sustain what makes us more human. Too human. Thus, it can be said that the dead people of the pandemic are numerous but innumerable, that is, far from being reduced to numbers in staggering statistics, they should be recognized in their unique biographical experiences, as proposed by the collaborative project Memorial Inumeráveis (Innumerable Memorial), created by artist Edson Pavoni (https://inumeraveis.com.br).

To become numb in the face of an unspeakable reality can create indifference. Indifference towards death goes hand in hand with disregard for life. On the other hand, as a radical existential experience, the appreciation for life is always connected to acknowledging of death in all its aspects. With its devastating effects, the pandemic calls on us to recognize this so that the revaluation of life can be possible. It is not only life from the viewpoint of human existence but also that of preserving life itself in all its aspects on planet Earth.

However, what does the virus teach us?

As Boaventura de Sousa Santos (2020) states in his book A cruel pedagogia do vírus (The Cruel Pedagogy of the Virus), a pandemic affects everyone, generally speaking. Nevertheless, some groups are affected more dramatically due to previous vulnerability. The disaster conditions make these groups more visible in reinforcing injustice, discrimination, and social exclusion.

The pandemic gives us a lesson on the social determinants of health and the importance of public policies that ensure a minimal social welfare state.

Unfortunately, health is not equally distributed but depends on socioeconomic and educational status, gender, color, and ethnicity. These inequalities imply disparity in health conditions and quality of life and create differences in life expectancy and how people die, including violent death.

As we well know, the 2019-nCoV pandemic found Brazil and its centuries-old structural inequalities, with a great number of people living in squalid conditions, without sanitation or access to water and electricity, living in precarious and overcrowded housing, and suffering from a high incidence of chronic diseases, such as hypertension and diabetes, not to mention the so-called neglected diseases, such as tuberculosis, and re-emerging zoonoses, such as yellow fever and dengue fever (Andreazzi et al., 2020).

We are a country built upon hidden bodies, and, in this sense, the pandemic reveals everything we did not want to know about the daily reality. A reality that is historically marked by the trauma arising from exclusion and violence towards indigenous, black, and dispossessed people. Contradictorily, we are a collective body living under the aegis of denial, which does not recognize itself in the other who exposes our original cultural marks; we are a collective body that rejects the differences that show the nation’s diversity and quietly accepts the profound social inequalities present in everyday life. In this way, we are a country where the majority is excluded from eternal social abandonment.

In this fertile soil, it comes as no surprise what various studies have been demonstrating: the risk of contracting the virus and the risk of dying of COVID-19 is greater among the poorest. One study in São Paulo showed that, between March and June 2020, residents in the outskirts of the city were 50% more likely to die from COVID-19 than the residents of more affluent areas, and this risk keeps on increasing during the pandemic (Bermudi et al., 2020). Similarly, a broad national study underway, Epicovid19-BR (Evolution of the Prevalence of COVID-19 Infection in Brazil), shows that poorer people have double the risk of infection compared to richer people, and indigenous people have a risk of infection five times greater than that of white people, according to epidemiologist Pedro Hallal (2020). Given this, we cannot help but emphasize that indigenous populations have been vilified by the negligence of the government, which not only has failed to provide them with humanitarian aid but also has abandoned them to violence by land-grabbers and squatters. Concerning black people, although information about race/skin color is flawed or incomplete in many data sets, worse previous health and housing conditions, as well as lower access to health care, has led to these people being over-represented in the hospital mortality by COVID-19 statistics (Baqui et al., 2020), once again showing evidence of the social exclusion of Afro-descendants.

Unlike the list by Schindler — the man who saved working Jews from the claws of the Gestapo — the list made by Boaventura de Sousa Santos (2020) in his aforementioned book suggests an enormous group of people who, because of conditions prior to the pandemic, present most significant risk not only of contracting the disease but of dying from it, increasing a large number of deaths which grows every day.

They are casual workers, prevalent nowadays all over the world due to the neoliberal policies which have progressed in the past few decades, workers who must earn daily to be able to survive on a daily basis; the “uberized workers”, delivery workers who have made the quarantine possible for other people and who many times are not able to protect themselves from the pandemic; the homeless occupying the viaducts, tunnels, subway stations or the sidewalks, leaving us to question what quarantine is for those who do not even have a house. At the beginning of the pandemic, someone remarked, gloomily, that they were walking, wearing a mask, along a street where many homeless people were when one of them asked: ‘What is happening? Why are people wearing masks?’

Moreover, the list goes on: refugees and migrants, who live in areas where the spreading of the virus is even greater; people with disabilities, with mobility difficulties, discriminated against because of their special needs and who depend on someone else to help them; the elderly, many times left in care homes, who go from riches to rags, and who end up suffering with the increased isolation, as well as with a greater risk of contamination; and women, who suffer from the increase in domestic violence during the quarantine.

Faced with complex sanitary and socioeconomic backgrounds, nowhere in the world has it been easy to choose, at each stage, the best governmental strategies to deal with the COVID-19 pandemic, considering the meager, albeit growing, scientific knowledge about the new coronavirus, its fast dissemination and the potential risk to life for a number of those infected (Barreto et al., 2020). In terms of prevention, at the moment, no drugs can avoid infection, and a vaccine is not yet available. Therefore, behavioral measures — personal and environmental hygiene (washing hands, wearing masks, following breathing etiquette, cleaning surfaces) and social distancing (ensuring physical distance between people, avoiding travel, working from home) — are the recommended strategies agreed by international scientific bodies (Allegrante et al., 2020).

In Brazil, the implementation and maintenance of such measures have been a tough challenge. Here, remarkable efforts have been made on several fronts by health workers and scientists who seek to offer support to the public sector in such a trying undertaking, with the prominent response of the Unified Health System (Sistema Único de Saúde - SUS) in care and of the public universities in research. Nevertheless, regarding federal government actions, we are faced with the staggering fact of having the third Health Minister during the pandemic, and with daily news denouncing the militarization of the ministry and the lack of coordinating actions in fighting the pandemic. As if that were not enough, every day we read news about the shenanigans of a president who trivializes the pandemic, disrespects hygiene guidelines, mocks the number of deaths, does not recognize the pain of the mourners (The Lancet, 2020), and supports fantasies of prevention and magic cures, despising the science and promoting what can be called necropolitics.

In this truly maddening scenario, a time of pain, helplessness, and perplexity, the virus pedagogy invites us, above all else, to work on creating meaning and inventing new ways of care and social bond. It is necessary to insist on solidarity links, considering the differences which form our collective day-to-day.

Thus, writing on the core topic proposed by the editors, Pandemic, psychopathology, and subjectivity, the authors invited for this special issue of the Revista Latinoamericana de Psicopatologia Fundamental present excellent papers, reflecting on the various aspects of the COVID-19 pandemic, from clinical, social, cultural, historical and psychopathological standpoints.

Referências

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• Andreazzi, C. S. de, Brandão, M. L., Bueno, M. G., Winck, G. R., Rocha, F. L., Raimundo, R. L. G. et al. (2020). Brazil’s COVID-19 response. The Lancet, 396 (10254), E30, September 19. <https://doi.org/10.1016/S0140-6736(20)31920-6>
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• Baqui, P., Bica, I., Marra, V., Ercole, A., & van der Schaar, M. (2020). Ethnic and regional variations in hospital mortality from COVID-19 in Brazil: a cross-sectional observational study. Lancet Glob Health, 8: e1018-26. Recuperado de: <https://doi.org/10.1016/S2214-109X(20)30285-0>.
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• Barreto, M. L., Barros, A. J. D. de, Carvalho, M, S., Codeço, C. T., Hallal, P. R. C., Medronho, R. de A., Struchiner, C. J., Victora, C. G., Werneck, G. L. (2020). O que é urgente e necessário para subsidiar as políticas de enfrentamento da pandemia de COVID-19 no Brasil? Revista Brasileira de Epidemiologia, 23, e200032. https://dx.doi.org/10.1590/1980-549720200032
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• Bermudi, P. M. M., Lorenz, C., Aguiar, B. S. de, Failla, M. A., Barrozo, L. V., Chiaravalloti-Neto, F. (2020). Spatiotemporal dynamic of COVID-19 mortality in the city of São Paulo, Brazil: shifting the high risk from the best to the worst socio-economic conditions. arXiv:2008.02322. Disponível em: https://arxiv.org/abs/2008.02322
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• Coronavírus Resource Center Johns Hopkins University & Medicine. Recuperado em 29 set. 2020 de: <https://coronavirus.jhu.edu/>.
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• Pfefferbaum, B., & North, C. S. (2020). Mental Health and the Covid-19 Pandemic. N Engl J Med, 383, 6. <https://doi.org/10.1056/nejmp2008017>.
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• Santos, B. de S. A cruel pedagogia do vírus Coimbra, PORT: Almedina, 2020.
• The Lancet. Editorial: COVID-19 in Brazil: “So what?” (2020). The Lancet, 395 (10235), p. 1461, May 09. <https://doi.org/10.1016/S0140-6736(20)31095-3>
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Editors: Profa. Dra. Ana Maria Galdini R. Oda e Profa. Dra. Sonia Leite

Publication Dates

• Publication in this collection
  30 Oct 2020
• Date of issue
  Jul-Sep 2020

History

• Received
  02 Sept 2020
• Accepted
  10 Sept 2020