'Enormous disparities': coronavirus death rates expose Brazil's deep racial inequalities

Dom Phillips in Rio de Janeiro

Marcos dos Santos Jr has counted 13 deaths from Covid-19 among Brazilian families he is close to in São João de Meriti, a satellite town of Rio de Janeiro. Like him, they were black, and therefore proportionally more likely to be killed by the pandemic in Latin America’s biggest country.

All but one of the victims came from families helped by the Inclusion Project, which Dos Santos, 43, and his wife Élida, 40, launched in 2014 to educate teenagers away from drugs and crime. It now helps to feed poorer families who lost jobs or income as shops and businesses across Rio state closed for quarantine.

“As we have a lot of faith in Jesus Christ, people are always asking for prayers and that’s how we know about these deaths,” he says. “Most people here are black and mixed race.”  

One victim was his father, also called Marcos, who was 68. He went to hospital with heart problems, caught Covid-19, and died. “It was very really difficult,” says Dos Santos. “When you have a good relationship with your father, it is even worse.”

Covid-19 first hit Brazil’s white upper classes, who brought it back from abroad. Now the virus is scything through the country’s poorer suburbs, favelas and low-income towns such as São João de Meriti – where 63% of the population self-declared as black or mixed race in Brazil’s last census in 2010, compared to 48% in nearby Rio de Janeiro. As of 8 June Brazil had almost 700,000 confirmed cases and 37,000 deaths.

The virus is not as democratic as it initially seemed.

Government statistics show it is more lethal for BAME people in the UK. Figures reveal a higher mortality rate for black Americans. And a new study added to evidence that the virus is killing proportionally more black Brazilians than whites, exposing, in sharp relief, the country’s staggering inequalities.

The study was released in the same week that the killing of George Floyd in Minneapolis sparked anti-racism demonstrations across the US, which Dos Santos says he can well understand. “This revulsion that people feel is just,” he says, adding that he “really feels” racism in Brazil. “It’s hidden, not as loud as it used to be.”

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Researchers, doctors and health specialists believe factors including poverty, poor access to health services, overcrowded housing and high rates of health issues such as hypertension are some of the reasons Covid-19 kills proportionally more black Brazilians.

“There is clearly a difference in lethality for whites and non-whites,” says Fernando Bozza, a researcher in infectious diseases at the government research institute Fiocruz, who co-authored the analysis of deaths by race published on 27 May by the Nucleus of Health Operations and Intelligence.

The researchers studied health service data on 30,000 patients diagnosed with Covid-19, who had either recovered or died by 18 May. It found that 55% of the black and mixed-race patients died, compared to 38% of white patients.

It noted that a black patient who could not read had nearly four times more chance of dying than a white university graduate, “confirming the enormous disparities in access and quality of treatment in Brazil”.

A report by the Pública investigative media outlet showed more Covid-19 deaths in neighbourhoods in Rio de Janeiro and São Paulo with majority black populations. According to health ministry figures reviewed by the Guardian, from 26 April to 23 May, the numbers of deaths of black and mixed-race Brazilians who died of Covid-19 after testing positive (where race was listed) increased 7.2 times, and white Brazilians 4.5 times.

“The majority of black people in our country are more vulnerable to contamination and more vulnerable in terms of access to treatment and health,” says Rita Borret, a black doctor working in Jacarezinho, one of Rio’s poorest favelas, who heads the black health study group at the Brazilian Society of Family and Community Medicine. “The pandemic has exposed these inequalities.”

Inequality extends to official data, she says, which in the city of Rio is so thin that favelas started their own online counts of Covid-19 cases and deaths.

As of last year, 43% of Brazilians self-declared as white, 9% as black and 47% as mixed race – the latter two groups earned less than 60% of the salaries of white Brazilians in the first quarter of 2020. While white Brazilians isolate in apartment buildings in middle-class neighbourhoods, black Brazilians make deliveries, work in pharmacies and supermarkets, drive buses, and clean apartments – exposing them to more risk.

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After authorities closed their fast-food trailer in São João de Meriti, Sandra Gonçalves, 48, and her husband Carlos, 51, who both identify as mixed race, began selling herbs and spices on the street. They receive food parcels from the Inclusion Project – just as other residents of poorer communities and favelas across Brazil are helped by donations of food and hygiene products.

In early May, her brother-in-law Sebastião Gonçalves, 53, a diabetic, fell ill and was hospitalised.

“They said it was Covid,” she says. “He spent two days and a night in a chair, there was no bed for him.” The day after a bed was found, he died of a heart attack. Last week her stepfather Serafin Suarez, 67, died after a week in hospital. Doctors said he had Covid-19.

“The poor can’t afford to pay for health plans so we run to the health centre, and it is very badly prepared to receive someone who’s sick. The staff work well, but they don’t have the structure,” she says. “These hospitals are very precarious … They’re not ready for this.”

Brazilians such as Gonçalves have been bombarded by fake news – one WhatsApp video she saw claimed the coronavirus was created to cull an overpopulated planet. Others were swayed against social isolation by far-right president Jair Bolsonaro, who has dismissed the pandemic and railed against isolation measures because of their negative impact on the economy.

“He’s right,” Gonçalves says of the president. “If we don’t work, we go hungry, if we get sick we don’t have money to buy medicine.”

In favelas such as Jacarezinho, Borret says, Bolsonaro’s message was reinforced by evangelical pastors – many of whom support the far-right populist. “People did not know what to believe. And when a country goes through a pandemic without knowing what to believe, this is very dangerous,” she says.

Another study suggested that poverty makes black Brazilians more at risk.

The technical note by Brazil’s Institute of Health Policy Studies, a thinktank, found 12% more under-60s who hadn’t completed high school had a Covid-19 “risk factor” such as hypertension than those who finished school. Of those who didn’t complete school, 64% were non-white, says one of its authors, Letícia Nunes.

In Brazil, 34% of the population live in housing that lacks basic sanitation – and 66% of people included in this figure are non-white. “That contributes to the dissemination of the virus and makes isolation more difficult,” says Nunes.

Others involved in the Inclusion Project feel racism keenly. “In our country white people have the advantage in everything, in the pandemic or outside of it,” says Rosana de Souza, 43, a school bus driver whose son Fabricio takes part in the project. “People of colour are treated differently.”

Her cousin Glaucio da Silva, 42, a nurse, died after contracting Covid-19. Her husband Fabio de Souza, 44, lost his cousin Antonio Ferreira, who was 39. “People much older than him recovered. The family expected him to recover,” De Souza says.

Ferreira had to keep working: he was a police officer. So does De Souza, who is a bus driver. “We worry,” he says. “But I need to work, the bills don’t stop coming.”

The family does not currently have a health plan, like 80% of black Brazilians – according to health ministry research. They depend on Brazil’s overstretched public health system, which saw beds fill up quickly in the pandemic, rather than the private hospitals that middle-class, white Brazilians turn to – which in many places still have beds.

Bolsonaro’s government is making emergency monthly payments of about £90 to poorer Brazilians for three months. Many had problems registering for the money on a cellphone app, causing queues outside government banks.

Others kept working, such as Lívia Nogueira, 29, whose journey by train and bus from Piabetá in the Baixada to Rio’s upmarket Zona Sul – where she cleans a restaurant – takes two hours each way. With three children and an unemployed husband, she has no choice, so she carries alcohol gel to clean her hands on the commute and wears a mask.

She thinks Bolsonaro’s rhetoric has been “totally wrong” and knows five people who have died. “I work with fear, scared all the time,” she says. “I protect myself as much as I can.”