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Reuters

Health

Pedro Fonseca

Coronavirus, spreading in Brazil's interior, threatens to 'boomerang' back to major cities

FILE PHOTO: Healthcare workers walks in the riverside community Pinheiro, as they visit riverside communities to check on residents during the coronavirus disease (COVID-19) outbreak, in the municipality of Portel, on Marajo island, Para state, Brazil, June 6, 2020. REUTERS/Ueslei Marcelino

The novel coronavirus, now spreading through the smaller towns of Brazil's interior, risks returning to major cities in a so-called "boomerang effect," as a lack of specialized medical treatment forces patients into larger urban centers.

The impact of a potential second wave of new cases in urban centers could complicate attempts to reopen businesses and get the economy going again, experts said.

FILE PHOTO: A healthcare worker treats a child who has an infection, as his mother looks on, in front of their home at the riverside community Menino de Deus, as healthcare workers visit riverside communities to check on residents during the coronavirus disease (COVID-19) outbreak in the municipality of Portel, Marajo island, Para state, Brazil, June 13, 2020. REUTERS/Ueslei Marcelino

"The boomerang of cases that will return to the (state) capitals will be a tsunami," said Miguel Nicolelis, a leading medical neuroscientist at Duke University who is coordinating a coronavirus task force advising the state governments of Brazil's northeast.

Brazil, home to the world's second worst coronavirus outbreak behind the United States, has over 1.2 million cases of the virus, which has killed nearly 55,000 people. On most days, it is spreading faster in Brazil than in the United States, the top country by cases.

The virus initially came to Brazil through airports and spread mostly in its largest cities, but since late May it has been spreading faster in the interior of the country.

FILE PHOTO: A child looks through the window as the coffin holding Andrelina Bizerra da Silva, 49, who died on the way to a health clinic after she experienced days of suffering from shortness of breath and then fainted at her home, is left next to a burning candle during her wake, by the river Camaraipi where she lived, during the coronavirus disease (COVID-19) outbreak, in the municipality of Portel, on Marajo island, Para state, Brazil, June 10, 2020. REUTERS/Ueslei Marcelino

Last week, 60% of new cases were registered in smaller cities, according to health ministry data. Deaths are also rising outside of the major cities, and now account for about half of all daily deaths in Brazil.

Brazil's response to the coronavirus has been criticized by many health experts, as President Jair Bolsonaro has played down the severity of the disease, shown indifference to its rising death toll and aggressively promoted the unproven remedy hydroxychloroquine.

As the virus spreads outside of Brazil's cities, doctors are facing constraints. Only about 10% of Brazil's municipalities have intensive care units, according to public health institute Fundação Oswaldo Cruz (Fiocruz). That means seriously ill patients need to be transported to cities.

FILE PHOTO: Relatives listen to medical recommendations before transfer of Valter da Silva, 51, who tested positive for COVID-19, to hospital from his home at the riverside community Pinheiro, as healthcare workers visit riverside communities to check on residents during the coronavirus disease (COVID -19) outbreak, in the municipality of Portel, Marajo island, Para state, Brazil, June 13, 2020. REUTERS/Ueslei Marcelino

"The virus moves into the interior, along the highways, you start having community transmission, people fall ill, get worse and return to the (state) capital to be treated," said Nicolelis, describing the "the boomerang effect."

At the same time, Brazil's largest cities are reopening. Sao Paulo's mayor said on Friday that it could reopen restaurants, bars and hair salons as early as July 6. Thousands of shops have already reopened, sending workers back to their regular commuting patterns.

"The disease is now feeding off people's movement," said Gonzalo Vecina Neto, a public health professor at the University of Sao Paulo. "It goes to the interior with truck drivers, it goes to the interior with people who come to the large cities to buy things to resell in the interior. That's the path."

FILE PHOTO: Children are seen by the entrance of their home at the riverside community Menino de Deus, as healthcare workers visit riverside communities to check on residents during the coronavirus disease (COVID-19) outbreak in the municipality of Portel, Marajo island, Para state, Brazil, June 6, 2020. REUTERS/Ueslei Marcelino

The patterns are causing concern about overlapping curves, as cities like Sao Paulo and Rio de Janeiro pass their peaks and fall, while smaller cities are still on the rise.

Some experts say the spread of the virus should have been better contained at first. Now, one possible mitigation option is to create testing checkpoints along highways, said Christovam Barcellos of the Institute for Communications, Scientific Information and Health Technology at Fiocruz.

"Identifying the person who is going to take the virus to a place is a positive thing, it's the least that we can do," Barcellos said.