Pregnant women and their unborn babies dying in Brazil as COVID deaths set to pass 500k mark
Brazil is likely to pass the awful mark of 500,000 COVID-related deaths in the next two days. Only the United States has a higher number of dead across the world.
Currently averaging 2,500 deaths a day, Brazil’s P1 variant has long been identified as a highly virulent cause for concern, prompting travel bans to most countries.
But researchers in Sao Paulo, one of the worst-hit cities in the country, say the P1 variant has started infecting and killing pregnant women and their unborn children in startling numbers.
Thais Ferreira de Lomes and her three-month-old baby Ezequiel, who has just been released from hospital
Currently 42 pregnant women die every week from COVID-19; many more women are being intubated and their premature children delivered by caesarean section without consultation with obstetricians, according to medical researchers at the Brazilian Obstetric Observatory.
Dr Rossana Pulcineli Vieira Francisco from the observatory said: “The virus transmissibility is higher with this variant and I think the big problem is that the health system for maternal care in Brazil is very bad.
“In some states the patient starts treatment in one hospital, a general hospital, and when her condition starts to worsen, and she needs to deliver the baby, she will be transported while intubated because they’re not at the right hospital to do the delivery.”
This, she believes, is part of the reason Brazil is seeing a higher rate of maternal mortality.
She says obstetricians and intensivists should be working together to find the right outcomes for mother and child, otherwise it will be very difficult to stop maternal mortality during COVID.
“I think we have more cases because of the variant, and because our maternal health system is very fragile, we have this result.”
People queueing for a COVID vaccine jab in Sao Paulo, but overall rollout in Brazil is slow
I asked her if it’s a perfect storm.
“Yes”, she replied, “and I think our only chance to stop this is the vaccine.”
The data from her and her colleagues’ research reveals that last year 10 pregnant women were dying each week from COVID-19.
This year, with the emergence of the new variant, the new figure is more than 40 per week.
Poor medical care and facilities already contributed to a high death rate for pregnant women in Brazil of 55 per 100,000 women. In Britain the figure is just 9.7.
But Dr Francisco says their research so far indicates that with COVID-19 as a factor the new number could double to over 100 per 100,000 by the end of the year.
The high overall transmission of the P1 variant (it accounts for nine in 10 coronavirus cases in Sao Paulo) combined with an overwhelmed health service, puts pregnant women at extreme risk.
When her kidneys failed the doctors told Thais she wouldn’t live to see her third child
The practice of intubating pregnant women and delivering the baby while the mother is in a highly stressed condition is criticised by the researchers as a “bad outcome” for both the mother and her child.
For their part, doctors working in overstretched public hospitals prioritise the life of the mother over the child and without extensive experience of intubating anyone, let alone pregnant women, they have little choice but to deliver the baby while saving the mother.
In Jardim Almeida Prado, a poor neighbourhood in the south of the city of Sao Paulo, Thais Ferreira de Lomes looks down at her tiny three-month-old baby Ezequiel, who has just been released from hospital.
Ezequiel was born 12 weeks prematurely, after Thais was intubated.
Previously fit and healthy, like most people, Thais and her family thought she was in no danger when the first symptoms of COVID developed, but they were wrong.
When her kidneys failed, the doctors said she wouldn’t live to see her third child.
She’s still scarred by her near-death experience – her uncle had died of COVID when she first got sick.
“It was great to come home, see my family, and know that God gave me the opportunity to live again,” she tearfully told me.
“Seeing so many people dying, so many people dying like my uncle died with COVID. Many people are dying with COVID.”
Even though she is over the worst of her experience, she is scared for her and her children’s futures, and worries Ezequiel might still get coronavirus.
“Even today I’m afraid because he’s tiny, he was born prematurely. I told my mother-in-law that it’s hard for me to look at him and not think that something might happen.”
Dr Patricia Sella, who treated Ezequiel, says the P1 variant is infecting young pregnant women like she hasn’t seen before
At the Graiau Hospital, the maternity ward and its premature babies section where Ezequiel was cared for, are currently free of COVID cases, but doctors and nurses have no expectation that it is going to stay this way – other hospitals in the city are still treating infants with COVID-19 and their sick mothers.
Dr Patricia Sella, the medical coordinator for gynaecology – and the doctor who treated baby Ezequiel – says she has no doubt that the P1 variant, sweeping across the country, is infecting young pregnant women like she hasn’t seen before.
“In 2021 we observed an increase in pregnant women affected by COVID, likely because of the new strain.
“In 2020, in our hospital mainly, we had a very small number of pregnant women with COVID, but this year we have at least one pregnant woman hospitalised with COVID every week,” she explained to me, standing in the hospital’s neonatal intensive care unit.
She puts this down to the high infection rate of the P1 variant.
“So, actually, I think that with the change in the strain, we saw that the inflammatory process, [and] the vasculitis caused by the virus is much greater, right, and that ended up changing, bringing it to pregnant women.
“[Pregnant women] already have decreased lung compliance due to the pregnancy itself and the evolution of the pregnancy. With the COVID infection, this ends up getting worse.
“What we observed is that this strain ended up infecting pregnant women who do not have any other pre-existing conditions, so they do not have hypertension, and do not have diabetes during pregnancy. We observed that there was an increase and an increase in severity of the cases.”
Douglas Silverio with his sons, Pedro, 5, and Bento, 3, and their sister, Maria Helena
In the middle-class suburb of Jardim America, Douglas Silverio proudly shows off the latest addition to his family, three-month-old Maria Helena.
She has two elder brothers Pedro, five, and Bento, three, who run around their home playing with toys while their grandmother prepares lunch.
She now lives with the family because her daughter and the children’s mother, Vanessa, is dead; killed by COVID-19.
Vanessa was just 33 when coronavirus struck.
Within five days she deteriorated and was intubated, and Maria Helena was delivered by caesarean section, coincidentally on her dad’s birthday.
Vanessa never recovered.
“I told my sons, ‘let’s say goodbye to her’.
“Pedro, who is five years old, cried too, and he said, ‘goodbye mother, you are going to heaven’.
“The youngest one did not understand what happened. And it was crazy, that was a crazy time, because we had prayed a lot for the baby, a lot of prayers from our family, but I was not ready to bury my wife in this process.”
Vanessa Silverio, 33, seen with husband Douglas, died from COVID while pregnant and her daughter was delivered by caesarean section
On the day Douglas held mass for his wife’s death, baby Maria Helena was released from hospital.
He wants everyone to fear COVID and to listen to the warnings about the disease.
“I miss my wife. And she was my friend, we had a lot of plans together.
“I get scared when I see on the streets some pregnant women without masks. I say to them please take care of yourself.”
The entire medical profession in Brazil now acknowledges that the only way to fight the virus and to stop the country being a petri dish for creating COVID-19 variants that will continue to threaten the world, is for the country’s vaccination programme to speed up and reach all members of society.
The rollout is currently very slow and so far has only started to include 56-year-olds in Sao Paulo.
Many in the profession directly blame the country’s president, Jair Bolsonaro, for the country’s poor response to the pandemic.
He still refuses to take the vaccine, has continuously played down the danger of coronavirus and still discourages the use of face masks anywhere.
The identification of the virus as a specific threat to young pregnant women has set off the alarm bells here that COVID-19 variants are attacking younger and younger members of society, who were previously thought to be relatively safe from serious illness.
World
Israel says first hostages handed to Red Cross as Palestinian prisoners also expected to be released
Israel says Hamas has handed over the first seven hostages to the Red Cross to be released as part of the Gaza ceasefire deal.
The remaining Israeli hostages are being released by Hamas after being held in Gaza for more than two years, in exchange for over 1,900 Palestinian prisoners held by Israel.
The Red Cross will drive the hostages to Israeli security forces, who will take them into Israel, where they will be reunited with family and flown by helicopter to hospitals.
Follow the latest updates here
Red Cross vehicles and buses in Khan Younis, southern Gaza Strip. Pic: AP
Tens of thousands of Israelis watched the transfers at public screenings across the country.
The families and friends of hostages broke out into cheers as Israeli TV channels announced the hostages were in the hands of the Red Cross.
Israel previously said that of the 251 initially taken captive in Hamas’s 7 October 2023 attack, 20 of the hostages that remained in Gaza were thought to be alive, 26 were presumed dead, and the fate of two was unknown.
The 20 hostages are all men aged between 20 and 48, who have spent more than two years in captivity.
As part of the first phase of US President Donald Trump‘s ceasefire agreement, Hamas was given 72 hours to release all the Israeli hostages, alive and dead.
The agreed ceasefire started at midday local time (10am UK time) on Friday, with tens of thousands of displaced Palestinians moving back towards northern Gaza, which was mostly destroyed by Israel.
Read more:
Inside rooms where hostages will spend first nights of freedom
Britain has been playing a role behind scenes of Trump’s deal
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Who are the hostages to be freed?
Hamas has released a list of the 20 living hostages it will free. Tap on their pictures to read more about them:
Once all the hostages are released, Israel is expected to free 250 Palestinian prisoners serving life sentences and 1,700 Gazans detained after the 7 October attacks.
A second phase of the plan, which all sides have yet to agree on, could see Israeli troops further withdrawing from Gaza.
Trump says ‘war is over’
Mr Trump boarded Air Force One in Washington on Sunday to fly to Israel.
“The war is over,” he said. Asked about prospects for the region, he added: “I think it’s going to normalise.”
The US president will receive a hero’s welcome when he addresses Israel’s parliament on Monday. He will be awarded Israel’s highest civilian honour later this year, Israel’s President Isaac Herzog said.
The war began when Hamas-led militants stormed into Israel on October 7 2023, killing around 1,200 people and taking 251 hostage.
Israel invaded Gaza in retaliation, with airstrikes and ground assaults devastating much of the enclave, killing more than 67,000, according to its Hamas-run health ministry, which does not differentiate between civilians and combatants but says around half of those killed were women and children.
This breaking news story is being updated and more details will be published shortly.
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A teddy sits on a bed in a bright hospital room. Beside it is a small fridge stocked with bottled water and Coca-Cola.
While the bear might make you think a child is about to arrive, this room will soon be welcoming one of the 20 Israeli hostages believed to be alive in Gaza.
With phase one of Donald Trump’s peace plan now under way, an entire nation is holding its breath for the return of the hostages, not least the medical teams preparing to receive them.
Gaza latest: Israel prepares for hostages’ release
Sky News was given special access to one of the teams in the Rabin Medical Center in Petah Tikva, a city north-east of Tel Aviv.
It was sobering and emotional, but also inspiring, talking to its doctors and nurses as they showed us around what one calls the “homecoming unit”.
A welcome sign and Israeli flag greet the returning hostages
Director of Nursing Dr Michal Steinman took us into the light airy rooms where hostages will be allowed to recover at their own speed in private, choosing when and for how long they emerge, slowly reengaging with a world they’ve not known for two years.
She explained that each of the hostages – who are all men – will be given their own private room, where a gift basket filled with thoughtful items such as a teddy, a blanket, slippers and a phone charger awaits them.
The teddy is there to help bring comfort to the freed captives.
“Our research says each one of us has a child inside,” Dr Steinman told me. “We need something to pet and feel soft, and reassure them after the lack of senses for such a long time.”
Phones, she said, will be provided by the army.
Read more:
The hostages believed to be alive
Drones reveal devastation in Gaza
The bear is one of many small touches added to bring the hostages comfort in the coming days
The families will also bring items from home to make the area feel more familiar to their loved ones as they slowly adjust to freedom.
The men will also have access to other areas, including a private living space where they can spend time with loved ones or greet any visiting dignitaries. Their families will also be provided with rooms to stay in, as well as an area for the children of the hostages when they visit.
Medical equipment is kept in dedicated treatment rooms as part of an effort to make the rooms feel more like accommodation than a hospital.
One of the areas where family members can wait for their loved ones who have been in captivity to arrive
While the unit is pristine and ready for the new arrivals, it has previously been used to house other hostages released by Hamas.
Staff shared anecdotes revealing what may lie ahead. Dr Steinman told us of one released hostage who had had trouble not with sleeping, but with waking up.
“When I opened my eyes,” they had told her, “I was thinking that I’m still in a dream because there’s no way that I opened my eyes and I’m not in the tunnel. I thought, ‘it’s a dream inside a dream’.”
The hostages, she said, “can’t believe for the first moments they’re not in other place.”
A living space for the men and their families to relax in
Dr Steinman found another freed captive “stuck” and standing still after opening the refrigerator.
“I told him, ‘It’s hard for you to choose?’,” she explained. “And he said, ‘I’m just amazed at the colours. All I’ve seen for 100 days is black, white and brown’.”
The professor reinventing ‘hostage medicine’
For the head of the centre, Professor Noa Eliakim-Raz, and her team, the return of the hostages will be the culmination of two years of painstaking work.
They have effectively reinvented what they call ‘hostage medicine’, learning from the treatment of groups of hostages received during this war.
Professor Noa Eliakim-Raz tells me she has been ready for this moment for a long time
She is a serious and dedicated clinician. With professional precision, she told me of the challenges ahead, including the life-threatening risks of mistreating malnourished hostages held for so long underground.
Then she gave us a glimpse into the human side of their work.
“All the team, we’ve prepared for so long, I mean really, we’ve been in this for two years and all the time, we’re preparing and ready,” she said. “This ward that you saw is ready every day.”
How does she feel as the hostages’ arrival draws near?
“I feel very grateful, and I think that’s the strongest emotion, to be part of this,” she said.
Clearly moved, Professor Noa had to pause and collect her emotions, her eyes welling up when asked what she’d be thankful for most.
“I think being part of a small step,” she began, before pausing again. “A small step of making them feel hugged again and trusting the system.”
It will, she said, be a big relief when it’s over.
Professor Noa is writing a first-of-its-kind multi-disciplinary protocol for treating long-term hostages, literally rewriting the book on how to return them to normality.
Her department did not exist before October 7. In the two years since its inception, it has pioneered a form of treatment involving many different disciplines to maximise the chances of recovery.
The Rabin Medical Center’s staff believe the lessons they’ve learned will benefit doctors around the world in future.
But they hope never to have to use them on Israelis again.
Drones have been a common sight in Gaza for a long time, but they have always been military.
The whine of a drone is enough to trigger fear in many within the enclave.
But now, drones are delivering something different – long, lingering footage of the devastation that has been wreaked on Gaza. And the images are quite staggering.
Gaza latest: Chants of ‘thank you Trump’ in Hostages Square
Whole city blocks reduced to rubble. Streets destroyed. Towns where the landscape has been wholly redesigned.
Whole city blocks reduced to rubble
Decapitated tower blocks and whole areas turned into black and white photographs, where there is no colour but only a palette of greys – from the dark hues of scorched walls to the lightest grey of the dust that floats through the air.
And everywhere, the indistinct dull grey of rubble – the debris of things that are no longer there.
Gaza is full of people returning to their homes
The joy that met the ceasefire has now changed into degrees of anxiety and shock.
Gaza is full of people who are returning to their homes and hoping for good news. For a lucky few, fortune is kind, but for most, the news is bad.
Umm Firas has been displaced from her home in Khan Younis for the past five months. She returned today to the district she knew so well. And what she found was nothing.
Umm Firas returned to find nothing
“This morning we returned to our land, to see our homes, the neighbourhoods where we once lived,” she says.
“But we found no trace of any houses, no streets, no neighbourhoods, no trees. Even the crops, even the trees – all of them had been bulldozed. The entire area has been destroyed.
“There used to be more than 1,750 houses in the block where we lived, but now not a single one remains standing. Every neighbourhood is destroyed, every home is destroyed, every school is destroyed, every tree is destroyed. The area is unliveable.
“There’s no infrastructure, no place where we can even set up a tent to sit in. Our area, in downtown Khan Younis used to be densely populated. Our homes were built right next to each other. Now there is literally nowhere to go.
“Where can we go? We can’t even find an empty spot to pitch our tent over the ruins of our own homes. So we are going to have to stay homeless and displaced.”
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It is a story that comes up again and again. One man says that he cannot even reach his house because it is still too near the Israeli military officers stationed in the area.
Another, an older man whose bright pink glasses obscure weary eyes, says there is “nothing left” of his home “so we are leaving it to God”.
“I’m glad we survived and are in good health,” he says, “and now we can return there even if it means we need to eat sand!”
A man says there is ‘nothing left’
A bulldozer moves rubble
The bulldozers have already started work across the strip, trying to clear roads and allow access. Debris is being piled into huge piles, but this is a tiny sticking plaster on a huge wound.
The more you see of Gaza, the more impossible the task seems of rebuilding this place. The devastation is so utterly overwhelming.
Bodies are being found in the rubble while towns are full of buildings that have been so badly damaged they will have to be pulled down.
Humanitarian aid is needed urgently, but, for the moment, the entry points remain closed. Charities are pleading for access.
It is, of course, better for people to live without war than with it. Peace in Gaza gifts the ability to sleep a little better and worry a little less. But when people do wake up, what they see is an apocalyptic landscape of catastrophic destruction.
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