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.
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.”
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.
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.”
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.”
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.”
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.
Turkey election: President Erdogan declared winner with more than 52% of vote
Recep Tayyip Erdogan has won the presidential run-off election, with leaders from around the world congratulating him.
With 99% of the votes counted, Mr Erdogan, who served as prime minister from 2003 to 2014, won with a share of 52.1%.
It means he has secured a record-breaking third term as president and will serve at least five more years in power.
Turkey election latest
Erdogan thanks crowds as election officials declare him winner
Polls closed at 5pm local time (3pm BST) and while votes were counted fast, for hours it remained too close to call. At one point, less than a percentage point separated the incumbent from his rival, Kemal Kilicdaroglu.
Shortly after 8pm local time (6pm BST) Mr Erdogan stepped out of his home and thanked people for “giving us the responsibility to rule for the next five years”.
He has been congratulated by a host of world leaders. Among them, Vladimir Putin, who wrote a lengthy message to Mr Erdogan, which concluded: “From the bottom of my heart I wish you new successes in such a responsible activity as the head of state, as well as good health and well-being.”
French President Emmanuel Macron also sent well-wishes, as well as reiterating the “immense challenges” both countries face.
“The return of peace to Europe, the future of our Euro-Atlantic Alliance, the Mediterranean Sea,” he tweeted.
“With President Erdogan, whom I congratulate on his re-election, we will continue to move forward.”
Opponent refuses to admit defeat
Kemal Kilicdaroglu took the stage earlier this evening, and in a rousing speech, he refused to admit defeat.
“I wasn’t able to defend your rights,” Kilicdaroglu began by saying. “I did not shirk against an unjust structure, I could not be a silent devil and I was not.
“I could not stand quiet against millions of people becoming second-class citizens in this country.
“I could not let them stand all over your rights. For your children to go to bed hungry. For farmers to not to be able to produce. I could not allow these things.”
He concluded by thanking the 25 million people who voted for him – and says the “battle continues”.
First presidential run-off in Turkey’s history
The pair were forced to go head to head when neither reached the required 50% of the vote in the first round on 14 May and Mr Erdogan’s win will have profound consequences for Turkey, and the wider world.
The two candidates offered sharply different visions of the country’s future and its recent past.
Mr Erdogan’s government vetoed Sweden’s bid to join NATO and purchased Russian missile-defense systems, which prompted the United States to oust Turkey from a US-led fighter-jet project. But it also helped broker a crucial deal that allowed Ukrainian grain shipments and averted a global food crisis.
Meanwhile, Mr Erdogan’s 74-year-old challenger promised to restore a more democratic society.
Sudan conflict: Pregnant woman and baby killed in shooting – but husband left unaware
Men in crisp white thobes sit on mats under a leafy thorn tree carefully cutting pieces of white material.
They slowly stitch them together with tender, experienced precision.
Another shroud for another life lost to senseless violence.
More men arrive and they raise their hands in prayer to grieve the recently deceased.
The latest victim of the militias terrorising their community lies in a two room morgue a few metres away.
Fatma was eight months pregnant and travelling on a cart with her young son and daughter to Hajr Hadeed in eastern Chad.
She left her husband in the violence of al Geneina, the state capital of West Darfur in Sudan, where fleeing residents are reporting a citywide massacre.
Fatma’s sister Zeinab says her five-year-old nephew El-Sheikh was holding his pregnant mother’s body when the cart arrived in the village.
She rushed with close relatives to Adre Central Hospital.
They could feel the heaviness of Fatma’s body, but held out hope that the baby in her belly was still alive.
Hospital workers were cleaning the blood from the floor when they arrived at Dr Mahmoud Adam’s office.
He said Fatma was dead when she arrived and was quickly able to ascertain that the baby too had died.
“Since the war in Khartoum started so many wounded civilians are passing through the border from Darfur,” said Dr Mahmoud, whose hospital now has treatment tents operated by the medical aid agency Medecins Sans Frontieres (MSF) in its grounds.
He recalls the 2003 genocide and observes there is little difference between then and now.
“It is so sad that to see people dying and suffering like this,” he said.
We walk over to the morgue where Fatma lies covered on a cement slab.
“She was shot in the back of the head,” he said.
Dr Mahmoud believes she died instantly.
Read more on Sudan crisis:
Scale of destruction in before and after images
The fighting explained
Zeinab sits under a tree just outside the morgue building.
Her eyes are wet and wide and every couple of minutes she muffles her sobs with her dark tobe.
Fatma’s small children lie silently across her lap.
More family arrive from their village as the body is prepared for burial.
Zeinab is handed different phones as family from across the region call to extend their condolences.
One call that doesn’t come is from Fatma’s husband Adam in al Geneina where telecommunications have been down for more than a week.
The only information from there is coming from the fleeing residents who have safely made it across the violence-ridden region.
The city ‘is on fire’
They say the city is on fire and that there are too many deaths to count.
Deep in the al Geneina blackout, Adam is still unaware that his wife and unborn child have been killed.
No one can reach him to deliver the news.
Fatma emerges from the morgue wrapped in the white shroud.
She’s lifted onto the back of a military grade Toyota pick-up by the men from her family as wailing rings out from the crowd of women.
Dread and panic
The cries carry more than just loss, but notes of dread and panic.
The fearful anticipation that there is more grief to come.
Health Secretary Steve Barclay rules out new pay offer for nurses despite ‘constructive’ meeting with RCN chief
Health Secretary Steve Barclay held a “constructive” meeting with Royal College of Nursing (RCN) chief Pat Cullen – but made clear that a new pay offer for nurses will not be forthcoming.
Ms Cullen previously recommended the members of her union accept the deal agreed with the government, but it was rejected by members.
However, the offer was imposed because a majority of the NHS Staff Council body wanted to take the deal – despite the opposition from the RCN.
‘Manifestly wrong’ for MPs to claim driving fines back on expenses
Speaking to Trevor Phillips, who was hosting Sophy Ridge on Sunday on Sky News, Mr Barclay was asked about a recent summit with Ms Cullen.
He said they “had a very constructive meeting this week” – but described what was offered previously and accepted by the NHS Staff Council as a “full and final” offer.
This offer amounted to a 5% pay rise, plus a cash top-up.
Currently, the RCN is balloting over whether to take further strike action, with close to 30,000 members taking part in the vote.
Ms Cullen said previously: “Once again, we have been forced to ask our members if they want to take to the picket lines in their fight for fair pay.
“This is unfinished business and the government can get it resolved without the need for more strike action.”
The cost of living crisis saw the RCN take part in nationwide industrial action across England for the first time in its history.
After other health unions also took action, Unison, GMB, the Chartered Society of Physiotherapists and the Royal College of Midwives were all among those who in the end voted to accept the pay increase offered by the government.
Demands aren’t ‘legally possible’
Speaking about the deal, Mr Barclay told Sophy Ridge on Sunday: “It means a band six, entry-level nurse gets over £5,000 over the two years – recognising the huge, valuable contribution that NHS staff have made.
“Now what some in the RCN are asking us to do isn’t legally possible.
“It’s not possible to give a band six nurse different pay to a band six midwife or a band six paramedic.”
Unite was another union which rejected the government’s offer.
Members at Guy’s and St Thomas’ NHS Foundation Trust in London, and the Yorkshire Ambulance Service NHS Trust, last week announced they would be downing tools on 1 June – and junior doctors will be walking out for 72 hours on 14 June.
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The RCN leadership is encouraging its members to vote in favour of strikes.
While Mr Barclay said the pay element of the deal is closed, there is room for talks about issues like violence against staff and pension abatement, he added.
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