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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 looks down at her three-month-old baby Ezequiel, who has just been released from hospital
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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.

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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.”

Queueing for a COVID vaccine jab in Sao Paulo
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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
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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
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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 with his sons, Pedro, 5, and Bento, 3, and their sister, Maria Helena
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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
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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.

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‘If someone took Trump’s land, how would he feel?’ – Ukrainians view peace talks with suspicion

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'If someone took Trump's land, how would he feel?' - Ukrainians view peace talks with suspicion

A Ukrainian farmer-turned-soldier in the Donbas has a message for Donald Trump as the US president attempts to broker a peace deal between Kyiv and Moscow.

Anatolii, 59, said: “If someone took a piece of his territory, what would he say to that? The same goes for us.”

Like many Ukrainians, the serviceman volunteered to join a territorial defence unit when Russia launched its full-scale war almost four years ago.

He has been fighting ever since, but will have the option to quit next year once he turns 60.

Anatolii and a colleague
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Anatolii and a colleague

Unable to wear body armour anymore because of its weight, Anatolii now operates further back from the frontline in a small workshop on the outskirts of the city of Kramatorsk where he helps to fix and improve the performance of drones – a crucial weapon on the battlefield.

“I want this war to finally end,” he said. “I want to go home, to my family, to my land.”

But not at any price.

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He and other soldiers in 107 Brigade of Ukraine’s Territorial Defence Force view Mr Trump’s efforts to negotiate a peace agreement with suspicion.

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Peace deal: Russia ‘in no mood to compromise’.

An initial proposal envisaged the Ukrainian government giving up Donetsk and Luhansk, the two regions that make up the Donbas, to Russia.

This includes large swathes of land that are still under Ukraine’s control, and that thousands of Ukrainian soldiers have lost their lives fighting to defend.

“I feel negative about it,” Anatolii said, referring to the proposal.

“So many people already fell for this land … How can we give away our land? It would be like someone comes to my house and says: ‘Give me a piece of your home.'”

However, he added: “I understand, we have nothing to take it back with. Maybe through some political means…

“I do not want more people to fall, more people to die. I want politicians to somehow come to terms.”

A short drive away from the workshop is a hidden bomb factory where other soldiers from the same unit are focused on a different kind of war effort.

Surrounded by 3D printed gadgets, metal ball bearings and plastic explosives, they make improvised bombs, including anti-personnel mines and devices that can be fitted onto one-way attack drones and exploded onto targets.

Vadym, 41, is in charge of the production line.

He has been fighting since Russian President Vladimir Putin first attacked eastern Ukraine in 2014.

Vadym
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Vadym

Asked whether he felt tired, he said: “We are always tired, we have no motivation as such, but there is the understanding that the enemy will keep coming as long as we do not stop him. If we stop fighting, our children and grandchildren will fight. That keeps us going.”

Vadym is also against simply handing over Ukrainian land to Russia.

“If we now give away borders, give away Donbas, then what?” he said.

“Any country can come to any other country and say: This is our land. Let’s coordinate, do business, and keep living as before. That is not normal in my view.”

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The Ukrainian president says ‘everyone must be on this side of peace’

The city of Kramatorsk stands testament to Ukraine’s will to fight, remaining firmly in Ukrainian hands, though Russia’s war is inching closer.

Nets stretched like a tunnel line a main road leading into the city to protect vehicles from the threat of small, killer drones.

Coils of barbed wire are also strung across fields around the outskirts of Kramatorsk along with other fortifications such as mounds of dirt and triangular lumps of concrete.

Many civilians have remained here as well as the nearby city of Slovyansk, even as other landmark sites such as Mariupol, Bakhmut and Avdiivka have fallen.

Yet the toll of living in a warzone is clear.

Stallholders swept away rubble and broken glass on Sunday after a Russian missile smashed into a central market in Kramatorsk on Saturday night.

Some, like Ella, 60, even chose to reopen despite the carnage.

“It’s frightening. We need to earn a living. I have my mother, I need to look after her, help my children. So we do what we have to do,” she said.

Her adult children live in Kyiv and want her to leave, but Kramatorsk is her home.

“We’ve been living like this for four years now. We’re so used to it. A drone flies overhead and we keep working,” she said.

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Is the UK prepared to fight a war?

Asked how she felt about what the war had done to her city, Ella’s voice wobbled and she wiped tears from her eyes.

“We keep it all inside, but it still hurts. It’s frightening and painful. I just want things as they used to be. We don’t want anything here to change,” she said.

As for what she would do if a future peace deal forced Ukraine to surrender the area, Ella said: “That’s a hard question … I wouldn’t stay. I’d leave.”

Production by security and defence producer Katy Scholes, Ukraine producer Azad Safarov, camera operator Mostyn Pryce

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‘No one helped us’: The community left in a mass of mud and loss after cyclone

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'No one helped us': The community left in a mass of mud and loss after cyclone

This community in Sri Lanka’s Kandy District is a mass of mud and loss.

The narrow, filthy streets in Gampola are filled with broken furniture, sodden toys and soiled mattresses. A torrent of floodwater ripped through this neighbourhood and many people had no time to escape.

Trying to reach their now destroyed homes is like wading through treacle – the mud knee-deep.

Many locals say they were not warned about the threat Cyclone Ditwah posed here before it struck last Friday, and weren’t told to evacuate. They say they’ve received very little help since.

Resourceful neighbours were left to try to help rescue survivors. But some had to carry the bodies of the dead, too. Mohamed Fairoos was one of them.

Fairoos Mohamed
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Fairoos Mohamed

“We took five bodies from here,” he says, gesturing to a house full of debris, where mattresses hang drying over the balcony.

“We took nine bodies in total and handed them over to the hospital.” He appears both shocked and exasperated at the lack of support this community received.

The house where Fairoos pulled the bodies from
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The house where Fairoos pulled the bodies from

“When I took the bodies, the police, the navy, no one sent for us.” He tells me he even posted a video online appealing for boats, hoping it might help.

I ask him if he thinks the government has done enough. “No,” he says forcefully. “No one called for us. No one helped us. No one gave us any boats.”

Read more: Families count the cost of devastating floods

Kumudu Wijekon and her husband Kumar Premachandra
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Kumudu Wijekon and her husband Kumar Premachandra

‘Five people were killed here’

Just a few doors down, a group of volunteers have come to clear another home filled with floodwater. “Five people were killed here,” one of them tells me.

Five of them came from one family: a mother, father, their two daughters and son. Kumudu Wijekon tells me she was friends with them and they’d fled here to a friend’s house, hoping to escape the threat.

“There was heavy rain, but they didn’t think there would be flooding. They left their own home to save themselves from landslides. If they had stayed, they would have survived.”

Chamilaka Dilrukshi
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Chamilaka Dilrukshi

‘We don’t have a single rupee’

A short drive away, Chamilaka Dilrukshi is sobbing inside the photography studio she shares with her husband Ananda. They have two children aged four and 11.

Chamilaka is clutching a bag of rice – she says it’s been donated by a friend and it’s all they have to eat.

Ananda Wijebandara and his wife Chamilaka Dilrukshi
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Ananda Wijebandara and his wife Chamilaka Dilrukshi

Everything in the shop is wrecked – expensive cameras and lighting equipment covered in thick layers of mud, and outside, rows of broken frames and ripped pictures.

They think they’ve lost nearly £2,500 and their home is severely damaged. She weeps as she tells us: “We don’t have a single rupee to start our business again. We spent all of our savings on trying to build our house.”

Like Mohamed, she believed they should have been warned. “We didn’t know anything. If we did, we would have taken our cameras and our computers out. We just didn’t know it was coming.”

The studio was caked in mud
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The studio was caked in mud

Anger at government’s perceived failings

Sri Lankan president Anura Kumara Dissanayake has declared a state of emergency to deal with the aftermath of the cyclone, and international aid has arrived.

But many people are angry at the government’s perceived failings. It’s been criticised for not taking the warnings from meteorologists seriously two weeks before the cyclone made landfall, as well as for not communicating enough messages in the Tamil language.

It is going to take places like Gampola a long time to rebuild, repair and restore trust. And in a country still recovering from an economic collapse, nothing is guaranteed.

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Why Putin won’t agree to latest Ukraine peace plan

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Why Putin won't agree to latest Ukraine peace plan

The Americans were given the full VIP treatment on their visit to Moscow. 

There was a motorcade from the airport, lunch at a Michelin-starred restaurant, and even a stroll around Red Square.

It felt like Steve Witkoff and Jared Kushner were on more of a tourist trail than the path to peace.

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Trump’s envoys walk around Moscow

They finally got down to business in the Kremlin more than six hours after arriving in Russia. And by that point, it was already clear that the one thing they had come to Moscow for wasn’t on offer: Russia’s agreement to their latest peace plan.

According to Vladimir Putin, it’s all Europe’s fault. While his guests were having lunch, he was busy accusing Ukraine’s allies of blocking the peace process by imposing demands that are unacceptable to Russia.

The Europeans, of course, would say it’s the other way round.

But where there was hostility to Europe, only hospitality to the Americans – part of Russia’s strategy to distance the US from its NATO allies, and bring them back to Moscow’s side.

Vladimir Putin and Steve Witkoff shaking hands in August. AP file pic
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Vladimir Putin and Steve Witkoff shaking hands in August. AP file pic

Putin thinks he’s winning…

Russia wants to return to the 28-point plan that caved in to its demands. And it believes it has the right to because of what’s happening on the battlefield.

It’s no coincidence that on the eve of the US delegation’s visit to Moscow, Russia announced the apparent capture of Pokrovsk, a key strategic target in the Donetsk region.

It was a message designed to assert Russian dominance, and by extension, reinforce its demands rather than dilute them.

Read more:
Michael Clarke answers your Ukraine war questions
‘Thousands’ of Westerners applying to live in Russia

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‘Everyone must be on this side of peace’

…and believes US-Russian interests are aligned

The other reason I think Vladimir Putin doesn’t feel the need to compromise is because he believes Moscow and Washington want the same thing: closer US-Russia relations, which can only come after the war is over.

It’s easy to see why. Time and again in this process, the US has defaulted to a position that favours Moscow. The way these negotiations are being conducted is merely the latest example.

With Kyiv, the Americans force the Ukrainians to come to them – first in Geneva, then Florida.

As for Moscow, it’s the other way around. Witkoff is happy to make the long overnight journey, and then endure the long wait ahead of any audience with Putin.

It all gives the impression that when it comes to Russia, the US prefers to placate rather than pressure.

According to the Kremlin, both Russia and the US have agreed not to disclose the details of yesterday’s talks in Moscow.

I doubt Volodymyr Zelenskyy is filled with hope.

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