RIO DE JANEIRO, BRAZIL – Brazilians’ life expectancy has returned to the 2013 level. The drop interrupts a cycle of growth in life expectancy in the country, which started from an average of 45.5 years in 1945 to reach the estimated 76.7 years in 2020, an average gain of five months per calendar year.
The assessment of the impact of covid-19 on population survival was conducted by a team of researchers led by demographer Marcia Castro, a professor at Harvard University’s School of Public Health. Life expectancy, that is, the estimate of how many years a given population born in a given year should live, is an important indicator of life quality and one of the components in the calculation of nations’ Human Development Index (HDI).
“It works as a social gauge because it shows you how we are progressing in increasing the longevity of the population, through public health measures, sanitation, and also shows you how a certain shock, like a war or, at this moment, a pandemic, reduces this indicator because there is a higher than expected mortality pattern,” said Marcia Castro to BBC News Brazil.
With the second highest mortality rate in the world in absolute numbers, Brazil registers more than 355,000 deaths caused by the novel coronavirus. And the impact of this mortality on the life expectancy of the country’s population is now 72% higher than that verified in the United States, leader in deaths by Covid-19 (560,000). While Brazilians lost 1.94 years, on average, Americans lost 1.13 years of life expectancy in 2020 because of the pandemic (reduction from 78.8 years to 77.8 years).
More than two years?
But the data may actually be worse than that estimate. “We know that there was great difficulty in accessing the Covid-19 test, underreporting, and many deaths from the novel coronavirus that were not recorded as such,” explains Castro.
So the researchers considered an alternative scenario: they calculated the impact on Brazilian life expectancy by adding all the deaths officially registered as Covid-19 plus 90% of those identified as being caused by severe acute respiratory syndrome (SARS), a condition commonly caused by the novel coronavirus. In this scenario, the reduction in life expectancy in Brazil would exceed two and a half years.
“Still, these are two very conservative estimates. The measures should be even greater because even after accounting for deaths from Covid-19 and SARS, we see that there is still an excess of deaths over what is expected, which can be caused by lack of basic medical care for other diseases, for example,” says Castro. The demographer and the other researchers are now working on new research to estimate this loss.
Will it be greater in 2021?
Moreover, the current status of the pandemic in Brazil indicates that in 2021, rather than recovering a little from the tumble, life expectancy in the country may suffer an even more severe reduction. This year, the country is recording the equivalent of nearly half of all Covid-19 deaths from 2020. “We are not even in mid-April and states like Amazonas and Rondônia register more deaths this year than in all of last year. So it’s easy to predict that this year should be even worse,” notes Castro.
According to the scientist, the trend is not one of improvement because vaccination is advancing slowly in the country – not even 12% of the population has received at least one dose of the immunizer – and the public health measures that could contain virus transmission – such as the wearing of masks and social distancing – have not been adopted consistently throughout Brazil. The current rolling average of daily deaths of Brazilians from covid-19 is over 3,000.
To make matters worse, according to Fiocruz, in recent weeks the country is facing the largest hospital collapse in its history. Under these circumstances, the number of deaths from treatable and preventable causes tends to increase, as the population is unable to get regular access to health care in a system overwhelmed by Covid-19 victims.
Adding the situation of food insecurity to this, estimated at tens of millions of people, as the economy skids and current emergency aid amounts to less than half of that granted in 2020. “So you have the pandemic, poor health care, a set of families with their lives and incomes disrupted because they lost one or two breadwinners, there’s hunger again in Brazil, and all of this affects mortality rates not only among the elderly, but infant mortality and the Brazilian productive force as well,” says Castro.
In a worst-case scenario, Brazil could see a reduction in life expectancy comparable to that recorded in the United States during the Spanish flu epidemic in 1918, when there was a loss of between 7 and 12 years of the estimated longevity of Americans. “What we realize is that Brazil is neither taking the necessary measures to try to get out of the current wave, as the pandemic runs wild, nor preparing for the possibility of a new wave of covid-19 later this year,” says Castro.
Worse in the North, better in the Northeast
The study, still in preprint version (to be peer reviewed), also indicates that the pandemic has reduced life expectancy unevenly depending on the region of the country.
A similar phenomenon was registered in the United States. There, studies done according to race showed that, while a white American man had a reduction of 0.8 years in life expectancy as a result of the pandemic, a black man had a drop of 3 years in the indicator and a Hispanic man, 2.4 years.
In Brazil, the calculation by race did not prove feasible because one-third of the covid-19 death records did not contain this information. “I have no doubt that we would find data similar to the American data, with black and brown people victimized more in Brazil as well, but the estimate would be fragile due to the lack of complete data,” said Castro.
The solution was to verify the mortality differences per state. The first finding is that, in the absence of a centralized strategy from the federal government to combat the pandemic, local strategies varied and so did the results in relation to the pandemic.
The researchers found that the Federal District, where the country’s capital is located, registered the worst results: there, life expectancy dropped by more than 3 years. The region gained prominence both for the collapse of the health system, which recently led to scenes of piles of bodies of victims of covid-19 on the floor of public hospitals, and for the repeated excursions of President Jair Bolsonaro to the satellite cities that make up the Federal District. On these occasions, the president, with no mask, prompted crowds and repeated the usual speech against measures such as social distancing.
The Federal District was followed by three Northern States: Amapá, with a drop of 2.98 years in life expectancy, Amazonas, with a loss of 2.92 years, and Roraima, with a reduction of 2.74 years.
At the other end, among the states that lost the least in life expectancy in 2020, are several northeastern states, such as Maranhão, Piauí, and Bahia, all three below a 1.49 year reduction in life expectancy.
The finding intrigued the researchers, since, as they point out in the study, the “states in the North and Northeast regions have the worst indicators of income inequality, poverty, access to infrastructure, and availability of doctors and hospital beds.” So why hasn’t the Northeast been as devastated by the pandemic as the North of the country?
In an article published this Wednesday, April 14th, in the scientific journal Science, they address hypotheses for this disparity between the two poorest regions in the country.
One of them is the speed with which the pandemic has internalized in the states. The researchers used a scale of 0 to 100, where the closer to 100 the more geographically concentrated the cases and deaths are. If the pandemic had been successfully restricted to a few counties, the indices should have remained at values above 50 for several weeks. If it had spread uncontrollably throughout the territory, the tendency would be for these figures to fall rapidly within a few weeks.
The finding could not be more illustrative. In the first week in which covid-19 cases were diagnosed, Amazonas, Roraima, and Amapá (precisely those states with the greatest reduction in life expectancy) already registered case and death rates below 50 in the researchers’ methodology, i.e., a highly disseminated and rapid transmission throughout the territory.
“This suggests undetected circulation of the virus prior to the first official records (and thus by the time diagnoses began there was already a large fraction of the population infected), or rapid and multiple introductions of the virus followed by rapid spatial spread,” the scientists write in the study. The scientists concluded that the new coronavirus was already circulating in Brazil at least a month before the first officially diagnosed case, in late February 2020.
The result of the picture seen in Amazonas, Roraima and Amapá is a very high number of cases over a wide geographical space and in a short period of time. And this is, according to Castro, the recipe for mortality to advance not only by the effects of the virus, but by the lack of health structure. “In Amazonas, for example, only Manaus has ICU beds. If these beds are quickly exhausted, only with patients from the capital, while there are patients who need them many hours away, what happens is inevitable: this distant patient will die,” explains Castro.
But that’s not all. The researchers also noted how the states’ response produced better or worse results as the weeks went by. “The impact on life expectancy is obviously linked to how the epidemic spread, which is a direct function of the absence of control of the virus. And the absence of control of the virus is linked to the issue of the political alignment of governors to Bolsonaro,” says Castro.
According to her, the researchers found a correlation between the current governors’ support for then-presidential candidate Jair Bolsonaro in 2018 with their propensity to take measures such as lockdowns and imposing the use of masks, which went against the guidelines given by the federal government.
In the Northern Region, of the seven elected governors, five openly supported Bolsonaro: Gladson Cameli (PP), in Acre; Wilson Lima (PSC), Amazonas; Coronel Marcos Rocha (PSL), in Rondônia; Antonio Denarium (PSL), in Roraima; and Waldez Góes (PDT), in Amapá. On the other side, in the Northeast, of the nine governors, none declared support for Bolsonaro in the election.
“The measures that were taken against the pandemic when you compare the two regions are completely different. In the Northeast region you verify measures that went completely against what the president wanted to be done,” says Castro. Bolsonaro even lodged a lawsuit against the governors in the Supreme Court (STF) to prevent lockdowns.
In March 2021, when Bahia’s governor Rui Costa decreed severe restrictions on population movement and commerce, Bolsonaro promised to go to court to overturn the state order. Costa reacted by saying that the president was a “virus ally”.
Baby boom in sight?
For Castro, the coming months will be crucial to define the demographic future of the country. According to the demographer, after a mortality shock like the one experienced by Brazil, it is common to see a “baby boom,” a wave of births that recovers the population rates of the place.
The researcher, however, doubts whether something similar will happen in Brazil now, given the gloomy scenario that is projected for the coming months and the difficulty of seeing an end to the pandemic in the country. “We are likely to have many couples who have postponed their plans for children in the past year. But that doesn’t mean they will see condition to have a child now,” says Castro.
In 2020, cities like Rio de Janeiro have already recorded more deaths than births. The carioca population deficit stood at almost 5,000 people. This was a trend projected by IBGE to happen only in 2047.
According to Castro, it is difficult to predict how the pandemic will change the demographic aspects of the country. “We still make calculations based on the 2010 Census. We do not know, for example, the size of the impact that these deaths can have on the social security system. Or on the population composition of the cities. Or on the population replacement rate in certain areas, with more deaths than births,” says Castro.
The pandemic delayed the implementation of the Census, which is carried out every 10 years, and pushed the survey to 2021. But the reduction in the public budget set aside for the undertaking – from R$2 billion to R$71 million – now threatens to make it impossible to carry out a new Census, which would leave Brazil in the dark about the configuration of its own population.
Source: BBC Brasil