Highly transmissible variant and behavioural factors blamed as intensive care units fill with younger patients
One month after Michel Castro’s premature brush with death, the coronavirus infection has receded but the nightmares persist.
In them the 31-year-old father relives the spine-chilling scenes he witnessed as his Covid-hit body battled for survival in a Rio ICU. The six-month-old baby who appeared to be suffocating right next to him. The man urinating blood after his kidneys failed. The unnerving bleep-bleep-bleep of machines warning doctors that yet another life was on the line.
“It was agony. When you closed your eyes – God forgive me – but it was as if you were in hell,” said Castro, a systems analyst and devout Christian who fell ill in early March as Brazil was thrust into the deadliest month of a coronavirus disaster that has killed more than 365,000 people.
“I saw everything in there. Children, adults, young people, bodybuilders – the lot. All of them going through the same thing,” Castro recalled, rubbishing the idea that only elderly people were in danger. “If you’re a human being you’re at risk,” he said. “This disease is a total game of Russian roulette.”
When Covid first hit Brazil last February it was, as elsewhere, considered mainly a threat to the ageing or infirm. A year later, as Brazil grapples with by far the most traumatic phase of its epidemic, a troubling trend has emerged, as intensive care units fill with younger patients such as Castro, some seemingly battling more severe forms of the disease. An unusually high number of infant fatalities has also been reported with more than 1,000 Brazilian babies dying last year compared with 43 in the US.
Brazilians have been particularly shocked by the case of Paulo Gustavo, a 42-year-old television star who has spent the past month fighting for his life in a Rio ICU despite being previously fit and healthy. Last week, the Brazilian Association of Intensive Care Medicine said that for the first time, most Covid patients in ICU were under 40 – a finding echoed by frontline doctors.
“We’re seeing a really big increase in young patients,” said Pedro Carvalho, a critical care doctor from the country’s northeast whose hospital’s ICUs have admitted Covid victims aged 27, 28, 29, 32, 33 and 34 in recent days. Two were women who had just given birth. The wife of the 33-year-old patient is expecting their fourth child but he is on dialysis and his chances of survival slim. “It really feels like we’re at the eye of the hurricane and things are just getting worse and more intense,” Carvalho said.
Clarisse Bressan, a tropical medicine specialist working at Rio’s Fiocruz Covid hospital, said she had detected a similar shift in the last three weeks, including a disturbing rise in the number of pregnant women being admitted. “The average age really has gone down. One Friday we had more patients in their 40s than over-80s.”
“The patients seem to be suffering a more drawn-out illness. They deteriorate later – after 12 or 14 days rather than 10 – and I’ve seen young people with more symptoms,” Bressan added. “They don’t necessarily end up with more serious conditions but I’m seeing fewer completely asymptomatic young people than I did at the start of the pandemic.”
The explanation for the generational shift remains unclear, although some suspect a highly transmissible new variant linked to the Brazilian Amazon may be partly to blame. “It’s clearly connected to the P1 variant,” said Marcos Boulos, a infectious disease specialist from the University of São Paulo who believes the virus is now both spreading faster and hitting young people harder.
Boulos said the vaccination of older Brazilians partly explained the increasing proportion of younger patients in ICU. “But there’s no doubt young people are being [physically] more affected by this new variant. It’s unquestionable.”
“Sometimes … these young people will die after just a few hours or days with very acute, severe illnesses – and you won’t find any comorbidity or factor to explain why. It’s dramatic,” added Boulos, pointing to similar suspicions that the South African variant might be affecting the young more.
Bressan suspected behavioural factors were also at play, with younger Brazilians more likely to be frequenting places where they might be exposed to greater doses of the virus, more often. “It’s younger people who are going out to work, to parties, restaurants and nightclubs,” said Bressan, adding that many of the patients she was now seeing in their 40s were domestic workers, cleaners, retail workers and waiters. “People who absolutely have to leave home to work.”
Castro has no idea which variant brought him to the casualty of a hospital on Rio’s northern outskirts last month, with a raging temperature and a respiratory system on the verge of collapse. “My lungs were totally black,” he said, recalling how one doctor told him it was a miracle he had made it there at all. “You should be drowning on dry land,” the doctor said as Castro was rushed into an improvised ICU.
“It’s terrifying,” he said of what he saw inside. “It’s like those war films where you see a warehouse full of wounded people and say, ‘No this is just a scene from a movie – The Walking Dead.’ Only it’s for real. This is what’s happening.”
After a sleepless night, Castro was moved to a specialist Covid unit where he came within a whisker of death. His oxygen levels plummeted and he suffered a series of cardiac arrests, with his heart rate shooting up to 140 beats per minute, then back down to 40.
“I remember feeling something so strange that I’d never felt before. I felt so cold, so much pain. My chest hurt so much. I was coughing so much. Everything hurt. And then suddenly everything just stopped. The feeling I had was that I was going to die. I didn’t feel afraid any more. I didn’t feel pain. I didn’t feel the cold. I stopped feeling everything … it was as if my body had switched off … I felt I was dead.”
More than 66,000 Brazilians lost their lives last month and as many as 100,000 are expected to die in April with their country now the global epicentre of the pandemic. But somehow Castro survived, the inflammation and infection suddenly clearing over the next four days before he was allowed to return to his home in the Chatuba favela.
“Dude, this is a miracle,” Castro remembered his doctor telling him as he was discharged into the arms of his overjoyed wife and 20-month-old son, Arthur. “Your lungs are really badly damaged but you’ve beaten the disease.”
A month later, Castro said he still suffered occasional panic attacks and fatigue and was relearning how to breathe, walk and eat. A childhood friend was also struggling to recover after being taken off a ventilator. She was so weak she was using a walking frame to get around. “We’re talking about someone in her 20s, who exercises, eats well … and doesn’t have any major health problems and now she’s debilitated like a 90-year-old woman.”
Castro, who believes he was infected at a small family gathering, said he hoped telling his story would convince other young Brazilians to take fewer risks.
“Contrary to what they say, this disease is extremely aggressive. It does attack young people,” he said. “Maybe with you it won’t be so aggressive – maybe you’ll feel nothing. But the person next to you – your friend, your dad, your mum, your uncle, your aunt – they might never make it home.”
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