This month should have been one of the happiest in Letícia Aparecida Gomes’s life. The pregnant 23-year-old Brazilian had been due to marry before delivering her baby, Elloah, in August.
Instead, as the Covid-19 pandemic swept Gomes’s country claiming thousands of lives each day, she was taken to hospital having been infected herself.
“I felt desperate when I realised it was serious because this is my first pregnancy, my first daughter,” said Gomes, a nursing technician from Maricá, a coastal city an hour’s drive east of Rio de Janeiro.
Gomes was lucky. After an agonising week in intensive care, she was discharged and is now recovering at home and preparing to welcome her child.
Others have been far less fortunate. At least 803 pregnant and postpartum women have died from Covid-19 since the pandemic hit Brazil last February, according to a Brazilian taskforce that is studying Covid’s impact on pregnancy. More than half of those deaths, 432, happened this year as Brazil’s pandemic accelerated into by far its deadliest phase.
In recent weeks Brazilian newspapers have filled with heartbreaking stories of young mothers killed by the disease including another 23-year-old, Maria Laura Prucoli, who died on Rio’s deprived outskirts last week after her daughter, Lavínia, was delivered by emergency C-section. On 3 April, three days before Gomes was admitted to hospital, a 20-year-old woman who was seven months pregnant died in the midwestern state of Mato Grosso after waiting four days for an intensive care bed.
Concern over the risk Covid poses to pregnant and postpartum women has been expressed around the world, including in the UK where doctors have reported an increase in intensive care admissions and the use of ventilators during the second wave.
But experts and activists say the situation in Brazil is particularly alarming, with authorities recently urging women to delay having children until the country’s outbreak loses steam.
“We are facing a calamity of maternal deaths here,” said Carla Andreucci, a Brazilian obstetrician and member of the pregnancy taskforce.
“There are women dying without finding an ICU bed, without being offered ventilation, without being intubated … It’s like we’re just standing by and watching this happen.”
Last July Andreucci’s group published a study suggesting 77.5% of the world’s Covid-related maternal deaths had occurred in the South American country, although they noted that some low-income countries did not release such data.
Specialists say a range of factors help explain the high number of pregnant women falling severely ill and losing their lives to Covid in Brazil. They include the way in which the pandemic-induced healthcare collapse deepened historically high rates of maternal deaths. Inadequate access to prenatal care and family planning are longstanding challenges of Brazil’s public health system, with the country suffering rates of maternal deaths more than three times the average of OECD countries even before the pandemic.
Some suspect new forms of coronavirus, such as the P1 variant linked to the Brazilian Amazon, may also be partly responsible although there is still no concrete evidence of this.
“We don’t have genetic tests but we believe the outbreak of P1 in January played a role in this catastrophe,” Andreucci said, noting that the profile of victims had changed in recent months. Last year, most victims were non-white women from poor areas with risk factors such as diabetes, obesity and cardiovascular disease. This year, white women with no risk factors have been dying as well.
Letícia Gomes had been enjoying a healthy pregnancy until she started experiencing coughing fits, tiredness and a temperature in late March and her oxygen levels fell to a worrying 83%. She suspects she was infected making the 20-minute bus journey from her house to the nursing home where she works.
During her first night in hospital, Gomes remembered sharing a room with eight other patients: “It was nerve-racking because you saw people in need of oxygen, people dying in front of you, doctors having to choose who had priority.”
The next day Gomes was transferred to a specialist unit for pregnant women with Covid at the State Public Servants Hospital in Rio. There, doctors reassured her the illness had not affected her child. “They made me listen to my baby’s heart, so I knew she was fine,” said Gomes, who recalled feeling overjoyed when she called home with news of her discharge over a week in the ICU.
“Everyone was surprised and cried. I cried too,” Gomes said. Her wedding will finally happen on 21 May.
A domestic outcry over the plight of Brazilian pregnant and postpartum women saw the health ministry this week include them in the priority vaccination group. So far, however, fewer than 10% of Brazilians have received two doses meaning most pregnant women will face a long wait.
In the meantime, the leftist congresswoman Sâmia Bomfim, who is seven months pregnant with her first child, is proposing new legislation that would allow expectant mothers to work from home during the pandemic. “I am able to socially isolate and work from home, but the majority of pregnant women in Brazil don’t have this privilege”, Bomfim said. A total of 8.5 million Brazilian women have left the workforce since the epidemic began last February.
Raíssa Perlingeiro, an infectious disease specialist at the Covid centre in Rio, said that over the past three months, as Brazil’s outbreak intensified, her unit had become busier and their shifts more demanding. Patients were arriving with more serious conditions than before.
“It is very tough work and it’s very hard to watch women go through this – particularly because I’m seven months pregnant myself,” Perlingeiro said.
The 32-year-old doctor said she had decided to continue working at the unit after being vaccinated as part of a campaign to protect frontline healthworkers. “I couldn’t be away from work at such a difficult time, the team is already small,” Perlingeiro said. “I had to do my part.”