By Gram Slattery, Stephen Eisenhammer and Amanda Perobelli
RIO DE JANEIRO/SAO PAULO (Reuters) - Imported by the Brazilian elite vacationing in Europe, the new coronavirus is now ravaging the country's poor, ripping through tightly-packed neighbourhoods where the disease is harder to control.
Public health data analysed by Reuters for the cities of Sao Paulo, Rio de Janeiro and Fortaleza show a shift in recent weeks from the wealthy boroughs that seeded the outbreak to the gritty urban outskirts.
The change has coincided with a spike in confirmed coronavirus deaths, which are now just shy of 6,000 in Brazil. Many scientists point to Latin America's largest country as the next deadly hotspot for COVID-19.
Researchers at Imperial College London estimate Brazil's transmission rate this week will have been the highest in the world.
The trend revealed by the data complicates Brazil's battle against the virus. Many favelas, as the labyrinths of cinder block homes that constitute the poorest neighbourhoods are known, suffer from a lack of running water, septic systems and healthcare facilities.
Perhaps more challenging still, the state is weak in the favelas, with drug gangs often the de facto authority. That would make lockdown measures difficult to enforce - even if they had the support of the country's skeptical leader, President Jair Bolsonaro, who has repeatedly shrugged off fears about the coronavirus and described state and city measures to slow its spread as extreme.
Residents in Brasilandia, a poor district at the north end of Sao Paulo with the highest coronavirus death toll in the city, told Reuters that bars were still crowded and open-air dance parties attracted thousands of revellers on the weekends.
Brasilandia only had one confirmed case at the end of March, according to city data, at a time when the vast majority of cases were clustered in the wealthier center-west districts. The most recent report from this week showed 67 deaths from COVID-19.
"For those that haven't been through it, it's like the disease doesn't exist," said Paulo dos Santos, 43, who lost his father to the virus in Brasilandia.
In Rio, the tony neighbourhoods of Leblon, Copacabana and Barra da Tijuca were the first to suffer at the start of the outbreak in Brazil, reporting 190 confirmed cases by March 27.
In contrast, the low-income areas of Campo Grande, Bangu and Iraja had only reported eight cases at the time.
That has changed in the past week, with those poorer neighbourhoods reporting 66 new cases, while the wealthier trio saw 55. Reuters observed the same trend in Fortaleza, a northeastern state capital with over 25,000 cases.
Despite the rising death toll, calls are growing for lockdown measures to be relaxed. Bolsonaro has pushed to restart the economy, describing shelter-in-place policies as a "poison" that could kill more via unemployment and hunger than the virus.
In poor neighbourhoods, where hunger is an acute threat, few are adhering to quarantine measures.
William de Oliveira, a community leader in Rio's poor hillside neighbourhood of Rocinha, can rattle off the names of several friends killed by the virus. Yet it was clear on Wednesday that life continued more or less as usual, with shops and bars bustling, which he lamented.
"We can reverse economic problems," Oliveira said, "but we can't reverse deaths."
The number of cases in poorer areas is probably far higher than reported, due to a lack of testing, said Keny Colares, an epidemiologist at Fortaleza's Sao Jose hospital. Some low-income patients, he said, were showing up at hospitals days after they should have sought medical attention.
Poor Brazilians are also more likely to die if infected, due to higher levels of pre-existing conditions and less access to healthcare.
In Leblon, for example, just 2.4% of confirmed cases have resulted in deaths - roughly in line with global trends and suggesting a relatively accurate picture of infection numbers. In Iraja, the death rate is 16%. In Sao Paulo's Brasilandia, it is a staggering 52%.
Hugo Simon, head of the adult intensive care unit at Campo Grande's Rocha Faria City Hospital, said the public health service was at its limit. His hospital has had to start treating COVID-19 cases because there is no longer space at hospitals originally designated to deal with those patients.
Campo Grande's COVID-19 caseload is now among the biggest in Rio, at 146. Two adjacent low-income communities, Realengo and Bangu, are also in the top ten worst hit of Rio's 160 official districts.
"This really started in Rio's Southern Zone, and has come to my area after," Simon said, referring to the city's wealthiest area. "We're heading towards maximum capacity."
(Reporting by Gram Slattery in Rio de Janeiro, Stephen Eisenhammer and Amanda Perobelli in Sao Paulo; Additional reporting by Ricardo Morães in Rio de Janeiro; Editing by Brad Haynes and Rosalba O'Brien)