Younger adults are now accounting for a higher share of reported COVID-19 mortality in Brazil [1]. Between November 2020 and March 2021, the proportion of reported COVID-19 deaths among people aged between 30 and 59 rose from 20.3 to 26.9 per cent. This occurred at the same time as a sharp rise in overall reported COVID-19 mortality, from around 500 to around 2,500 deaths a day [1].

Does Brazil’s changing COVID-19 mortality age profile prefigure a more global trend? The Brazilian experience partly reflects the impact of vaccination programmes focussing on people at older ages [2]. Additionally, large numbers of deaths among older Brazilians over the past year may mean those who survive are relatively healthy and therefore more resilient; an effect also seen in other countries [3]. Behavioural factors may have also contributed to Brazil’s surge in deaths at younger ages. As in other countries, there are reports of reduced social distancing by younger adults due to economic necessity and “isolation fatigue” [4]. This was highlighted by the death of a high-profile social media influencer, aged 22, after posting a film celebrating her crowded parties [5]. Concerns have also been raised that older Brazilians are prematurely abandoning social distancing after just one dose of the vaccine [6].

All these effects are not unique to Brazil. More specifically, there is preliminary evidence that case fatality among younger adults for the new Manaus variant is higher than for earlier variants [7]. The rapid spread of the Manaus variant beyond Brazil’s borders is cause for global concern [8].

Though significant, the shifting age profile of COVID-19 mortality in Brazil should not obscure the fact that nearly three-quarters of these deaths still occur among people aged 60 or more. Despite their reduced share of reported COVID-19 mortality, the absolute number of daily COVID-19 deaths for people aged 60 or more has risen from around 400 to over 2,000 over the past four months. The media’s focus on younger people is understandable, but can contribute to an ageist bias in perceptions of the pandemic. This has included some unhelpfully ageist commentaries:

There are fewer wrinkles and less gray hair among patients in Brazil’s intensive care units as the country reels from a surge in Covid-19 that is increasingly hitting people under 60 [9].

Moreover, there is emerging evidence that the risk of COVID-19 mortality for people of all ages, old and young, is significantly higher for disadvantaged groups [10]. COVID-19 is a disease of socio-economic disadvantage, just as much as it is one of later life.

One key lesson emerges from Brazil for the rest of the world. Though important, mass COVID-19 vaccination cannot turn the tide of the pandemic single-handedly, especially when dangerous new variants become prevalent. When this happens, there is no alternative to strict, coordinated measures including lockdowns. Tragically, President Bolsonaro continues to place politics over the lives of his citizens.

REFERENCES

1. Ministério da Saúde. Fiocruz. Boletim Observatório Covid-19. Semanas epidemiológicas 10 e 11. 07 a 20 de março de 2021. https://portal.fiocruz.br/sites/portal.fiocruz.br/files/documentos/boletim_covid_2021-semanas_10-11-red.pdf
2. Noticias R7. São Paulo registra queda de 51% em mortes de idosos por covid-19. 17.3.21 https://noticias.r7.com/sao-paulo/sao-paulo-registra-queda-de-51-em-mortes-de-idosos-por-covid-19-17032021
3. Raleigh, V. UK’s record on pandemic deaths BMJ 2020; 370:m3348.
4. Taylor, L. Covid-19: Brazil’s spiralling crisis is increasingly affecting young people. BMJ 2021;373:n879
5. Al Jazeera. ‘A miracle I survived’: Younger Brazilians hit by COVID surge. 28.3.21. https://www.aljazeera.com/news/2021/3/28/miracle-i-survived-younger-brazilians-hit-covid-surge
6. CNN Brazil. Fiocruz: internação de idosos pode subir com relaxamento após primeira dose. 5.4.21 https://www.cnnbrasil.com.br/saude/2021/04/05/fiocruz-internacao-de-idosos-pode-subir-com-relaxamento-apos-primeira-dose
7. Freitas A, Beckedorff O, Cavalcanti L, et al. The emergence of novel SARS-CoV-2 variant P.1 in Amazonas (Brazil) was temporally associated with a change in the age and gender profile of COVID-19 mortality. Sci ELO; 2021 [preprint] https://preprints.scielo.org/index.php/scielo/preprint/view/2030.
8. BBC News. Covid surge in South America as Brazil variant spreads. 6.4.21 https://www.bbc.co.uk/news/world-latin-america-56648716
9. Bangkok Post. In Brazil, Covid increasingly hitting the young. 20.3.21. https://www.bangkokpost.com/world/2086879/in-brazil-covid-increasingly-hitting-the-young
10. Campos de Lima, E., Gayawan, E., Baptista, A. and Lanza Queiroz, B. Spatial pattern of COVID-19 deaths and infections in small areas of Brazil. PLoS ONE 2021; 16(2):e0246808.