Graves of people who died in the past 30 days fill a new section of the Nossa Senhora Aparecida cemetery in Manaus, Brazil, on May 11, 2020. The new section was opened last month to cope with a sudden surge in deaths.
Felipe Dana—AP

A skeptical president. Millions refusing to socially isolate themselves. An overburdened healthcare system. These are among the factors that are turning Brazil into the next coronavirus epicenter, and perhaps one of the worst affected countries in the world.

Despite implementing social distancing measures nearly two months ago, Brazil’s COVID-19 infection rate is still rising sharply. Researchers from Imperial College London predict there will be 7,790 deaths this week, the second highest in the world after the U.S. The country’s reproduction number or R rate, the average infected by each person with the virus, stands at 2. The U.S. and other major impacted countries have brought their R rates close to 1.

That means the largest nation in Latin America could soon be the world’s biggest hotspot for infections. “My concern is that Brazil is going to be a new epicenter of COVID-19,” Miguel Nicolelis, one of the most respected scientists in Brazil who is coordinating a committee to tackle the virus, tells TIME. “Despite the very serious problems in the U.S., the exponential curve of cases and deaths in Brazil suggests we are not even close to our peak yet.”

Here’s what to know about the severity of Brazil’s coronavirus outbreak:

How many cases has Brazil had?

So far, Brazil has recorded just over 200,000 cases and 14,000 deaths. On Thursday, it announced it had suffered another 844 deaths from the disease. But, according to Nicolelis, the infection rate is likely being underestimated by a factor of 10 to 12, owing to underreporting and a lack of testing. Brazil is “testing 20 times less than the USA, which itself is not testing at the European level,” he says. The University of Washington predicts almost 90,000 will die in just eight of Brazil’s 26 states by early August.

Why are the numbers still rising so sharply?

All Brazilian states implemented some social distancing measures in March, when the spread of the virus was less advanced than it was in Europe. But the slow growth of COVID-19 here over many weeks and the vocal antipathy to isolation measures from President Jair Bolsonaro has led to fewer and fewer Brazilians respecting the restrictions. As of this week, those respecting social isolation ranged from 40% to 55% of people, depending on the state. The country’s large population, concentrated in dense cities, has also helped the virus spread.

“Brazil has everything for a quick spread of the disease,” says Carlos Machado, coordinator of the observatory against COVID-19 at Brazil’s leading epidemiological institute, Fiocruz. “This would not have happened if effective measures had been adopted from the start. Brazil adopted half measures, not as firm as they should have been, which is prolonging the suffering and economic impact. The longer we stay in this intermediate state, the greater the economic cost.”

Attitudes are also a problem, Nicolelis notes. “There is a continuous conflict of message and strategy, and a political conflict, and this is reflected in Brazil’s difficulty in acquiring equipment, such as respirators and tests, and even individual protection material, such as masks,” he says. Brazil’s public health system has carried out 63 tests per 100,000 people – one of the lowest rates in the region. “Brazil has never had a war; has never suffered an attack like this; has never participated in a battle like this. So it is very difficult for Brazilians to understand the seriousness of it.”

How is President Bolsonaro responding to the crisis?

Brazil’s firebrand far-right president has been dismissive from the start of the seriousness of COVID-19, going on walkabouts to greet supporters and saying the virus was just a “little cold.” When Brazil passed the 5,000-death mark, his response began: “So what?” When it passed the 10,000 mark last weekend, he took a widely-publicised jet-ski ride on a Brasília lagoon.

The crisis has also caused serious instability in the federal government. Health Minister Luiz Henrique Mandetta was fired by Bolsonaro after clashes over how to handle the epidemic and popular Justice Minister Sergio Moro quit after claims of political interference. On Friday, Mandetta’s replacement Nelson Teich also resigned after rejecting Bolsonaro’s request to recommend the unproven drug hydroxychloroquine as a treatment.

Throughout, Bolsonaro has been hostile to protective measures adopted by state governors, which have included suspending schools, prohibiting intercity buses, and shutting down shops, bars and beaches – but have generally stopped short of complete lockdowns. Just this week, the president decreed gyms and beauty salons as “essential” businesses that could reopen.

“From the beginning, Brazil did not have a clear strategy and homogeneous message from the federal government,” Nicolelis says. “Even with the previous Health Minister, the message was dubious and ineffective. The aid to states was minimal, and far from adequate.”

Who is opposing Bolsonaro?

Bolsonaro has faced opposition from state governors, mayors, the Supreme Court and his own ministers. João Doria, the governor of São Paulo, and Wilson Witzel, in the state of Rio de Janeiro, imposed strict isolation rules in their states in March and criticised Bolsonaro.

As the crisis has worsened, lockdowns have been introduced in the states of Maranhão, Pará and Ceará. But most governors have shied away from a complete shutdown that would shutter industry and create the potential for social disorder in a country where nearly half the workforce lives hand-to-mouth, earning a few hundred dollars a month from the informal sector.

How is the Brazilian healthcare system handling it?

Not well. Brazil is ostensibly well-equipped to manage a national outbreak. It has 21 ICU beds for every 100,000 people, about double the proportion of such beds in Italy, France and Spain. But they are not evenly distributed geographically, or between the public and private sectors. In practice, corruption and inefficiency, as well as Bolsonaro, have slowed down an effective response. Eleven states are investigating the possibility that millions in funds intended for medical equipment were improperly diverted.

And so the system is quickly becoming overwhelmed. Eight state capitals have ICU occupancy of more than 90%, and in Rio there are more than a thousand people waiting for hospital beds. Of three emergency hospitals set up in the city to cope with the crisis, only three are operational. Brazil has already surpassed the U.S. in the number of healthcare workers who have died. If cases continue rising at the current rate, the healthcare system is expected to collapse imminently.

What’s the impact on Brazil’s economy?

The IMF predicts a 5.3% contraction in Brazil’s economy in 2020. The number of cars produced in the country has fallen to its lowest level since 1957. Unemployment is expected to hit at least 17%. The expectation is the country may only return from the crisis at the start of 2022. There is the risk of political instability, too, with dozens of impeachment petitions filed against Bolsonaro.

“The recovery is going to be very slow without state action,” says Laura Carvalho, a professor at the School of Economics at the University of São Paulo. The verve with which Bolsonaro’s Finance Minister Paulo Guedes would like to cut public spending may not suit the moment, she adds. The insistence on a reform agenda that is aimed at reducing the size of the state is far from an agenda for recovery.”

Brazil had barely recovered from the severe political and economic crises that hit most strongly in 2015 and 2016, before being floored again by the coronavirus. “When public health emergencies overlap with extremely precarious political and economic crises, it can create a humanitarian crisis,” says Machado. “Brazil is heading there.”

How are the most vulnerable Brazilians coping?

They are among the worst affected communities. When the virus first arrived in Brazil, it mainly hit rich areas of major cities. But over time it has spread rapidly in major favelas and to rural areas that lack necessary healthcare services. The three most affected municipalities are all remote communities in the Amazon rainforest. There, indigenous tribes with a lack of immunity are particularly vulnerable.

Brazil is at least giving financial support, despite Bolsonaro’s reluctance. The country is making monthly emergency payments of just over $100 each to 80 million poor informal workers, costing the government $26.6 billion until June. Queues have gathered outside state bank branches, waiting overnight for the payment.

“We have all the elements that made the crisis very serious in other countries and we added to that structural inequalities in income, health, access to sanitation, housing, and so on,” Carvalho says. “We were caught by this shock in a very fragile [economic] situation, especially at the base of the pyramid, which does not have a ‘protective mattress,’ … These lines of people in front of banks greatly impairs the control of the spread of the virus.”

Contact us at letters@time.com.

Read More From TIME

Related Stories

EDIT POST