Frederic Lima arrived at the already overwhelmed Emilio Ribas hospital in Sao Paulo with coronavirus symptoms. Less than 12 hours later a doctor told the 32-year-old's aunt: "We did everything possible."
It's become an all too familiar sight for Dr Fernanda Gulinelli, who treated Lima.
She signs as many death certificates as release forms in the intensive care unit (ICU) at Emilio Ribas, the state's first public hospital to be pushed to breaking point by the coronavirus.
In Brazil there have been more than 3,300 deaths from COVID-19, with hardest-hit Sao Paulo state home to one-third of the country's cases.
"Usually we have more discharges than deaths outside of the pandemic, but with the seriousness of these patients we have days with more deaths than discharges," said Gulinelli.
Brazil still hasn't reached the apex of its outbreak, which the health ministry predicts will not occur until May.
Apart from a 22-year-old suffering from tuberculosis, all the patients at the Emilio Ribas ICU, aged from 37 to 66, are either confirmed or suspected cases of COVID-19, said Jaques Sztajnbok, a medical supervisor at the unit.
The 54-year-old says that this disease is different from any other he's come across in his 28 years at Emilio Ribas.
Now "we always have 100 percent occupancy because when one person leaves there are 100 requests" to come in, said Sztajnbok.
Beds only become available when an existing patient either recovers, or dies.
For Sztajnbok, what's different about COVID-19 is "the huge number of cases" and that it's "a very serious disease that affects various organs and requires weeks of intensive care."
The problem is that "you need to maintain the capacity to treat the five percent (of cases) that according to statistics need intensive care. No country has that many intensive care beds and Brazil is no exception," he said.
'We did everything'
After he was admitted, Lima was put on a ventilator but doctors couldn't increase his oxygen levels. Even after one hour of CPR they were unable to revive him.
"You question whether you really did everything. I know we did everything but it affects you a lot. Since he stopped (breathing) I've felt like I was run over," said Gulinelli.
Lima was a doctor himself, originally from the north, working in the ICU of another public hospital.
He lived alone and started feeling symptoms last week but didn't tell his aunt Rosa da Rocha, one of his few family members in Sao Paulo.
"I don't know why he didn't say anything, maybe because he was young. He didn't have any health problems, he exercised, he was young, he had his whole life in front of him," said Da Rocha minutes after receiving the bad news.
Lima had been taken to the ICU as soon as he arrived at hospital. Luckily, there was a spare bed.
Dr Luciana Borges, the accident and emergency supervisor at Emilio Ribas, said the public hospital already had a shortage of beds before the coronavirus outbreak exponentially increased demand.
Half the patients that arrive at the emergency care unit need hospital treatment, she added.
In the Emilio Ribas, where AFP was granted access, medical professionals are feeling the strain and their numbers are dropping because of the disease.
Of the 22 doctors that work there, two had to be isolated because they were among the most vulnerable population.
One doctor has contracted the disease and a second is showing symptoms.
For Gulinelli, this "is a new chapter in medicine that we're having to write on the go, and we don't know what the next sentence will be."
by Paula Ramon, Agence France-Presse
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