Hospitals in Brazil’s main cities are reaching capacity, health officials have warned, as the country recorded the world’s highest COVID-19 death toll over the past week, triggering tighter restrictions on Thursday in its most populous state.

Intensive care wards for treating COVID-19 patients have reached critical occupancy levels over 90% in 15 of 27 state capitals, according to biomedical center Fiocruz.

In Porto Alegre, the largest city in southern Brazil, there are no free intensive care units (ICUs), and occupancy has also hit 100% in two other state capitals, Fiocruz reported.

The Health Ministry on Wednesday reported a record 2,286 deaths from COVID-19 in the last 24 hours, as new infections rose by 79,876.

With more than 270,000 deaths, Brazil’s pandemic death toll over the past year trails only the United States. But over the past week, Brazil has averaged more than 1,600 deaths per day, ahead of some 1,400 in the United States, where the outbreak has ebbed.

As President Jair Bolsonaro rails against lockdowns and urges Brazilians out of their homes, governors and mayors have struggled to enforce restrictions, often pleading in vain with a population inured to the rising tide of the epidemic.

Brazil’s two most populous cities, Sao Paulo and Rio de Janeiro, on Thursday moved to tighten measures as their hospitals struggled with a second wave of the virus, spurred by a more contagious variant that emerged in the Amazon region.

While Europe and the United States ramp up vaccinations and bring down their caseloads, Brazil’s federal government is off to a slow start, with only 2% of the 210 million Brazilians fully inoculated so far.

In the nation’s capital Brasilia, which is under a nighttime curfew, public hospital ICU wards are 97% full and private ones are at 99%, forcing the city to again set up field hospitals as it had during a peak in cases last year.

On Thursday, Sao Paulo Governor João Doria announced a “new stage” of restrictions to enforce social distancing, arguing it is now the only weapon against the spread of the virus.

They include a curfew from 8:00 p.m. to 5:00 a.m., the suspension of religious services and sports events, including soccer matches, and people not being allowed to use beaches and parks.

“This is a tough, unpopular decision. No governor wants to stop the economic activities in their state,” Doria said in a video.

The state of Sao Paulo, home to some 44 million people, is currently allowing only essential stores such as supermarkets and pharmacies to receive shoppers.

The Sao Paulo health secretary said hospitals in more than half of the state’s municipalities are full. (Reporting by Eduardo Simoes in Sao Paulo and Rodrigo Viga Gaier in Rio de Janeiro; Writing by Jamie McGeever and Anthony Boadle; Editing by Brad Haynes, Bill Berkrot and Jonathan Oatis)

This story has been published from a wire agency feed without modifications to the text.

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