Emerson Barata draws a circular map of Sao Paulo’s largest slum, Paraisopolis, and begins to mark confirmed coronavirus cases in blue ink. At the center of the favela of around 120,000 people, which crowds between luxury apartment blocks and high-walled mansions, he draws four dots.

Medical personnel walk through the city's biggest slum Paraisopolis after residents have hired a round-the-clock private medical service, in Sao Paulo, Brazil March 30, 2020. REUTERS/Amanda Perobelli

“It’s going to get a lot worse,” the 34-year-old tells an assembled medical team, adding another two dots to the favela’s outer districts. “The surge hasn’t hit yet.”

Barata is leading the coronavirus response in this labyrinth of red cinder block homes where, beyond the six confirmed cases, his team suspects another 60.

He is not connected to the Brazilian state, and nor is the medical team around him. The former minor league soccer pro is part of an association of Paraisopolis residents whose deep distrust of government has led them to take things into their own hands.

The residents’ association has hired a round-the-clock private medical service including three ambulances, two doctors, and two nurses, as well as drivers and support staff. While President Jair Bolsonaro has dismissed the virus as “a little flu” and told Brazilians to get back to work, Barata is sleep-deprived trying to get his favela ready for what he describes as a “war.”

Barata declined to say how much this would cost or how it was being funded, beyond saying some was covered by donations. Much of it still needs to be raised, he said. The medical team is on an initial 30-day contract, likely to be extended.

“Favelas are going to be hit the worst,” he said, standing in a parking lot outside a mechanic’s workshop that doubles as a base for the medical team. “The places that are already neglected by the state will be neglected even more.”

Public health experts agree. The packed living conditions, poor sanitation, lack of healthcare and flouting of lockdown measures make Brazil’s slums – home to around 11 million people or 6% of the population – particularly vulnerable to the virus.

Paraisopolis is likely to be on the front line. Many of its residents work in the nearby wealthy neighborhood of Morumbi, ground zero for the outbreak in Brazil. Across Latin America, many of the first cases were diagnosed in those affluent enough to travel abroad, but the virus is expected to hit the poorest hardest.

Brazil is Latin America’s worst affected nation by the coronavirus so far, with nearly 7,000 confirmed cases and 240 deaths.

The Paraisopolis residents who have tested positive include two who work in the nearby Albert Einstein Hospital, a private medical facility that diagnosed the first case in Latin America. Another was a live-in nanny.

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Celia Parnes, the Secretary of Social Development for the state of Sao Paulo, said the government was concerned about the “speed of contagion in the favelas” and was working to assist poor neighborhoods like Paraisopolis with subsidized meals and debt relief.

She said public healthcare in Paraisopolis was no different to the rest of the city, saying ambulances do reach the favela and talk of an absence of the state “was a major exaggeration.”

But she complimented the work of the residents’ association. “I recognize it and tip my cap,” she said.

City Hall, in an emailed statement, said it handed out free food and essentials to residents of Paraisopolis, as well as driving cars with loud speakers pronouncing the importance of washing hands and staying indoors.

Sao Paulo’s water and sanitation firm said it was distributing 2,400 water tanks to poor neighborhoods, including Paraisopolis, to help during the health crisis.

CLOSE QUARTERS

The population density in Paraisopolis is about the same as Manhattan, although most buildings are just two or three stories tall. Residents complain the water runs dry after 8 p.m. and rubbish piles up along the tight, damp alleyways that weave through the community.

De facto authority here lies with the First Capital Command, Brazil’s largest and most powerful gang, known by its Portuguese acronym PCC.

A member of the medical team said their work had the gang’s blessing. Reuters was not immediately able to contact any of the gang’s local leaders.

“I think it’s going to get ugly... This is a ‘little flu’ that kills,” said Luiz Carlos, a short, gray-haired doctor who is part of the hired medical team.

Roberto de Souza, 41, believes he caught the virus through his job in a pharmacy - despite wearing disposable gloves and a facemask when serving customers. He developed terrible pain in his legs and a constant cough soon followed.

After testing positive he isolated himself in a cramped second-floor flat in Paraisopolis.

“What hurts the most is being locked away, alone,” he said through a facemask, in between coughing fits. “I have to worry, not just about myself but about not giving it to the next person.”

De Souza lives by himself. In Paraisopolis that puts him in the minority.

Reuters visited one cramped home where a woman was self-isolating, sick with coronavirus symptoms. But her three children, mother and brother had nowhere else to go, so continued to live with her.

To address that challenge, the residents’ association is looking to use two local schools – closed due to the outbreak - to house up to 500 suspected and confirmed cases without life-threatening symptoms, removing them from tight living quarters.

Despite all the preparations, Barata is worried residents are not taking the threat seriously enough. Unlike in the rest of Sao Paulo, where a lockdown is in place, most bars and shops remain open in Paraisopolis. The streets bustle. Parties pound.

Barata fears many will change their attitude only once a parent or a friend dies. By then it might be too late.

“We’re trying to get the message out: This is no joke,” he said.