(CNN) For the sixth month in a row, the city of Rio de Janeiro has seen more deaths than births -- a devastating indicator of the nation's unceasing Covid-19 crisis.
Brazil's second most populous city, Rio de Janeiro registered 36,437 deaths in March -- 16% more than the month's 32,060 new births, according to the national Civil Register. It wasn't alone; at least 10 other Brazilian cities with populations over half a million people also registered more deaths than births last month.
Cities across the country have been hit hard by a recent surge in Covid-19 cases and deaths, fueled in part by new variants believed to be extra contagious, as well as some Brazilians' disregard for social distancing precautions. The grim ratio of deaths to births is one more lens onto a national crisis that federal and local officials have largely failed to contain more than a year into the pandemic.
According to Johns Hopkins University statistics, 77,515 people across Brazil have died due to Covid-19 in the past month, and over 2 million new cases have been diagnosed. All but three of Brazil's 27 states and federal district are currently seeing intensive care unit occupancy rates of 80% or more, according to data from state health secretaries.
Brazil's vaccine rollout has been slow, plagued from the outset by internal political bickering and difficulty procuring vaccine doses. Just 6.3 million people -- about 3% of the population -- have been fully vaccinated, according to Brazil's Health Ministry. The same ministry statement said that 21.1 million people have received at least one dose of the vaccine -- but that at least 1.5 million of them are behind schedule for their second shot.
Both the Coronavac and AstraZeneca vaccines, upon which the country depends, require two doses. The Health Ministry has not offered any reasons why some Brazilians have failed to receive their second doses. However local media have raised issues of confusion or misconceptions among the public about the importance of the second dose, and difficulties that low-income Brazilians face in accessing vaccination centers.
As long as the coronavirus circulates uncontrolled, new mutations could emerge, experts say. Existing coronavirus variants in the country are already raising alarm; the P.1 variant first identified in Brazil is driving a rise in cases in neighboring countries, and prompted France this week to suspend flights to and from the country.
Bombastic President Jair Bolsonaro has embraced vaccines, recently approaching Russia for a potential deal over the Sputnik V vaccine. But critics wish he would apply the same urgency to other fronts in the battle against the coronavirus. The President has repeatedly downplayed the danger of Covid-19 -- which he famously once referred to as a "little flu"-- and insists that the country's economic health must be prioritized over lockdown measures.
In public statements last week, Bolsonaro vowed never to accept a national lockdown strategy to contain the coronavirus -- despite calls to do so by the United Nations and the respected Brazilian medical research center Fiocruz. He seemed unmoved by the country's sobering death toll and soaring cases, which he shrugged off as "spilled milk" during an April 7 event in the southern Brazilian city of Foz do Iguacu.
"We are not going to cry over spilled milk. We are still experiencing a pandemic, which in part is being used politically not to defeat the virus, but to try to overthrow the President. We are all responsible for what is happening in Brazil," Bolsonaro said. "Which country in the world did not see deaths? Unfortunately, people die everywhere."