Sao Paulo/Brasilia — As Brazil’s accelerating caseload propels it into the second-worst coronavirus hotspot, one of the most alarming aspects is the epidemic’s path: spreading into areas so poor they lack not only intensive care units but often clean water.

Restricted at first to Brazil’s rich neighbourhoods and capitals in close contact with international travellers, the virus has migrated inland and to states such as Maranhao, where 20% of the population live in extreme poverty and most workers have unregulated jobs...

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