COVID-19 in Brazil: "So what?"

The coronavirus disease 2019 (COVID-19) pandemic reached Latin America later than other continents. The first case recorded in Brazil was on Feb 25, 2020. But now, Brazil has the most cases and deaths in Latin America (105 222 cases and 7288 deaths as of May 4), and these are probably substantial underestimates. Even more worryingly, the doubling of the rate of deaths is estimated at only 5 days and a recent study by Imperial College (London, UK), which analysed the active transmission rate of COVID-19 in 48 countries, showed that Brazil is the country with the highest rate of transmission (R0 of 2·81). Large cities such as São Paulo and Rio de Janeiro are the main hotspots now but there are concerns and early signs that infections are moving inland into smaller cities with inadequate provisions of intensive care beds and ventilators. Yet, perhaps the biggest threat to Brazil's COVID-19 response is its president, Jair Bolsonaro.

When asked by journalists last week about the rapidly increasing numbers of COVID-19 cases, he responded: “So what? What do you want me to do?” He not only continues to sow confusion by openly flouting and discouraging the sensible measures of physical distancing and lockdown brought in by state governors and city mayors but has also lost two important and influential ministers in the past 3 weeks. First, on April 16, Luiz Henrique Mandetta, the respected and well liked Health Minister, was sacked after a television interview, in which he strongly criticised Bolsonaro's actions and called for unity, or else risk leaving the 210 million Brazilians utterly confused. Then on April 24, following the removal of the head of Brazil's federal police by Bolsonaro, Justice Minister Sérgio Moro, one of the most powerful figures of the right-wing government and appointed by Bolsonaro to combat corruption, announced his resignation. Such disarray at the heart of the administration is a deadly distraction in the middle of a public health emergency and is also a stark sign that Brazil's leadership has lost its moral compass, if it ever had one.

Even without the vacuum of political actions at federal level, Brazil would have a difficult time to combat COVID-19. About 13 million Brazilians live in favelas, often with more than three people per room and little access to clean water. Physical distancing and hygiene recommendations are near impossible to follow in these environments—many favelas have organised themselves to implement measures as best as possible. Brazil has a large informal employment sector with many sources of income no longer an option. The Indigenous population has been under severe threat even before the COVID-19 outbreak because the government has been ignoring or even encouraging illegal mining and logging in the Amazon rainforest. These loggers and miners now risk bringing COVID-19 to remote populations. An open letter on May 3 by a global coalition of artists, celebrities, scientists, and intellectuals, organised by the Brazilian photojournalist Sebastião Salgado, warns of an impending genocide.

What are the health and science community and civil society doing in a country known for its activism and outspoken opposition to injustice and inequity and with health as a constitutional right? Many scientific organisations, such as the Brazilian Academy of Sciences and ABRASCO, have long-opposed Bolsonaro because of severe cuts in the science budget and a more general demolition of social security and public services. In the context of COVID-19, many organisations have launched manifestos aimed at the public—such as Pact for Life and Brazil—and written statements and pleas to government officials calling for unity and joined up solutions. Pot-banging from balconies as protest during presidential announcements happens frequently. There is much research going on, from basic science to epidemiology, and there is rapid production of personal protective equipment, respirators, and testing kits.

These are hopeful actions. Yet, leadership at the highest level of government is crucial in quickly averting the worst outcome of this pandemic, as is evident from other countries. In our 2009 Brazil Series, the authors concluded: “The challenge is ultimately political, requiring continuous engagement by Brazilian society as a whole to secure the right to health for all Brazilian people.” Brazil as a country must come together to give a clear answer to the “So what?” by its President. He needs to drastically change course or must be the next to go.