The impact of coronavirus in Brazil: politics and the pandemic.

Since COVID-19 was first reported in Brazil in February 2020, the country has quickly become one of the worst affected globally. Brazil comprises many states with vulnerable communities, an emerging economy and a relatively weak social protection system. These issues make it difficult for local authorities to persuade people to stay at home. Moreover, President Bolsonaro has often minimized the severity of the pandemic, repeating mantras such as “just a little flu”, “only the elderly are at risk”, the “economy must come first” and “social isolation is an extreme measure”. I believe that the contradiction between local leaders begging people to stay at home and the president telling them to return to work has fuelled widespread confusion.

By early April, the virus began spreading into the favelas of São Paulo and Rio de Janeiro, and the patient profile changed. People younger than 50 years have been hospitalized and have died at higher rates than in Europe, China and the USA, suggesting that extreme inequality and poverty increase vulnerability to the disease. In countries with few resources, people who might have survived elsewhere are dying of COVID-19.

André Luís Balbi

extreme inequality and poverty increase vulnerability to the disease

Brazil’s health system is now on the brink of collapse; >1,500,000 cases of COVID-19 and >60,000 deaths have been reported, but these numbers are undoubtedly underestimates. Brazil has a population of 200 million and has run only ~14,000 tests for every 1,000,000 people. Hospitals in São Paulo, Manaus, Belém, Salvador and Rio de Janeiro have denounced a lack of essential supplies and an increase in prices. The cost of a box of masks rose from R$4.50 in January to R$140 by March; the federal government did not prevent this huge increase and seemingly did not negotiate with industry to meet the increased demand.

I am appalled that politics seems to have been prioritized over the pandemic in the past few months. While Brazil’s mayors and state governors implemented measures to restrict the movement of people and combat the coronavirus, Bolsonaro appeared to focus on political battles. He has already lost two health ministers who were physicians: one was fired and the other resigned. In their place he appointed Eduardo Pazuello, a general with no medical background, as interim health minister. Although lockdowns have been only partly implemented, the Brazilian economy is projected to shrink by 5% in 2020. In my opinion, Bolsonaro does not want to be held responsible for the worst economic crisis in the history of Brazil and sees prioritizing the economy as his best chance for re-election. Perhaps the impact of the Brazilian pandemic would have been less severe if states, cities and the federal government had implemented integrated health, communication and economic action plans.

The hospital where I work, the Clinical Hospital of Botucatu Medical School, São Paulo, strategically planned the fight against coronavirus in partnership with local leaders. We prepared for the worst possible scenario — a ‘hurricane’ of cases — by cancelling elective procedures, expanding the intensive care unit (ICU) and acquiring equipment and supplies. Laboratory personnel were trained in virus testing, and extensive testing and contact tracing was implemented. The mayor of Botucatu and the governor of São Paulo implemented social isolation and closed schools and malls. The ‘rain’ came in March and remains constant. We have treated hundreds of patients but have not yet encountered a ‘hurricane’ and our ICU has enough beds and supplies. After 14 weeks we are physically tired and emotionally exhausted, but we are working together and confident that we can cope with an influx of patients.

We must fight for health as well as the economy or both will suffer

In the past few weeks, the São Paulo state governor and local leaders have decided to reopen the country. I do not think that this is a good decision. More than 1,000 people are dying every day and the virus has migrated from capitals to the countryside. If the virus is not well controlled, lifting restrictions will result in an increase in the number of cases. We must fight for health as well as the economy or both will suffer. Nobody knows the future of the pandemic in Brazil but most agree that the real picture is worse than official data suggest.