Assessing government responsibility for COVID-19 deaths.

Pedro Hallal describes how Brazil's President Bolsonaro has ridiculed the COVID-19 pandemic, hindered scientists, and implemented unreasonable policies. One point, holding the president's policies accountable for the death of 156 582 people, warrants a closer look. The estimate is based on the premise that Brazil should have COVID-19 death rates equal to the world average. However, there are substantial limitations to that assumption. Many of the countries reporting death rates that are less than the world average have authoritarian governments that typically control and censor information. These governments can under-report cases to avoid unrest.

Furthermore, these countries make use of force, restrictions, and surveillance in a way that is not always viable in democracies in middle-income and high-income countries. The mobility of people in high-income countries might increase the risk of spread. Population risks differ with age distributions, for example in Africa. Comparisons within regions might be more reasonable to establish expectations for a single country. A look at several South American countries reveals that COVID-19 death rates per 100 000 people by Jan 25, 2021, in Peru (120), Argentina (104), Colombia (102), Chile (94), Bolivia (86), and Ecuador (83) do not substantially differ from those in Brazil (102). Even within regions, the comparison of COVID-19 infections and death rates between countries can be limited because of different testing capacities, that have resulted in 10-times differences within South America.

Assessing omissions and delays of specific policy interventions could be a way forward to better understand the links with infection and death rates. The method presented in the Correspondence, to hold a government accountable for a precise number of COVID-19 deaths, needs to be refined and can unduly raise expectations that legal consequences will be faced by the government.