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Covid-19: Brazil’s president rallies supporters against social distancing

BMJ 2020; 369 doi: https://doi.org/10.1136/bmj.m1589 (Published 21 April 2020) Cite this as: BMJ 2020;369:m1589

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  1. Owen Dyer
  1. Montreal

Brazil’s president, Jair Bolsonaro, has fired his popular health minister, Luiz Henrique Mandetta, after weeks of conflicting messages from the two men about the risks associated with the covid-19 pandemic and what should be done about them.

Mandetta has supported state governors, most of whom have closed non-essential businesses and urged citizens to stay indoors, while Bolsonaro has argued that “the real problem is hysteria” and urged Brazilians to continue life as normal while making a point of greeting crowds of supporters and shaking hands.

Bolsonaro, who had earlier told an interviewer that Mandetta “lacked humility” and said that he would fire officials who were “full of themselves,” replaced Mandetta with the oncologist and entrepreneur Nelson Teich.

A recent poll showed 76% support for Mandetta’s handling of the crisis, while only 39% backed Bolsonaro’s approach.

In Brazil’s cities, residents angry at Mandetta’s sacking emerged onto their balconies banging pots and pans. Such anti-Bolsonaro demonstrations, called panelaços, are often heard at 8.30 pm since the pandemic reached Brazil.

At a press conference with Bolsonaro on 17 April, Teich said that his ideas were aligned with those of the president, while he also promised a technocratic approach with no radical changes from current policy. The new minister wrote in support of social distancing measures in his personal blog on 3 April.1

Bolsonaro’s popularity has fallen amid widespread ridicule of his comments on covid-19, which he has called a “little cold” and a “media trick.” He claimed that Brazilians were resistant to infection and could “dive in sewage” without catching anything.

Like his US counterpart Donald Trump, Bolsonaro has hyped the unproved antimalarial drug chloroquine. Both men this weekend offered their backing to street demonstrations against social distancing measures. Both presidents are at loggerheads with state governors who make the key decisions on public health measures, though Bolsonaro’s isolation is more acute, with 25 of 26 governors effectively allying against his stance.

Bolsonaro’s campaign has led to supporters blocking traffic in several cities this weekend, and reporters have described shops reopening after his speeches. Only 53% of Brazilian city dwellers stayed home in early April, one survey found, a small decline from March.2

Fear is growing that the nation of 210 million is especially exposed to the pandemic. It combines a relatively high median age (31.4, whereas it is 26.8 in India and 19.7 across Africa) with a weak health system, crowded favelas, and extreme poverty. The shortage of doctors serving poor Brazilian districts became more acute in 2018, when Cuba pulled 8300 doctors from the country after Bolsonaro said he would not recognise their qualifications.

The country’s official covid-19 caseload is 39 144, with 2484 deaths recorded, but Mandetta has called this an undercount, as it was based on only 62 000 tests performed so far. Rio state’s health secretary, Edmar Santos, said that for every case reported there were probably another 50 to 100 infected people who have not been tested.

More than 41 000 Brazilians were admitted to hospital last week for respiratory symptoms, of whom only 15% had formal covid-19 diagnoses. In March Brazil registered 2239 more deaths from respiratory failure and pneumonia than it did in March 2019.3 The pandemic has already reached inaccessible parts of the Amazon basin, where case numbers are unknown.

Drauzio Varella, an oncologist who is a frequent commentator in Brazilian media, told BBC News Brazil on 20 April that he regretted his early “optimism” about covid-19, which he said will produce a “national tragedy.”

“Now we are going to pay the price for this social inequality that we have lived with for decades, accepting it as something natural. Now comes the bill to pay,” he said. “As long as we have this spread in places unfit for human habitation, you don’t get rid of the virus.”

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