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:m1589Read our latest coverage of the coronavirus pandemic
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Dear Editor
Read with great interest the story about Brazilian President Bolsonaro. Like US President Trump he too seems to have dared to a stand against the opinion of WHO and worlds’ expert epidemiologist challenging the contagion, risking lives of millions of his countrymen. Result is the death of more than 10000 citizens and more than 147261 fallen prey to the virus. What interests me much more as a doctor, is president’s favoritism for chloroquine for Covid.
A study from Brazil used very high doses of Chloroquine 600mg twice a day for 10 days to sick and elderly suffering from Covid 19. Lethal dose of chloroquine base in adults is about 5g. Elderly population is particularly prone to chloroquine toxicity especially at high doses. To my utter shock semiconscious and sick were given the drug by naso-gastric tube. We in India having good experience of using the drug would refrain from using such high doses. Results of the study also showed higher mortality in the elderly receiving supra therapeutic doses of chloroquine.
It can be argued that Brazilian President might not have directly influenced the study, but his over enthusiastic statements must have certainly fueled the zeal of investigators for an experiment to steal the show. World leaders must show restraint and set an example by following the experts rather than airing their whims and fancies about things they know little.
References:
1. Effect of High vs Low Doses of Chloroquine Diphosphate as Adjunctive Therapy for Patients Hospitalized With Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection A Randomized Clinical Trial Mayla Gabriela Silva Borba, MD; Fernando Fonseca Almeida Val, PhD; Vanderson Souza Sampaio, PhD; et al
JAMA Netw Open. 2020;3(4):e208857. doi:10.1001/jamanetworkopen.2020.8857
2. Gao J, Tian Z, Yang X. Breakthrough: chloroquine phosphate has shown apparent efficacy in treatment of COVID-19 associated pneumonia in clinical studies. Bioscience Trends 2020; 14:72–3
3. COVID-19: a recommendation to examine the effect of hydroxychloroquine in preventing infection and progression Dan Zhou, Sheng-Ming Dai and Qiang Tong J Antimicrob Chemother doi:10.1093/jac/dkaa114
Competing interests: No competing interests
Re: Covid-19: Brazil’s president rallies supporters against social distancing
Dear Editor,
Similar Approach of two Presidents but different outcomes for two Nations - Covid 19
With great interest we read your articles about US President Donald Trump and the similar stand taken by Brazilian President Jair Bolsonaro (1,2).
Both of them allegedly seemed to try to use the pandemic for political gains. Bolsonaro sacked his health minster supporting lockdown and in the US President Trump urged his supporters to “liberate” Michigan, Minnesota and Virginia — states with Democratic governors (3). Both the political leaders overtly or covertly supported anti-lockdown measures, Bolsonaro Govt supporting “Brazil cannot stop campaign” (4) and Trump defending protesters demonstrating against the lockdown stating, “These are great people. They've got cabin fever. They want to get back. They want their life back. Their life was taken away from them.” Both of them share the reputation of touting unpublished medical information, Bolsonaro proposing Chloroquine and Trump Hydroxychloroquine.
In this state of confusion both the countries are steering through the pandemic of corona, but their journey has not met the same fate. The US corona count has exceeded 1 309 550 as of 9th May 2020 while Brazil is struggling with 156 061 cases. The Covid count in USA is still far higher than Brazil even if one offsets the difference in population demographics. Covid 19 Death rate per million population in Brazil remains at 50.87 in comparison to USA where it has soared to more than 240 per million. And this is despite US per capita health Expenditure being nearly 26 .47 times more than Brazil in previous years. The US Govt health expenditure of nearly 40% of its Budget has not been able to grant new lease of life to its citizens against a novel Virus (5).
These figures compel one to think of other factors controlling the spread of disease and mortality. Population demographics might be one important factor, larger number of people in USA being in the age group of 60 year plus are likely to be vulnerable to severe disease explaining the high mortality (6). But incidence of disease and number of cases seem to be governed by other characteristics as well.
Immunity of population may be one such important factor. Observational data supporting the hypothesis of BCG vaccination or latent tuberculosis infection boosting immunity of the population may be a factor worth investigation. As per WHO figures, the Incidence of Tuberculosis in Brazil is nearly 10 times that of the United States. Also, there is continued practice of universal BCG vaccination in Brazil (7) while the same was withheld in United States a long while back (8). BCG vaccination being a live attenuated vaccine has been shown to reduce viremia in certain conditions like Yellow Fever vaccine viremia in volunteers and Mengovirus Viremia in animal studies. BCG probable acts by inducing some genetic changes increasing the innate immunity against subsequent infections. If the covid is less severe in those who received BCG vaccine might be a question of debate but above observations definitely give credence to the hypothesis (9).
Geographic location of the countries too could also affect the statistics of disease. Incidence as well as mortality of Covid 19 has been observed to be much more in the Northern hemisphere and much less near the equator in Southern Hemisphere, suggesting the effect of temperature, humidity and climatic conditions on survival and propagation of the virus.
World Political leaders may like to follow their counterparts in unprecedented situations like pandemic but requirements of the diverse nations would be different and so will be the outcome, therefore individual nations need to draw their own strategy based on expert advice and circumstances valuing the human life above political aspirations and economic considerations.
References:
1. https://www.bmj.com/content/369/bmj.m1589
2. https://doi.org/10.1136/bmj.m1643
3. https://www.ft.com/content/c8f6f413-39c4-47ce-b1ff-0e02969cb612
4. https://theconversation.com/brazil-jair-bolsonaros-strategy-of-chaos-hin...
5. https://countryeconomy.com/countries/compare/brazil/usa
6. https://en.wikipedia.org/wiki/Demographics_of_the_United_States
7. https://en.wikipedia.org/wiki/BCG_vaccine
8. https://www.utmb.edu/newsroom/article9605.aspx
9. https://doi.org/10.1016/S0140-6736(20)31025-4
10. https://www.cebm.net/covid-19/effect-of-latitude-on-covid-19/
6736(20)31025-4
Competing interests: No competing interests