Intended for healthcare professionals


Covid-19: Brazil now has third highest number of cases behind US and Russia

BMJ 2020; 369 doi: (Published 21 May 2020) Cite this as: BMJ 2020;369:m2059

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  1. Rodrigo de Oliveira Andrade
  1. São Paulo, Brazil

Brazil has overtaken the UK to become the country with the third highest number of confirmed covid-19 cases, behind only the US and Russia.

Data from the Johns Hopkins University Coronavirus Research Center1 show that Brazil had 19 951 new cases as of 20 May, taking its total number of cases to 291 579. These numbers are thought to be an underestimation, however, as the country has not been able to improve its testing capacity.

Brazil also recorded more than a thousand daily deaths from the disease for the first time, with 1179 reported on 19 May, and 18 859 in total.2

The worsening health crisis comes amid institutional chaos which has seen two health ministers depart in less than a month after clashing with Brazil’s President Jair Bolsonaro—who has repeatedly undermined social distancing and lockdown measures while pushing state governors to reopen the economy.

On 15 May, the minister of health, Nelson Teich, resigned after less than a month on the job. His predecessor, Luiz Henrique Mandetta, was fired in mid-April after publicly questioning Bolsonaro’s flouting of social distancing guidelines.

Teich had increasingly disagreed with Bolsonaro on social isolation and the use of hydroxychloroquine to treat covid-19. On 14 May Bolsonaro demanded that Teich publish federal guidelines for the early use of the anti-malarial drug to treat patients with covid-19, but the then minister resisted because of the lack of scientific evidence.

Teich had already experienced public embarrassment after discovering during a press conference that the president had given a decree without the health minister’s consent, classifying gyms, hair salons, and barbers as essential services.

Christovam Barcellos, deputy director of the Oswaldo Cruz Foundation’s Institute of Communication and Information in Health, told The BMJ, “Brazil is going through this crisis based on unscientific protocols and a lack of leadership and poor governance on how we should fight covid-19. It may seriously undermine the country’s ability to contain the spread of the disease, leading to a public health tragedy.”

Brazilian military cabinet members are pushing Bolsonaro to keep the interim health minister, Eduardo Pazuello, in charge until the end of the pandemic.3 Their argument is that, as a military man, Pazuello would follow the orders imposed by Bolsonaro without question, unlike the previous two ministers who were doctors.

On 20 May, on Bolsonaro’s advice, Pazuello released a document expanding the possibility of using chloroquine and hydroxychloroquine to treat patients with mild covid-19 symptoms. The advice until then was to use them only to treat patients with severe symptoms.

Marcos Espinal, director of the Department of Communicable Diseases and Health Analysis at the Pan American Health Organization, reinforced that “there is no evidence that these drugs are effective against covid-19. They may, however, cause serious heart problems, so they shouldn’t be used in people infected by the coronavirus.”

Meanwhile, as covid-19 spreads throughout the country, demand for beds in intensive care units is set to exceed hospitals’ capacity.

As well as affecting slums, smaller towns, and remote communities, the disease has also reached Brazil’s prisons, which have seen more than 800 cases and 30 deaths.4 There are fears that this may be a potential time bomb as the country has a prison population of 748 000—the third largest in the world.5

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