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Covid-19: Lack of testing in Brazil is a “major failure,” says MSF

BMJ 2020; 370 doi: https://doi.org/10.1136/bmj.m2659 (Published 02 July 2020) Cite this as: BMJ 2020;370:m2659

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  1. Jacqui Thornton
  1. London, UK

Brazil is ignoring the evidence by failing to take the necessary public health measures to tackle the coronavirus pandemic, according to the humanitarian organisation Médecins Sans Frontières (MSF). It said that case detection through testing was a “major failure” in the country.

As of 1 July, World Health Organization figures show that Brazil had 1 368 195 confirmed cases and 58 314 deaths from covid-19—the highest in the world after the US.1

MSF said that a lack of tests and inadequate testing was not helping the authorities prepare for the crisis or give its people the right message about the need for caution and social distancing.

The non-governmental organisation earlier reported that testing is being rolled out at an incredibly slow pace in Brazil, with 7500 tests per million people, which is almost 10 times fewer than the US (74 927 per million).2

It blamed a clear lack of willingness at central government level to fully engage in public health prevention and emergency response.

Brazil has huge numbers of people—poor, homeless, and indigenous communities—who cannot stay home or self-isolate and need heightened assistance, MSF said. But the local public health system is being stretched to the limit and problems with access to healthcare for them have worsened.

MSF is engaged in six covid-19 emergency response projects in Brazil, in São Paulo and Rio in the south, and Roraima, Manaus, São Gabriel da Cachoeira, and Tefé in the north, mainly with these vulnerable groups.3

Dounia Dekhili, MSF Brazil covid-19 emergency head of mission, told a briefing on 1 July, “The epidemic continues to spread from city centres to neighbourhoods, to the outskirts, to rural areas. Now you have more and more states that are facing an increase in cases. It’s a race against the clock.”

She said that when MSF arrived in Manaus there were death rates of 80% in intensive care units and all the hospitals were overwhelmed, with patients lying in corridors. Now, people were scared to go to hospital and were dying at home of other conditions.

Dekhili said that Brazil appeared to be doing the “entire opposite” of other countries in terms of tackling covid-19. “It’s a striking point: all countries have been struggling with this epidemic— it has had a huge impact everywhere, but we have learnt what works. In Brazil, it seems it’s being ignored by the authorities,” she said.

Eliana Ramos, the medical coordinator for the MSF project in Boa Vista, in the northern state of Roraima, said WHO recommends that 5% of tests are positive before lifting lockdowns and reopening society.

But she added it was “impossible” to have this data in Brazil, because not enough tests were being carried out, and the type of tests used was wrong.

There was some hope from Ana de Lemos, the executive director of MSF Brazil, who said increasing deaths and new cases was not inevitable and could be avoided, even at this stage, if the government had the will.

“There is a response that can and should be given to protect the most vulnerable that are clearly now the most affected by the pandemic,” she said. “This response has to be comprehensive and coherent. We are late but we still hope that we’ll be able to come back to this epidemic in a more efficient way, and many lives can be saved.”

Clinical staff are being particularly affected by the disease, with nurses in Brazil dying of covid-19 faster than in any other country in the world—almost 100 nurses dying from the disease per month.2

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