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Covid-19: Failed response in Brazil has led to humanitarian catastrophe, says MSF

BMJ 2021; 373 doi: https://doi.org/10.1136/bmj.n1002 (Published 16 April 2021) Cite this as: BMJ 2021;373:n1002

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The catastrophic Brazilian response to covid-19 may amount to a crime against humanity

  1. Zosia Kmietowicz
  1. The BMJ

The humanitarian charity Médecins Sans Frontières (MSF) has condemned Brazilian authorities for their failure to control the spread of covid-19, which has led to thousands of needless deaths, caused the health system to nearly collapse, and left staff exhausted and traumatised.

MSF called on the government to urgently adopt evidence based public health measures to control the disease and treatment guidelines for those infected. The refusal to act appropriately has led to “the unmitigated spread of covid-19 over the past year,” said Christos Christou, international president of MSF, and “sent far too many to an early grave.”

“The federal government has all but refused to adopt evidence based comprehensive public health guidelines, leaving Brazil’s dedicated medical staff to manage the sickest in intensive care units and improvise solutions when beds are unavailable,” he said. “This has put Brazil into a permanent state of mourning and led to the near collapse of Brazil’s health system.

“The response in Brazil needs an urgent, science based, and well coordinated reset to prevent further avoidable deaths and the destruction of the once prestigious Brazilian health system. Public health measures have become a political battlefield in Brazil. As a result, science based policies are associated with political opinions, rather than the need to protect individuals and their communities from covid-19.”

Last week, Brazilians accounted for 11% of the world’s covid-19 infections and 26.2% of deaths. On 8 April, 4249 deaths from covid-19 were recorded in 24 hours, alongside 86 652 new infections.

Meinie Nicolai, MSF general director, said that the response in Brazil needed to start in the community, not the intensive care unit. “Not only must medical supplies like oxygen, sedatives, and [personal protective equipment] reach where they are needed, but the wearing of masks, physical distancing, strict hygiene measures, and the restriction of non-essential movement and activities must be promoted and implemented in the community in accordance with the local epidemiological situation,” she said.

Last week, intensive care units were full in 21 of Brazil’s 27 state capitals. Brazil is also short of health professionals, but health staff with foreign qualifications are not permitted to work in the country.

MSF said that the incidence of covid-19 cases is being fuelled by the overwhelming amount of disinformation circulating in communities across the country. Masks, physical distancing, and the restriction of movement and non-essential activities, are shunned and politicised, while hydroxychloroquine and ivermectin are being used as prophylaxis and treatment for covid-19 despite a lack of effectiveness.

Pierre Van Heddegem, emergency coordinator for MSF’s covid-19 response in Brazil, said, “The devastation that MSF teams first witnessed in the Amazonas region has become the reality across the majority of Brazil. The lack of planning and coordination between federal health authorities and their state and municipal counterparts is having life or death consequences.

“Not only are patients dying without access to healthcare, but medical staff are exhausted and suffering from severe psychological and emotional trauma due to their working conditions.”

Vaccination has also been slow, with around 11% of the population having received at least one dose so far. With more than 90 variants of the virus currently circulating in Brazil millions of lives inside and neighbouring Brazil are at risk, said MSF.

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