Brazil has now reported more than 1 million confirmed cases of coronavirus and 48,954 deaths, marking a grim milestone for the South American country.
The health ministry on Friday reported 54,771 new cases, a record daily spike that brought the nationwide total to 1,032,913.
The Covid-19 pandemic is quickly spreading with no sign of slowing down, as major cities lift social distancing measures and begin reopening restaurants, shops and other nonessential businesses.
Many experts believe the number of cases could surpass the United States and that Brazil may soon become the country worst hit by the virus.
Despite this, President Jair Bolsonaro continues to downplay the threat by questioning global medical authorities and accusing opponents of trying to discredit his leadership.
Bolsonaro’s false sense of immunity
At first, Brazil seemed impervious to the virus as it spread through countries such as China, Italy and the United States. Bolsonaro only grudgingly agreed to repatriate Brazilian citizens from the then-epicenter, Hubei province, reportedly worrying that they would put the rest of the country at risk.
The first case was confirmed on February 26, when it was believed to be an isolated case of a man who flew back from Italy to Sao Paulo with the virus. A month later, coronavirus cases in Brazil had already risen to close to 3,000 and the death toll was at 77.
It was around this time when Bolsonaro first compared the virus to a “little flu” and falsely implied that Brazilians were immune to the virus.
“Brazilians don’t catch anything … they already have the antibodies to keep it from spreading,” the President said.
He said again that Brazilians are likely to be immune to the coronavirus during a March 26 press conference outside the Alvorada presidential residence in Brasilia.
“Brazilians should be studied, we don’t catch anything. You see people jumping in sewage, diving in it and nothing happens to them,” Bolsonaro said.
During the same press conference, Bolsonaro said he believed many Brazilians had already been infected but that those people already had “the antibodies that would help [coronavirus] not spread.”
Bolsonaro vs. Social Distancing
Cases began to quickly spread across the country and it became clear that Brazil would soon become a new hot spot for the virus.
By April 8, Brazil had confirmed more than 15,000 cases and 800 deaths. Despite warnings from health experts, images of Bolsonaro hugging supporters at a local bakery in Brasilia and posing without a mask emerged the following day.
Bolsonaro believed the social distancing and quarantine measures imposed by officials in major cities, such as Rio de Janeiro and Sao Paulo, would cause more harm than the virus itself and lead Brazil to a crippling recession.
“The issue of unemployment, the issue of the economy no longer working. We can’t let the side-effect of the fight against the virus be more harmful than the disease itself,” Bolsonaro said.
Bolsonaro frequently butted heads with mayors and governors of some of the hardest hit places by Covid-19 and ultimately fired Health Minister Luiz Henrique Mandetta on April 16 after he expressed his support for shutting down businesses and schools.
The following weekend, Bolsonaro attended an anti-lockdown rally in Brasilia without a mask where he coughed several times and shook hands with supporters. Opposition leaders considered the protests “anti-democratic,” after signs were seen calling for dissolving the Congress and Supreme Court and for the return of the dictatorship.
Military in the Health Ministry
Health Minister Mandetta’s successor, Nelson Teich, lasted less than a month in office before resigning. One of his major disagreements with Bolsonaro was over authorizing the use of chloroquine and hydroxychloroquine to treat Covid-19 patients.
Eduardo Pazuello, an army general with no health experience, was named as the interim Health Minister following Teich’s resignation. A few days after he assumed the role, he began replacing key positions within the ministry with other military brass. At least nine people were named within the first few weeks that he took office, to positions within the ministry dealing with planning, budget and public health issues.
Pazuello also issued new guidance authorizing the use of chloroquine and hydroxychloroquine, for all patients displaying Covid-19 symptoms.
“After two Health Ministers refused to do so and chose to resign instead of signing the document, it was up to General Eduardo Pazuello, who has assumed the ministry on an interim basis, to authorize the use of chloroquine for all Covid-19 patients,” Pazuello wrote on his personal Twitter account last month.
The US Food and Drug Administration (FDA) revoked permissions this week for the use of chloroquine and hydroxychloroquine to treat Covid-19 patients. That same day, Brazil’s Health Ministry expanded its guidance on the use of the drugs to include pregnant women and children.
The Health Ministry said the studies referenced by the FDA cannot be used as an example for the rest of the world because the “quality of the methodology is terrible” and claimed cases of Covid-19 were going down in areas where the drugs were being used, without presenting any proof.
The recommendation to use the drugs to treat children came despite guidance from the Brazilian Society of Pediatrics, saying there isn’t enough data to prove the drugs’ effectiveness in minors and that it should only be prescribed during clinical trials and with parental consent.
The World Health Organization (WHO) said on Monday that it is still reviewing the use of hydroxychloroquine in its Solidarity Trial, a multi-country clinical study of Covid-19 treatment options. The organization had temporarily paused the trial in May due to concerns surrounding the drug’s safety and in order to review its own data but resumed the program earlier this month.
Bolsonaro threatens to withdraw from WHO
Earlier this month, WHO called on nations to encourage the public to wear fabric masks in public.
“WHO advises that governments should encourage the general public to wear masks where there is widespread transmission and physical distancing is difficult, such as on public transport, in shops or in other confined or crowded environments,” WHO Director-General Tedros Adhanom Ghebreyesus said during a media briefing on June 5.
WHO’s updated guidance recommends masks be used as part of a “comprehensive package” to help curb the spread of Covid-19, which includes physical distancing, frequent hand washing, people who are sick self-isolating at home, suspected cases getting tested, and their contacts being traced.
Bolsonaro accused threatened to pull Brazil from the WHO that same evening and accused the organization of “ideological bias.”
“The United States left the WHO. We are considering that that also. Either the organization works without ideological bias, or we leave it too,” Bolsonaro told reporters. “We don’t need foreign people having a say in our health here.”
Bolsonaro doubled-down on his attacks on the organization recently, after he accused it of trying to drive Brazil towards an economic recession.
“The so-called World Health Organization, wants us to follow them blindly. First, they say that asymptomatic people cannot transmit the virus then they go back on their comment. It seems like there is something more serious behind all that, they want our countries to go broke,” Bolsonaro said during a press conference outside the Alvorada residence last Wednesday, referencing a WHO admission that asymptomatic transmission was a “major unknown.”
“The amount of economic problems this is going to cause will be huge, to the point of leaving Brazil broke,” he said, repeating his oft-mentioned worry that the economic impact of the virus will be worse than the death toll.
Triage vs. shutdown
Instead of enforcing social distancing measures, his health minister General Pazuello has advocated for setting up more health triage centers across the country. There is no such thing as “100% isolation,” he recently told CNN Brasil.
Cities across Brazil began gradually reopening last week. In major metropolitan areas, like Sao Paulo, malls and outdoor bazaars reopened for the first time in three months. Large crowds and traffic were reported in the bustling city center over the weekend by local media outlets.
Officials insist the decision is based on improving conditions, like increasing availability of intensive care beds and a flattening infection curve in some places. But experts say the conditions to reopen are far from ideal and worry the rush could lead to more transmissions and postpone a real recovery.
“You need to tackle the transportation issue. If everyone continues to take crowded buses and metro, which is what is happening, it won’t work,” said Paulo Lotufo, an epidemiologist at the University of São Paulo.
Shortly after Sao Paulo began reopening, Mayor Bruno Covas was diagnosed with coronavirus last Saturday. Covas, who is currently undergoing cancer treatment for lymphoma, displayed no symptoms, according to a statement from the mayor’s office. The statement also said Covas will be working from home and remain under observation.
Invading hospitals and Covid-19 wars
Recent studies conducted by the non-profit Institute for Health Policy Studies found that the country could run out of health professionals and intensive care unit (ICU) beds soon. More than 60% of Brazil’s population depends on the country’s public health care system and at least 10% of Brazilians live in areas where there are no ICU beds available, according to the Institute.
“The response to the pandemic could not have been any worse,” Miguel Lago, a lecturer at Columbia University and executive director of Brazil’s Institute for Health Policy Studies, told CNN. “This was not Sierra Leone before the Ebola crisis, Brazil had a solid public health care system that could have been put to better use at the beginning of the pandemic.”
A CNN team recently visited hospitals in the cities of Sao Paulo, Rio de Janeiro and Manaus where health professionals shared horror stories of overcrowded ICU units and doctors and nurses treating patients at high risk of exposure and death.
“It’s not a flu. It’s the worst thing we have ever faced in our professional lives,” Dr. Jacques Sztajnbok from Sao Paulo’s Emilio Ribas Infectious Disease Institute told CNN.
Yet, Bolsonaro continues to question the claims that more is needed and that ICUs and hospitals are overcrowded, recently encouraging his supporters to go into the facilities to gather some video proof.
“There are field hospitals and public hospitals near you, find a way to get in and film in there,” Bolsonaro said last Thursday during a Facebook live event. “We need more people to go in there and show if these beds are actually full. That helps us and all that material gathered from social media will then be sent to the Federal Police.”
Several instances of pro-Bolsonaro lawmakers and supporters trying to gain access to coronavirus treatment wards have recently been registered in the states of Sao Paulo, Espirito Santo and the Federal District, where the capital Brasilia is located.
“This type of behavior is unacceptable at a time when the state of Espirito Santo, the country and the world face this serious crisis,” the state health secretariat said in a written statement. “What’s worse is that this behavior was encouraged by an irresponsible statement from the leader of this nation.”
Brazil’s Attorney General Augusto Aras said he will call on state prosecutors offices to investigate the incidents, including claims of medical professionals being threatened and assaulted, according to a statement released by his office Monday.
“This behavior endangers the physical integrity of the brave professionals who dedicate themselves to reversing a health crisis unprecedented in the country’s history,” Aras said in the press release.
Brazil inches towards highest virus death toll
Brazil could overtake the US and become the country with the highest number of coronavirus deaths as early as August 1, according to a tracking model by the University of Washington. The model also predicts deaths will more than double to 100,000 in less than a month.
“I think we will pass the United States I think we will be the major victim of Covid-19 and this is directly linked to the fact that we don’t have a national plan,” Lago told CNN.
Brazil’s cases have been increasing by roughly 30,000 cases a day and deaths around 1,200 per day.
Earlier this month, an official Covid-19 tracker from the Brazilian Health Ministry began showing only data on new cases and deaths recorded in the past 24 hours, eliminating running cumulative totals of virus deaths and cases that had previously appeared on the same page.
Bolsonaro tweeted at the time that “cumulative data, in addition to not showing that the large part [of patients] no longer has the illness, does not depict the moment of the country. Other actions are in the works to improve case notifications and diagnostic confirmations.”
The move led to immediate backlash over lack of transparency. The Supreme Court later ruled the ministry must provide comprehensive data.
During a recent interview with CNN affiliate CNN Brasil, Pazuello said the Health Ministry had taken down the numbers because it was changing the way Brazil tallied its coronavirus data.
“The first thing we need to understand is that whatever methodology we use to tally the cases will not alter the number of obits,” Pazuello said. “There is no way to manipulate the data, because they are all registered. It would be absurd for us in the Health Ministry to have registered data and to then say it doesn’t exist.”
Brazil’s previous health ministers predicted the height of the pandemic would be May through July. Under the current leadership, there is no sense of when the peak will be or when it will plateau.
Several tests and vaccine trials are being conducted in Brazil. Two thousand Brazilians participated in tests of a vaccine against Covid-19 this month developed by Oxford University in partnership with AstraZeneca pharmaceutical, the Federal University of Sao Paulo (Unifesp) said in a statement.
The country is the first site of these vaccination tests outside the United Kingdom.
The Brazilian Butantan Institute, one of the country’s top biomedical research centers, announced an agreement with Chinese laboratory Sinovac Biotech to conduct Phase III of a clinical coronavirus vaccine trial on approximately 9,000 volunteers in Brazil in the first week of July.
The vaccine went through the first two phases of testing in China, where it was tested on 744 volunteers. The Chinese lab started human clinical trials with the experimental vaccine on April 17.
However, the real test will be whether or not Bolsonaro is able lead Brazil out of this crisis as he faces a pandemic, crippling recession, political upheaval and a probe into allegations he interfered with police investigations.
Back in April, when Brazil’s death toll reached 5,000, Bolsonaro’s answer to the pandemic was a simple one.
“So what? I’m sorry, but what do you want me to do?” Bolsonaro said on April 29, outside the presidential residence in Brasilia. “I’m sorry for the situation we are currently living with due to the virus. We express our solidarity to those who have lost loved ones, many of whom were elderly. But that’s life, it could be me tomorrow.”