In mid-March, Brazil took what seemed to be a forceful early strike against the coronavirus pandemic.
The Health Ministry mandated that cruises be canceled. It advised local authorities to scrap large-scale events. And it urged travelers arriving from abroad to go into isolation for a week. Although Brazil had yet to report a single death from COVID-19, public health officials appeared to be getting out in front of the virus. They acted on March 13, just two days after the World Health Organization called the disease a pandemic.
Less than 24 hours later, the ministry watered down its own advice, citing “criticism and suggestions” it had received from local communities.
In fact, four people familiar with the incident told Reuters, the change came after intervention from the chief of staff’s office for Brazil’s President Jair Bolsonaro.
“That correction was due to pressure,” said Julio Croda, an epidemiologist who was then the head of the Health Ministry’s department of immunization and transmissible diseases. The intervention by the chief of staff’s office has not been previously reported.
The about-face, given scant attention at the time, marked a turning point in the federal government’s handling of the crisis, according to the four people. Behind the scenes, they said, power was shifting from the Health Ministry, the traditional leader on public health matters, to the office of the president’s chief of staff, known as Casa Civil, led by Walter Souza Braga Netto, an Army general.
Brazil has lost two health ministers in the past six weeks – one was fired, the other resigned – after they disagreed publicly with Bolsonaro over how best to combat the virus. The interim leader now in charge of the Health Ministry is another Army general.
More importantly, the revisions underlined the hardening of Bolsonaro’s view that keeping Brazil’s economy running was paramount, the people said. Bolsonaro, a far-right former Army captain, has never wavered on that stance formulated during a crucial few days in mid-March, despite domestic and international criticism of his handling of the crisis, and a snowballing death toll.
Brazil now has the world’s second-worst outbreak behind the United States, with more than 374,000 confirmed cases. More than 23,000 Brazilians have died from COVID-19.
“So what?” Bolsonaro said recently when asked by reporters about Brazil’s mounting fatalities. “What do you want me to do?”
Casa Civil said changes to the March 13 guidance were made by the Health Ministry, following input from states and municipalities.
The Health Ministry said there had been a divergence of views due to differing situations in states and cities nationwide. It said the implementation of physical distancing measures was the responsibility of local health authorities.
“The strategy of the Brazilian response to COVID-19 was not impaired at any point,” the ministry said.
Bolsonaro’s office declined to comment for this story.
Reuters interviewed more than two dozen current and former government officials, medical experts, healthcare industry representatives and doctors to paint the most complete picture yet of Brazil’s missteps in containing the coronavirus outbreak in South America’s largest country.
They described a response that began promisingly, but which was soon hobbled by the president’s clashes with Health Ministry and cabinet officials who could not persuade him that Brazil’s economic fortunes ultimately hinged on how effectively it tackled its public health emergency.
Health experts were sidelined, the people said, and Bolsonaro embraced an unproven remedy to treat COVID-19 infections. Federal coordination foundered. State governors – some of whom Bolsonaro regards as re-election rivals – were left to set their own physical distancing policies and secure much of their own tests and equipment, the sources said.
Some experts said Brazil’s stumbles are all the more shocking because of its previous success containing malaria, Zika and HIV.
“One thing that has been a shining light in Brazil has been their public health system,” said Albert Ko, a professor at the Yale School of Public Health who has decades of experience in Brazil. “To see that all disintegrate so quickly, it’s just been very sad.”