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A dangerous game in the battle between life and death leaves Brazil the undisputed loser

In Latin America one name keeps recurring in the reporting on the spread of the corona pandemic: President Jair Bolsonaro. The world has witnessed an unperturbed leader who persists in describing the pandemic as an “exaggerated neurosis,” and who spends his time riding his water motorcycle while the death toll rises. What has been happening in these past months and where will it end?

The journalist Juliana Dal Piva reports from a country in dire crisis. In 2019 she was awarded the RELE prize for a reportage that revealed a large-scale system of nepotism and “ghost appointments” to posts that belong to the power sphere of the presidential family.

Credits Text: Juliana Dal Piva Translation from Swedish: Neil Betteridge Foto: Leo Martins June 10 2020

Saturday 9 May 2020. Blue sky, 25 degrees. This was the scenario in Brasilia, the capital of Brazil. Perfect for kicking back for a few hours. Many locals like to drive out to Lake Paranoá when they’ve got some time off. The place is once of the city’s best known tourist destinations. And this was exactly what the republic’s president Jair Bolsonaro decided to do that day.

The popular lake is set in the park surrounding the presidential palace Palácio da Alvorada, so seizing the opportunity to go to the lake to relax, Bolsonaro made a discreet exit from the back of the palace dressed in a football shirt and a pair of navy blue shorts. Once there, he donned a life jacket and settled himself onto a blue water scooter. With his bodyguard sitting astern the president headed out onto the water.

All well and good – except that on that very same day Brazil’s death toll from COVID-19 passed a tragic threshold to reach 10,627, up from 730 deaths the day before. By taking a ride on a jet ski on 9 May Bolsonaro was giving the finger to the warnings issued by health authorities around the world.

The provincial government in Brazil, which is independent of the President, had ordered everyone to wear a face mask when outside in the city. But Bolsonaro was having none of it, and both he and his bodyguard were maskless. Out on the lake he spotted a motorboat full of sympathisers and he slowed down to greet them. He shook hands with all of them, a gesture that has been banned during the ongoing pandemic. And then he launched into a verbal tirade, blaming the economic situation.

“If we don’t watch out, Brazil will end up in a state of unemployment and chaos,” he said to his sympathisers. “This is a neurosis. 70% will be infected by the virus, and that’s that. This is madness,” he added and continued on his way. When the media got wind of his excursion, the President refused to comment. And offered not a single word of comfort that day to the families and friends of those who had succumbed to COVID-19.

It seemed as if the happily smiling Bolsonaro was living in a completely different country, or perhaps even world. He did not look like the president of a country ravaged by the coronavirus pandemic. Or for that matter like the leader of a country that has lost three ministers in less than a month. Two of them were ministers of health, but all three had to go after questioning the President’s interference in their field of authority.

In April, while world leaders were campaigning for ventilators and masks, Bolsonaro fired Maurício Valeixo, director general of the federal police. This prompted Minister of Justice Sergio Moro to accuse the President of political meddling with the ministry’s law enforcement authority. The spat ended with his resignation. The same Moro was also a driving force in Operation Lava-Jato, a police anti-corruption investigation that resulted in the imprisonment of numerous politicians, amongst them ex-president Lula. Following the episode, an investigation was launched on 24 April into Bolsonaro’s alleged interference in police work. This was the first time since his coming to power in 2018 and it sparked a major constitutional crisis.

But while the head of the executive body was out having fun on 9 May, the legislative and judicial counterparts showed their solidarity with the grieving. That weekend, the federal Supreme Court and the National Congress announced three days of national morning, and the Brazilian flag was flown at half-mast in honour of the deceased. The ceremony on the open plaza between the three administrative buildings in Brasilia (Praça dos Três Poderes) was a clear demonstration that the strategy for dealing with the pandemic was in disarray.

Because it was only two of the three governmental state powers that had announced a period of mourning.

And now the devastation left by the disease is growing by the hour. On 9 May, the death toll was 10,627, but by 19 May it had risen to 17 971, a day which saw 1,179 deaths, the largest 24-hour figure to date. As I polish off this article on 20 May, Brazil is in third place on the list of countries with the most cases of COVID-19.

The discrepancy between Brazil’s leaders has been apparent ever since the country officially registered its first case of COVID-19 on 26 February. Like in many other countries, the infection was brought into the country by people flying back from their holidays in Europe and the USA during the Carnival, although some suspect that the virus had actually been circulating a few days earlier.

The first case in the country’s largest city, São Paulo, was a businessman returning from northern Italy. A few days later the first cases of Rio de Janeiro were registered. Now, the disease that had initially affected people with higher incomes started to creep, slowly but surely, into the suburbs. The first death in Rio de Janeiro was a 63-year-old woman, who worked as a home help and who was infected by the family she worked for after her employer had contracted the virus while on a trip, again to Italy.

The rapid transmission of the disease and the tragic news reports coming from Italy and then from Spain, France and the USA, alarmed the local health authorities in Brazil. We have a uniform national public healthcare system (the SUS) that that has been built up over three decades and that gives all Brazilians the right to seek and obtain free healthcare. Public healthcare is a constitutionally guaranteed right and means that diseases such as cancer and HIV are treated for free.

However, the SUS struggles to take care of complex cases and there is often a lack of intensive care beds, and it’s not unknown for patients to wait months, years even, for an operation. Some people have even been desperate enough to go to court to ensure their right to intensive care. Consequently a private healthcare system has developed, independent of the SUS.

But a shocking fact emerged in the midst of the pandemic. One third of the population have access to half of the country’s intensive care beds via healthcare insurance and private hospitals, something that the majority of people lack the means to benefit from. The other half of the intensive care beds are provided by the SUS, which receives two thirds of the population. According to the Brazilian Association of Intensive Care, the country had a total of 45,848 intensive care bed in March, of which 22,844 were in public hands and 23,004 in private. The WHO recommendation is 1-3 beds per 10,000 people. Brazil has 2.2. But due to their distribution between the different sectors, the average figures are actually 1.4 for the SUS and 4.9 for the private operators.

These figures have made many healthcare managers fear a collapse of the public health service. It’s not only intensive care beds that are lacking. There are millions of people in the provincial capitals like Rio de Janeiro and São Paulo (as well as in many other towns and cities) living in shanty towns without even daily access to fresh water. Take the favela Rocinha in Rio de Janeiro, perhaps the best known of Brazil’s slum areas – how on Earth can social isolation ever work in such a place, with families of four, five or six living in cramped conditions, sometimes in a single room? In Brazil, the idea of isolation seems almost a luxury.

And it was this very social isolation that gave rise to the first crisis. Lessons could be learned from Milan, where officials first campaigned against lockdown but later apologised. But in Brazil Bolsonaro seems to be playing a dangerous game with double the risk.

About fourteen days separate the first COVID-19 case and the first decree. Schools were closed and certain economic activities were limited in an attempt to restrict social movement, especially in Rio de Janeiro and São Paulo states, which had the largest number of cases.

The orders came from both provincial governments, which are led by political opponents of the President, so were not issued by Bolsonaro himself. Other states then followed suit. However, the measures only limit movement and people can roam freely outside with impunity. This is not the same as a lockdown. These measures were followed by guidelines from the Ministry of Health itself. The then minister Luiz Henrique Mandetta organised daily press conferences to present continually updated reports on how the virus was advancing in different parts of the country. He was always accompanied by a technical team of medical experts and researchers working in various fields.

Mandetta is not an infection doctor. He’s an orthopaedist and a politician from a traditional family in the state of Mato Grosso do Sul, an important region for Brazilian agricultural companies. He is a confirmed liberal from the centre-right Democrat party and was one of a group of congressmen who supported the impeachment of former president Dilma. He knew that the social isolation guidelines would lead to conflict with certain economic sectors, but he also knew that the measures were necessary.

On the one hand we have a minister coordinating initiatives with the state governors in order to prepare hospitals and clinics for testing and containing; on the other, we have a president who seems to be living in a completely different country. In early March, Bolsonaro travelled to the USA to meet President Trump, and on his return, 23 members of his delegation had been infected with COVID-19.

At the same time, Bolsonaro gathered his supporters to protest against the National Congress. According to sources close to the President, he lives in a state of paranoid fear that he will be impeached in the same way as the congress deposed his predecessor Dilma Rousseff in 2016. So despite the criticism and in contravention of the global guidelines to stay at home, Bolsonaro took part in the meeting, and even shook hands with demonstrators on 15 March.

The situation worsened ten days later when Bolsonaro could no longer ignore the fact that the state were now taking social isolation measures. Without consulting his health minister, Bolsonaro made an official announcement that was broadcast over the country’s radio and TV stations, in which he called COVID-19 a “little flu” and a “slight cold”. His speech succeeded in politicising the issue. With no science to back him up, he advocated “vertical distancing” that only concerned the elderly and other at-risk groups.

Following the President’s TV address, small business owners took to the streets to demonstrate against the social isolation guidelines, declaring that “our president says we can work”. But at the same time, the evident lack of serious action against transmission lead to vociferous protests. Since March, people around the country, day after day, have stood at their windows banging pots and shouting anti-Bolsonaro slogans.

After his tirades against isolation, Bolsonaro began to advocate the use of chloroquine, a drug used to treat malaria and lupus (SLE). Without first consulting his health minister, Bolsonaro held a new speech to the nation in which he addressed the issue. He then posted messages to his social networks saying that chloroquine raised “hopes” – riding roughshod over the medical community and the studies finding no evidence that the drug is effective against COVID-19.

The Minister of Health had no choice but to issue a public rebuttal of Bolsonaro’s claims. He criticised the president’s antics, his going about in public visiting shops and inciting mass meetings and protests. Bolsonaro’s advisors tried to force Luiz Henrique Mandetta to sign a document decreeing chloroquine in all cases, even mild ones as a prophylactic, but the minister refused. And a couple of days before he was replaced, he recounted the entire episode: “We must follow the science, the science. We must not lose focus: science, discipline, planning and focus,” he said.

Mandetta left his post on 16 April and was succeeded by Dr Nelson Teich, who promised to launch an extensive testing programme to revive the national economy. And as Teich tried to implement a plan to resume the country’s economic activities at Bolsonaro’s request, hospitals were being pushed to the limits of their capacity.

The first city to end up in a critical situation was Manaus, the state capital of Amazonas, where hospitals and funeral services collapsed and people who had died at home had to be buried in mass graves. The lack of intensive care places became acute in Fortaleza in the state of Ceará. Then the crisis reached Rio de Janeiro and São Paulo, which are under serious pressure.

When Teich was alerted to the nature of the situation, he called for a decree imposing a lockdown in certain places, just as Mandetta had done. But Teich was systematically ghosted by the government, which forced him instead to install a team of nine military officers in the ministry executive. Bolsonaro also issued numerous decrees allowing economic activities in the county without consulting the Health Minister. When Teich was questioned by journalists about a new decree allowing gyms and hairdressers to reopen, the Minister had to admit he knew nothing about it. “Was it published today?” he asked the journalists. “Whose responsibility is it? Beauty parlours, gyms, hairdressers... They’re not under our jurisdiction, it’s an attribution of the President,” he said.

Two days later, Teich handed in his resignation after having refused to sign the edict on using chloroquine to treat mild cases of COVID-19. At the time of writing, the ministry is headed by General Eduardo Pazuello, who though lacking any medical education, has close connections to Bolsonaro. And the official document on chloroquine has been extended, again with no backing from the medical community.

Brazil’s neighbours look with dread upon the country. Argentina, which has imposed a strict lockdown, on the 10th of june registered a total of 24 748 COVID-19 cases and 717 deaths from March. The battle between life and death, Brazil is playing a dangerous game that will leave them it undisputed loser.

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