H5N1

Death bed denials, pandemic 'hoax' accusations common in southern Manitoba hospital patients, doctor says

Via CBC News: Death bed denials, pandemic 'hoax' accusations common in southern Manitoba hospital patients, doctor says. Excerpt:

A southern Manitoba hospital physician says staff are exhausted by a recent crush of admissions, but they're also up against something else that's draining energy and morale. 

Staff at Boundary Trails Health Centre are routinely hearing from sick and unvaccinated patients who believe the pandemic is a hoax — some remaining defiant even on the brink of death. 

"We hear this almost every day, and I know that's startling," said Dr. Ganesan Abbu. "It's difficult ... to know that almost 100 per cent of our admissions have not been vaccinated." 

Abbu is an anesthetist and special care unit doctor at Boundary Trails, located over 100 kilometres southwest of Winnipeg and between Morden and Winkler. 

The district surrounding the two small cities has the lowest vaccination rate in the province, according to provincial data. 

More and more patients have flowed in during the past two weeks amid Manitoba's third wave. Abbu says he and many coworkers are waking up before dawn to start work lately just to keep up. 

The hospital has converted two of its medicine and surgery units into COVID-19 areas, he said. The hospital also experienced an oxygen shortage over the weekend based on the increasing number of COVID-19 patients being put on ventilators. 

Boundary Trails nurses and the lone respiratory therapist in the hospital have shouldered the heaviest workload burden, said Abbu. 

Staff are also being confronted with something beyond the painstaking hours caring for more people than usual. 

"I think nurses have found it difficult to handle a community, certain segments of the community, who believe that this is a hoax, that the virus doesn't exist, and other untruths, like the vaccine is going to put a chip into each one of us who's been vaccinated and people will be able to track us," he said.  

"It flies in the face of the efforts of nurses and health-care staff who are really extending themselves to help the community in need." 

Some staff are having to deal with family members who are frustrated they can't see their loved ones in hospital or believe they died of something other than COVID-19. 

It's not uncommon for people to flout rules and enter the hospital without a mask on either, he said.

"They say, you know, it's a hoax," he said. "We hear this all the time." 

Abbu has personally experienced patients who, even nearing death, remained in denial and continued to assert untruths about the pandemic. 

"I've had two patients who have died and even right until the time that they died, they didn't believe that they had it," Abbu said.  

"It's not as though we are trying to get the patient to acknowledge that they have COVID before they die. These patients are so much in denial, they are volunteering this information." 

Abbu said one patient who didn't believe they had COVID-19 went home and later died. The family of another patient who died didn't believe it was due to COVID-19 and asked if they could have an autopsy to confirm, he said.

N'Zérékoré: Gbakalaye still refuses Ebola response teams

Via Guineenews.org: N'Zérékoré: Gbakalaye still refuses Ebola response teams. The Google translation:

Ebola response teams operating in the capital of Forest Guinea, epicenter of the Ebola virus, since December 2021, have faced reluctance in the district of Gbakalaye. 

Indeed, for four days already, this locality in the sub-prefecture of Soulouta, has been closed to Ebola response teams. And this has the consequence of not following up at least of Gbakalaye's 96 contacts. 

According to our information, this reluctance is explained by the refusal of old "Zogo" who are the guardians of the tradition in the Kpèlè country. They categorically reject the return of the response teams, despite the intervention of national sons residing in N'Zérékoré. 

Note that for the time being, the cumulative number of confirmed cases is 16, for 7 hospitalized deaths and 46 contacts followed out of a total of 164 contacts to follow.

The order is to avoid lockdown, says Brazil's health minister

Via DW Brasil: The order is to avoid lockdown, says Brazil's health minister. The Google translation, lightly edited:

While Brazil continues to reports record counts of deaths by covid-19, the Minister of Health, Marcelo Queiroga, affirmed this Saturday (03/04) that "the order is to avoid the lockdown" in the country, but for that the country needs to do your "homework". 

"We need to organize ourselves so that we avoid extreme measures and we are able to ensure that people continue to work, earning their wages and income, making the economy work, leaving these extreme measures for another case. Avoiding lockdown is the order, but we have to do our homework, "said the minister at a news conference. 

According to Queiroga, this duty belongs not only to the federal, state and municipal governments, but "to each of the citizens". He referred to preventive measures against the advancement of covid-19, such as the use of masks and physical distancing. 

The statements were made after the minister's first meeting with the director general of the World Health Organization (WHO), Tedros Adhanom, in which the director of the Pan American Health Organization (PAHO) in Brazil, Socorro Gross, also participated. 

Queiroga also said that the ministry is working on a protocol to guide the population using public transport "to do this in a more orderly manner, in order to prevent the closure of our economy". The intention is to avoid crowding, he said. 

As much as he resists the idea of ​​a lockdown, following the posture of President Jair Bolsonaro, Queiroga defended the importance of preventive measures against the covid-19, in contrast to the speech of the head of state, who during the pandemic despised such actions. 

This Saturday, the minister made an appeal for the population to wear masks, always clean their hands, practice social distance and avoid crowds. 

"I take the opportunity, at this Easter time, to ask each Brazilian to wear a mask. Take advantage of the holiday so as not to make crowds, it is essential. We often see the population having parties, without masks. This is not appropriate, we need each one to collaborate," declared Queiroga. 

"The population's adherence is not easy. As much as we talk, you [journalists] talk every day on TV, and we were unable to make the population adhere to these measures that seem simple, but are efficient", he added. 

"We are against closing everything" 

Social isolation, the closure of the economy and restrictions on the movement of people are promoted by international health authorities as some of the most efficient measures to combat the coronavirus, and have been implemented by most governments around the world. 

However, against the rest of the world, Bolsonaro minimized the severity of the disease and attacked these restrictive measures throughout the pandemic, preferring instead to bet on drugs that have proven ineffective against the virus, such as chloroquine. 

This Saturday, the president took a walk alongside the new defense minister, Walter Braga Netto, in which he appears without a mask during a live broadcast on social networks. On a visit to the Casa de Maria Beth Myriam, in Brasília, Bolsonaro ate soup and again criticized rules imposed by governors in favor of distancing. "We are against closing everything." 

Brazil is currently experiencing the worst moment of the covid-19 epidemic, with successive records of daily deaths and collapsing hospitals. Last week, the country recorded 3,869 deaths in just 24 hours, the highest number since the beginning of the crisis. In all, more than 330 thousand people have died in the country as a result of the disease.

Coronavirus: At the height of the pandemic, Brazilian companies distribute 'COVID-19 kits' to employees

Via BBC News Brasil: Coronavirus: at the height of the pandemic, Brazilian companies distribute 'covid kit' to employees. The Google translation:

Brazilian companies are distributing to employees the "covid kit", as it became known a set of drugs with no proven efficacy or already proven ineffective for covid-19. 

BBC News Brasil found at least four companies that are doing this in São Paulo, Paraná and Santa Catarina. In one of them, employees heard last week, in person, a lecture by a doctor about the so-called "early treatment".

"The decision was made by the board because we believe in the treatment and do the treatment. We want to do for our employees the same thing that we do for our family", says Giselle Rêgo, industrial director at Tecnocuba, which produces stainless steel parts in Sao Paulo. 

The company offered the possibility of "early treatment" to all 105 employees. 

The supposed early treatment, or covid kit, usually refers to a combination that includes ineffective medications or even studies against covid-19, such as hydroxychloroquine, ivermectin, azithromycin, vitamin D, vitamin C, among others, which can bring side effects .

A collapse foretold: How Brazil’s Covid-19 outbreak overwhelmed hospitals

Via The New York Times: A Collapse Foretold: How Brazil’s Covid-19 Outbreak Overwhelmed Hospitals. Excerpt:

PORTO ALEGRE, Brazil — The patients began arriving at hospitals in Porto Alegre far sicker and younger than before. Funeral homes were experiencing a steady uptick in business, while exhausted doctors and nurses pleaded in February for a lockdown to save lives. 

But Sebastião Melo, Porto Alegre’s mayor, argued there was a greater imperative. 

“Put your life on the line so that we can save the economy,” Mr. Melo appealed to his constituents in late February. 

Now Porto Alegre, a prosperous city in southern Brazil, is at the heart of a stunning breakdown of the country’s health care system — a crisis foretold. 

More than a year into the pandemic, deaths in Brazil are at their peak and highly contagious variants of the coronavirus are sweeping the nation, enabled by political dysfunction, widespread complacency and conspiracy theories. 

The country, whose leader, President Jair Bolsonaro, has played down the threat of the virus, is now reporting more new cases and deaths per day than any other country in the world.

“We have never seen a failure of the health system of this magnitude,” said Ana de Lemos, the executive director of Doctors Without Borders in Brazil. “And we don’t see a light at the end of the tunnel.” 

On Wednesday, the country surpassed 300,000 Covid-19 deaths, with roughly 125 Brazilians succumbing to the disease every hour. Health officials in public and private hospitals were scrambling to expand critical care units, stock up on dwindling supplies of oxygen and procure scarce intubation sedatives that are being sold at an exponential markup. 

Intensive care units in Brasília, the capital, and 16 of Brazil’s 26 states report dire shortages of available beds, with capacity below 10 percent, and many are experiencing rising contagion (when 90 percent of such beds are full the situation is considered dire.)

In Rio Grande do Sul, the state that includes Porto Alegre, the waiting list for intensive care unit beds doubled over the past two weeks, to 240 critically ill patients. 

 At Hospital Restinga e Extremo Sul, one of the main medical facilities in Porto Alegre, the emergency room has become a crammed Covid ward where many patients received care in chairs, for lack of a free bed. Last week, the military built a tent field hospital outside the main entrance, but hospital officials said the additional bed space is of little use for a medical staff stretched beyond its limit. 

“The entire system is on the verge of collapse,” said Paulo Fernando Scolari, the hospital’s director. “People are coming in with more serious symptoms, lower oxygen levels, in desperate need of treatment.” 

The breakdown is a stark failure for a country that, in past decades, was a model for other developing nations, with a reputation for advancing agile and creative solutions to medical crises, including a surge in H.I.V. infections and the outbreak of Zika. 

Mr. Melo, who campaigned last year on a promise to lift all pandemic restrictions in the city, said a lockdown would cause people to starve. 

“Forty percent of our economy, our labor force, is informal,” he said in an interview. “They’re people who need to go out and work in order to have something to eat at night.” 

President Bolsonaro, who continues to promote ineffective and potentially dangerous drugs to treat the disease, has also said lockdowns are untenable in a country where so many people live in poverty. While several Brazilian states have ordered business shutdowns in recent weeks, there have been no strict lockdowns. 

Some of the president’s supporters in Porto Alegre have protested business shutdowns in recent days, organizing caravans that stop outside of hospitals and blast their horns while inside Covid wards overflow.

'Saddest March of our lives': Brazilians lament Covid-19 devastation as critics decry Bolsonaro

Via The Guardian: 'Saddest March of our lives': Brazilians lament Covid devastation as critics decry Bolsonaro. Excerpt:

Like so many on Brazil’s left, Pedro Carvalho was certain Jair Bolsonaro’s presidency would prove a nightmare: for human rights, for the environment and for the national health system the 41-year-old doctor cherishes and serves. 

“I felt this profound sadness, just utter, personal sadness,” Carvalho remembered of the fateful moment in October 2018 that the far-right populist was confirmed as his country’s new leader. 

“He’d been a politician for 30 years. Everyone knew who he was,” the intensive care physician said of the dictatorship-praising former paratrooper. “He is hatred. He is hatred itself.” 

Back then, of course, nobody knew Brazil was also barreling towards its most devastating public health catastrophe since the Spanish flu, or that Bolsonaro would so ruinously mishandle an epidemic that has now killed more than 300,000 of his citizens, his wife’s grandmother included.

“We thought perhaps he might delegate the response to a health minister and leave them to it … while he sat around making gun signs with his hands,” Carvalho said of Brazil’s pro-gun president. 

He was mistaken. From the start of Brazil’s Covid epidemic last February, Bolsonaro busied himself trivializing its dangers, shunning face masks, sabotaging social distancing and urging citizens to reject lockdown. In less than a year he has forced three health ministers from power, two for questioning his championing of bogus treatments such as the anti-malaria drug hydroxychloroquine. 

The consequences, say critics, have been deadly. On 24 March 2020, with Brazil’s Covid death toll at 46, Bolsonaro claimed the pandemic was being exaggerated “and soon it will pass”. 

On Wednesday, exactly a year later, the number of fatalities surpassed 300,000 after a record 3,000 lives were lost for the first time in a single day. Only the US, governed until January by Bolsonaro’s rightwing inspiration, Donald Trump, has suffered greater losses, with scant sign of Brazil’s outbreak being brought under control.

“We are adrift,” said Carvalho, who has a front-row seat to the tragedy at his ICU in the north-eastern state of Pernambuco, where all beds are now full. “What we are witnessing is the politics of death.”

Carvalho said he felt a mix of dejection and disgust as he reflected on Bolsonaro’s role in a calamity now steaming into its deadliest phase because of a months-long collapse of containment measures and the more contagious P1 variant linked to the Brazilian Amazon.

“I don’t expect things to improve, not for now at least,” he said, pointing to the country’s faltering vaccination efforts. “As a health professional, I wish … I could tell people: ‘Hang on people, we’ll get through this.’ But I just don’t see it. I can’t offer people words of encouragement any more.”

'Covid-19 is taking over': Brazil plunges into deadliest chapter of its epidemic

Via The Guardian: 'Covid is taking over': Brazil plunges into deadliest chapter of its epidemic. Excerpt:

It was midway through February when André Machado realized Brazil’s coronavirus catastrophe was racing into a bewildering and remorseless new phase. “The floodgates opened and the water came gushing out,” recalled the infectious disease specialist from the Our Lady of the Conception hospital in Porto Alegre, one of the largest cities in southern Brazil. 

Since then, Machado’s hospital, like health centres up and down the country, has been engulfed by a deluge of jittery, gasping patients – many of them previously healthy and bafflingly young. Among the recent admissions was a heavily pregnant 37-year-old who was brought in complaining of breathing difficulties and a cough. Doctors performed an emergency C-section to deliver the baby in a desperate bid to take the pressure off the expectant mother’s Covid-racked lungs. 

“We’re trying to help people but this disease is much faster and more aggressive than the tactics we’ve been using,” Machado, 44, said of his team’s efforts to keep pace with a tripling of admissions. 

“It’s like we’re flogging a dead horse,” he said, before adding: “This disease is going to kill many more people in Brazil.” 

At the end of last year Brazil’s president, Jair Bolsonaro – a Donald Trump-worshiping populist who has gleefully sabotaged Covid containment efforts – declared his country had reached “the tail end” of what was already one of the world’s worst outbreaks. 

Bolsonaro was wrong. 

Three months later Latin America’s largest nation has lost almost 100,000 more lives – taking its total death toll to more than 275,000, second only to the US – and been plunged into the deadliest chapter of its 13-month epidemic.

This week, as a record 2,349 daily deaths were reported, the former leftist president Luiz Inácio Lula da Silva castigated Bolsonaro’s “moronic” handling of the crisis and urged citizens to confront their incompetent “blowhard” leader. 

“This country is in a state of utter tumult and confusion because there’s no government. I’ll repeat that: this country has no government,” Lula declared, blaming Bolsonaro’s “uncivilised” leadership and rejection of science for the scale of Brazil’s disaster. 

“So, so many lives could have been saved,” Lula claimed, warning: “Covid is taking over the country.” 

As the emergency intensified this week, frontline health workers from Porto Alegre to Recife, a coastal city 3,000km further north, described scenes of heartbreak, despair and exhaustion as intensive care units and cemeteries fill up like never before.

“It feels like we’re putting a Band-Aid on a bullet wound,” said Eduarda Santa Rosa Barata, a 31-year-old infectologist who works in three ICUs in the north-eastern capital of Pernambuco state, all now stretched to the limit. “We’re engaged in damage reduction … You open new beds and they fill up immediately.” 

A few days earlier, Barata had admitted a 37-year-old man who had no underlying medical conditions but whose lungs were so badly damaged he needed intubation. “It seems so random,” she said. “It’s a bizarre disease. It’s frightening.” 

Machado saw several explanations for the torrent of cases he and other doctors are now seeing, including political mismanagement and the slackening of social distancing measures, principally among the young. In recent months such containment efforts have largely collapsed, with schools and businesses reopening and Bolsonaro’s tourism minister even urging citizens to start holidaying again. 

But the doctor suspected a third, more troubling element was also at work: an enigmatic and apparently more contagious variant called P1 that is thought to have emerged in the Amazon region in late 2020 but is now circulating across Brazil, including in the southern state of Rio Grande do Sul, where Machado works.

Dr. Paul Farmer’s faith versus 'clinical nihilism'

An editorial in the Pittsburgh Post-Gazette: Farmer’s faith.

Dr. Paul Farmer is rightly hailed as a great physician, medical anthropologist and humanitarian. 

And he has a very pragmatic message for us in the age of COVID-19 and near political despair, perhaps near political nihilism: Concentration — of public attention, will, resources, and devoted, educated and continually refined expertise – will make things better. 

The problem, be it Parkinson’s, lead poisoning and asthma in poor kids, or bigotry in a thousand forms, will not vanish with such focus. And it will not get better overnight. 

But it will get better. 

And, as Barack Obama liked to remind people, “better is still better.” 

Dr. Farmer is the co-founder of Partners in Health, which seeks to bring clinical care to the poorest of the poor around the world. It is perhaps the most-focused and efficient private charity of its kind in existence. PIH is particularly noted for its work in Haiti and West Africa. 

He is also a polymath — a medical professor at Harvard, a medical missionary constantly traveling the world and doing hands-on work with the sick and the destitute, a celebrity evangelist for better public and preventive health systems, everywhere, including in the United States, and an author. 

He has just published a book titled Fevers, Feuds and Diamonds: Ebola and the Ravages of History, which is one part reportage, one part scientific paper, and one part meditation on the passions of his own life and work. 

Dr. Farmer, too, uses the term nihilism, but in the classical sense of all meaning and purpose lost, or rejected. 

He says that in the case of fighting Ebola, the culprit was “clinical nihilism”: We cannot treat all the people with the disease, so we will instead try to contain it. Consequently, thousands died who could have been saved with simple and inexpensive medical care. Thousands more avoided a medical system they reasonably distrusted. 

In the case of fighting COVID-19, Dr. Farmer says the great error was “containment nihilism”: We will never be able to stop the spread of the disease because we don’t know how to do contact tracing well and people will not wear masks. 

Both errors, of course, derive from a lack of investment in public health. 

But they also evolve from something even more fundamental: Lack of faith in human ingenuity, action and reason, which is to say, lack of faith in ourselves. 

This is the root of true pessimism (a word that might make more sense for most Americans) or true nihilism in the way Dr. Farmer means it: We can never progress. We never really make things better. 

But, in fact, we can, and have. And this is what science is really all about and what the American dream is all about. 

We have, at last, made progress on the coronavirus — tremendous progress in the last 10 weeks to three months, especially. People are wearing masks and it is helping. We have three vaccines, and we are getting them out to people. We are not, and were never, helpless — as a people, economy or government. We are beginning to defeat the disease. 

We have also, historically, made progress on polio, TB and cancer, and on race, poverty (especially for the elderly) and child labor. 

We can make progress on free but respectful speech and social decency, too — if we put enough American will and thought into both. 

Dr. Farmer is often accused of being “pathologically optimistic,” an odd trait in one who spends so much time with the hurting and the dispossessed. 

But he says he is no such thing. He says he is, on the contrary, realistic and empirical. For he says he knows of no instance in which a person has applied himself, or a community has applied itself, in which there was not at least a partial positive result. 

He adds: “If you irrigate a medical desert [with ‘staff, stuff, space and systems’] it always blooms.”

Brazil hospitals pushed to limit as COVID-19 death toll soars another 2,233 today

Via Reuters: Brazil hospitals pushed to limit as COVID-19 death toll soars.

Intensive care wards for treating COVID-19 patients have reached critical occupancy levels over 90% in 15 of 27 state capitals, according to biomedical center Fiocruz. 

In Porto Alegre in southern Brazil, the main reference hospital for COVID-19 stopped admitting new cases because all its ICU beds were taken. A Reuters photographer saw patients on respirators crowding emergency rooms. 

“This is a warning. We’ve reached capacity and people need to become aware of how bad the situation is,” said Claudio Oliveira, director of the Conceiçao Hospital. It was the first time the hospital has turned away patients since the H1N1 epidemic in 2009. 

Oliveira told reporters the hospital closed its doors to avoid the collapse of care for the COVID patients there. 

The death toll from COVID-19 for the last 24 hours surpassed 2,000 for the second time, the Health Ministry said on Thursday, with 2,233 dead and new infections rising by 75,412. 

With more than 272,000 deaths, Brazil’s pandemic death toll over the past year trails only the United States. But over the past week, Brazil has averaged more than 1,600 deaths per day, ahead of some 1,400 in the United States, where the outbreak has ebbed. 

As President Jair Bolsonaro rails against lockdowns and urges Brazilians out of their homes, governors and mayors have struggled to enforce restrictions, often pleading in vain with a population inured to the rising tide of the epidemic. 

The far-right president attacked governors for the lockdowns again on Thursday, including Sao Paulo state’s move to ban soccer matches. He said they were increasing poverty with a medicine that was worse than the virus. 

“How long can we stand this lockdown irresponsibility? You close everything and you destroy millions of jobs. Lockdown is not a cure,” Bolsonaro said in a video address to a business group with Economy Minister Paulo Guedes at his side. 

 Brazil’s two most populous cities, Sao Paulo and Rio de Janeiro, on Thursday moved to tighten measures as their hospitals struggled with a second wave of the virus, driven by a more contagious variant that emerged in the Amazon region. 

While Europe and the United States ramp up vaccinations and bring down their caseloads, Brazil’s federal government is off to a slow start, with only 2% of the 210 million Brazilians fully inoculated so far. 

In the nation’s capital Brasilia, which is under a nighttime curfew, public hospital ICU wards are 97% full and private ones are at 99%, forcing the city to again set up field hospitals as it had during a peak in cases last year. 

On Thursday, Sao Paulo Governor João Doria announced a “new stage” of restrictions to enforce social distancing, arguing it is now the only weapon against the spread of the virus. 

They include a curfew from 8:00 p.m. to 5:00 a.m., the suspension of religious services and sports events, including soccer matches, and people not being allowed to use beaches and parks. 

“This is a tough, unpopular decision. No governor wants to stop the economic activities in their state,” Doria said at a news conference. 

The state of Sao Paulo, home to some 44 million people, is currently allowing only essential stores such as supermarkets and pharmacies to receive shoppers. 

The Sao Paulo health secretary said hospitals in more than half of the state’s municipalities are full and half the patients are under 50 years old. 

Last year, the most serious cases were concentrated among elderly Brazilians.

Covid-19 in Brazil: The government has failed to prevent the spread of the virus

An opinion piece in The BMJ by 3 professors at the University of São Paulo: Covid-19 in Brazil: the government has failed to prevent the spread of the virus.

Under the leadership of president Jair Bolsonaro, the federal government in Brazil has failed to implement a systematic plan to prevent the spread covid-19. Instead, under the pretext of shortening the public health crisis and protecting the economy, the Brazilian government has pursued a herd immunity strategy. We led a study that gathered and analyzed laws, judicial decisions, speeches, and public statements by federal officials. We found that these records suggest that the government pursued a three-prong approach to achieving herd immunity through widespread contagion of the public. 

Firstly, the president signed decrees that defined religious services, the construction industry, beauty salons, barber shops, and gyms as essential services so they could remain open even under lockdown. 

He vetoed a series of legislative measures to limit the spread of covid-19, such as the mandated use of face masks in prisons; the requirement that businesses which stay open during the pandemic supply employees with free personal protective equipment; the mandated use of masks in closed spaces (this was rejected on the grounds that it would encroach on the right to privacy in one’s home); and protections for indigenous communities—including the provision of drinking water, hygiene and cleaning products, hospital and ICU beds. 

The president also excluded various occupations from an emergency financial aid programme, effectively forcing people to keep working during the pandemic, while also blocking Congress’s proposed financial reparations to families who lost members on the frontlines of pandemic healthcare. These are just some of the measures that Bolsonaro has vetoed. 

Secondly, state and municipal government responses to the pandemic have been systematically obstructed. The president himself defined this as his “war” against government leaders who adopted disease containment measures. A few examples of this are: the unjustifiable delay of emergency funds to states and municipalities; the use of only a small portion of the pandemic response funds allocated by congress; and, through the Ministry of Health, the systematic mismanagement of purchases and distribution of fundamental items like diagnostic tests, personal protective equipment, respirators, oxygen, vaccines, and syringes. 

Despite tremendous pressure from businessmen and politicians, state and local governments have managed to avoid the collapse of Brazil’s national public healthcare system (SUS)—with shocking exceptions, like the city of Manaus.  

Finally, there has been a barrage of propaganda against public health. This has taken the form of political discourse that employs economic, ideological, and moral arguments, and disseminates disinformation and scientifically unverified      information with the purposes of discrediting health authorities, weakening public adherence to science-based recommendations, and encouraging political activism against the public health measures needed to contain covid-19.  

The president has not only held crowded public gatherings and travelled extensively around the country to preside over ceremonies like ribbon-cuttings; he has also systematically pushed the public toward contagion saying: “You’ll all catch it someday. What are you afraid of? Face up to it” and, further, “There’s no use trying to escape it, escape reality. We have to quit being a country of sissies.” 

Furthermore, he has pitted health against the economy. He incited supporters to invade hospitals to show that reports about overcrowded hospitals and the shortage of respirators were allegedly fake news. 

He has tried to discredit vaccines, claiming that they cause death and disabilities, and saying that “If you turn into a crocodile, it’s your problem.” He has also attempted to convince the public that the disease is vanishing. In December he said, “We’re now at the tail end of the pandemic.” 

His recommendation in the early stages of the pandemic that people use ineffective medicines, such as hydroxychloroquine, is an important element of this propaganda campaign. This recommendation was issued by the Health Ministry—but not before one minister was fired, and another stepped down. This longstanding, well-funded ministry had an exceptional technical staff that had weathered transitions of power for decades, but is now headed by a general, while more than twenty key posts are held by military officers, most lacking any public health training or background.  

Brazil has already surpassed 10,000,000 confirmed cases of covid-19 and 250,000 deaths, and the disease remains uncontrolled. Worldwide, one out of ten covid-19 deaths has occurred in Brazil; the SUS has spent a fortune on treating hospital in-patients, especially on ICUs, threatening the sustainability of the system; healthcare workers are exhausted; and, with the disease disproportionately impacting the most vulnerable, the pandemic has exacerbated Brazil’s already sharp social inequalities.

We recently read Kamran Abbasi’s editorial in The BMJ, which asks whether the behaviour of government rulers during the pandemic may constitute a crime. We wondered what is the purpose of having international or national laws and judiciaries if these do not serve to criminalize and punish public agents for decisions which cause the death of hundreds of thousands of people? Or which expose millions more to unpredictable consequences, under the unproven argument that it will protect economic activity?

It is our opinion that current international and Brazilian law offers grounds for immediately launching a debate on whether to hold Brazilian rulers accountable at civil and criminal levels. In fact, perhaps the absence of any such debate would merit the label “complicity.”