The Lowy Institute, an Australian think tank, conducted a survey about countries’ capacity to respond to the pandemic. From the data collected, researchers at the Institute organized a ranking and its results showed that several countries have seen difficulties to react and are acting ineffectively in controlling the pandemic. Among them, Brazil ranks in the worst position. 

The ranking considers the number of confirmed cases and deaths, the share of cases and deaths per million inhabitants, the number of confirmed cases compared with the proportion of tests applied and the share of tests per thousand inhabitants. Brazil is in the worst position among the 98 countries with available data. In order, the five worst cases are: Brazil, Mexico, Colombia, Iran and the USA. 

Performance of the Brazilian government

The performance of the Braziliand government is not only ineffective, it intends not to fight the pandemic with the establishment of an institutional strategy aimed to spread the coronavirus, as shown in the research by CEPEDISA (USP)/Conectas Direitos Humanos. 

Public health actions were initially conflicting and dubious, oscillating between the promotion of prevention and denial. However, the Brazilian strategy unfolded and consolidated from the denial of both the virus and the pandemic, through the minimization of Covid-19’s severity, to systematically discourage to wear masks and discouragement to vaccinate, all reinforced by the sale of a great illusion: the promise of a prophylactic and curative treatment embodied by the so-called “Covid-19 Kit”.

Successful strategy. The PNAD COVID-19 Survey, conducted in September 2020, shows that of the 8.3 million people who had flu symptoms, only 2 million sought medical attention. Of the remainder, 71.6% chose to stay home as a precaution, and 57.8% stated that they self-medicated. 

The Covid-19 Kit

Even without any scientific proof, the Covid-19 kit “went viral”, mainly because it was recommended, produced and distributed by the Ministry of Health, prescribed by many doctors, while Bolsonaro never missed an opportunity to promote the purported curative potential of these drugs, and to appear publicly without a mask and in crowds. 

Ivermectin, a lice medicine, is one of them. It was indicated for prophylactic use, and was even distributed free to the population by some municipal health departments. Continuous use was recommended “throughout the pandemic”. The drug should be taken, at a dose indicated by a doctor, every 15 days, a frequency necessary to maintain the “plasmatic level of the drug in the organism of the people for the duration of the pandemic”. It is not unusual to find people who have adopted the practice, without any medical follow-up and completely unaware of the risks to which they are exposing their health.  

The Covid-19 kit is successful in a society with a healing culture, which is accustomed to self-medication, it is true. But its greatest success is to free people: to work (of course!), but also for free movement, to organize parties, from family celebrations to large agglomerations, from New Year’s Eve to Carnival. 

Recently, beachgoers on the beaches of the city of Santos were highlighted in the media claiming that Covid-19 does not exist, or that a trusted doctor had said that one can only use the Covid-19 kit, because the disease would be nothing more than a little flu. Some interviewees reverberate the speech of Bolsonaro, who never tires of reminding us that “we are all going to die one day”! But the “we are all going to die” reverberated on the sands of the beaches is followed by: “if I can ride a bus, train or subway to work, I can go to the beach on the weekends.” 

When the individualized risk and the naturalization of death are imposed as a condition for survival, preventive and collective health strategies like the ones necessary to preserve life during the pandemic lose their meaning. It is the essence of the Unified Health System (SUS) put in check.

Pandemic and inequalities

Political decisions and speeches matter. They drive behavior, have the potential to promote chaos, or social cohesion. In pandemic times, their impacts are absolutely evident. In Brazil, the induced behavior translates into a dizzying increase in the number of cases, the emergence of new variants of the virus, the lack of essential supplies (such as oxygen in Manaus), and the explosion in the number of deaths. 

This is just the tip of the iceberg. Data from PNAD COVID-19 and the Severe Acute Respiratory Syndrome (SARS) hospitalization database, analyzed by researchers Lígia Bahia and Jéssica Pronestino, show the inequalities reproduced and deepened by the chaos, and the fallacy contained in the “we are all going to die”. 

According to the PNAD, 28.6 million people in Brazil were tested for coronavirus infection, of which 6.3 million tested positive. Among those earning between ½ and 1 minimum wage, 9.9% were tested; between 1 and 2 minimum wages, 14.4%; among those earning 4 or more minimum wages we observe a leap: 29.3% were tested. 

The lethality was higher among the poorest. The mentioned analysis shows that among the patients hospitalized with confirmed cases of SARS, considering their color/race, the lethality was 56% among whites, and 79% among non-whites. When we look at the proportion of deaths by level of schooling, we found a higher lethality among those who had completed elementary school II: 71.3% of deaths among those with no schooling; 59.1% among those who had completed elementary school I; 47.6% among those who had completed elementary school II. In the middle and higher levels we see the lethality drop: 35% among those with middle school education, 22.5% for those with higher education. 

Death by Covid-19 has color, class, income, education. It is socially and politically determined. Health is socially determined. It seems that the government has unlearned this valuable lesson. This is an evidence observed also in other countries, but aggravated in Brazil.

Neoliberalism and health

The pandemic, and the actions of countries like Brazil, place before us two urgent and complementary challenges, especially sensitive for public health systems: the first is to understand the power and the impacts of the neoliberal project in our societies and seek ways to allow a reaction; the second is to rescue and renew the conceptual and political debate of the social determinants of health and affirm to the citizens the importance of public managers acting from and about them. 

In this context, neoliberalism manifests itself in the lack of horizons, individually and collectively shared; in the presentism that imprisons people in the urgencies of daily life. With the possibilities of survival reduced to individual risk management, the individual dismisses the collective, is responsible for his fate and, perversely, for his health, which makes the fallacious promise of cure of the Covid-19 kit enchanting.

The erasure of the social gradually promoted by the neoliberal project in Brazil is at the core of the crisis we face today. It is necessary to rescue the centrality of the community if we want death not to be the only possible horizon. 

_{*Translation from Spanish by Ricardo Aceves}

_{Photo by Palácio do Planalto at Foter.com / CC BY}