Brazil and COVID-19: A new Minister of Health, Hydroxychloroquine and, Chloroquine

May 20, 2020
     President Jair Bolsonaro discredits the COVID-19 threat is causing a catastrophic number of human losses. This could have been avoided if rigid policies to prevent the virus spread were placed, as we see the success cases in some European countries. National policies on prevention were not encouraged, while misleading information on social isolation and medicines to treat the coronavirus became the slogan of Bolsonaro’s administration. The leadership instability in Brazil’s Ministry of Health also gained international attention due to its critical role in times of COVID-19, showing how the government is divided.
 
     Worldwide, until May 2020, COVID-19 has infected more than 4,900,000 individuals and has reclaimed the lives of more than 300,000. In the southern hemisphere, Brazil, the largest country, reaches the 4th place in the worldwide rank of infections on May 19. The country has 265,896 people suffering from the COVID-19, with a death toll of 17,840 people (Worldometers, May 19, 2020). Also, the forecasts are not looking positive. The home country of Christ the Redeemer statue has already surpassed Italy, France, and the UK; now ex-hotspots of a pandemic that left deep scars with dramatic images of the agony, crowded hospitals, and death. Worse yet, Brazilian’s administration shows no signs of commitment to change its approach to handle COVID-19.
 
     To recap history, on April 16, 2020, Brazilian Minister of Health, Luis Henrique Mandetta, was fired. Local news stated that the main reason for Mandetta’s leave was a disagreement between Bolsonaro’s and the former minister’s policies on social distancing to prevent the population’s contagion. Diverging from Bolsonaro, Mandetta followed science through statistics and was committed to following the WHO guidelines on COVID-19. Mandetta’s leadership on this stance gave him a 76% approval rating (The Brazilian Report, 2020). When Mandetta left office, Brazil had reported 30,683 cases of COVID-19 and 1,947 deaths (Worldometer, 2020).
 
     After Mandetta, the Health Minister role was occupied by Dr. Nelson Luiz Sperle Teich. In his first speech, Nelson Teich openly stated that he was completely aligned with the executive (and thus Bolsonaro’s policies). Also, as a doctor, he highlights the relevance of testing as an important method of knowing the truth virus spread rates as well as the significance of research on vaccines and medicines on COVID-19. However, he also showed a dubious posture on social distancing policies, stating that “there will be no abrupt or radical definition of what is going to happen.” Leaving many uncertain about what he was planning to do (Examen, 2020).
 
     To the surprise of many, Nelson Teich remained less than one month in the role. On May 15, 2020, he renounced, and in his last broadcasting speech, he emphasized that as a minister, “a testing program was built and ready to be implemented to help better understand the dimension of the COVID-19 in the country”. Also, he said that 4,000 ICU beds were deployed and supplied protective equipment and human resources while the world has a medical supply shortage (CNN, 2020a). Teich gave no specific reasons for quitting, but different news sources stated that Bolsonaro’s pressure to issue federal guidelines to adopt chloroquine as COVID-19 treatment to even those suffering mild-cases of the disease was the main culprit for Teich leaving office. Nelson Teich was opposed to the indiscriminate use of the drug (CNN, 2020b).
 
     Worldwide, the use of hydroxychloroquine/chloroquine in combination with other drugs in patients with COVID-19 is inconclusive. Neither medical consensus nor conclusive scientific evidence that guarantee the use of these drugs to prevent or cure patients with coronavirus is found. Two new studies published recently found that COVID-19 patients using hydroxychloroquine did not get better significantly faster than those not treated with the drug.” (Reuter, 2020). What these studies suggest is that there is no significant benefit while their collateral effects remain as a life-threatening risk, which includes fatal heart complications when used in patients with COVID-19.
 
     In the United States, in April 2020, the US Food and Drug Administration cautioned the use of hydroxychloroquine and chloroquine in patients suffering from the COVID-19. The recommendation emphasizes the risk of using the drugs outside the hospital setting or a clinical trial due to their risk of heart rhythm problems, which emphasize those previously diagnosed with heart and kidney diseases (US FOOD&DRUG, 2020). The organism is also warning the public that to decrease the deadly risks “...the hydroxychloroquine and chloroquine, either alone or combined with azithromycin when used for COVID-19 should be limited to clinical trial settings or for treating specific hospitalized patients” since the constant medical supervision is critical in case of side effects. 
 
      Although several similar data on the use of chloroquine were available in Brazil, President Bolsonaro is unable to listen and weigh the drug’s side effects in his decisions. After Nelson Teich left office, on May 16, 2020, it was announced that Eduardo Pazuello, the executive-secretary of the Ministry of Health and General of the Brazilian Army, would assume the leadership of the Ministry of Health provisionally (Examen, 2020b). On May 15, the Ministry of Health announced a new guideline to treat COVID-19 patients was being finished. This guide would allow the use of drugs like chloroquine to treat coronavirus patients, including those with mild symptoms (Globo.com, 2020a).
 
     Recently, on May 18,  the Brazilian Society of Immunology (SBI) issued a document titled: Scientific Opinion of the SBI on the use of Chloroquine/Hydroxychloroquine for the treatment of COVID-19. In the document, the SBI states that “.. based on the current evidence that evaluated the use of hydroxychloroquine for the treatment of COVID-19, the SBI concludes that the recommendation to use this drug in COVID-19 patients is still early since different studies show that there are no benefits for patients who used hydroxychloroquine. Also, it is a medication with serious adverse effects that must be taken into account. Thus, the SBI strongly recommends awaiting the results of ongoing multicenter randomized studies, which includes another study being coordinated by the WHO, to obtain a better conclusion as to the real efficacy of hydroxychloroquine and its associations for the treatment of COVID-19 patients…” (SBI, 2020).
 
     Even in the dramatic Brazilian context of COVID-19, politicians can not deny that there is no vaccine nor an effective drug to treat patients with coronavirus worldwide. Scientific data and research on COVID-19 are key to mitigate the chaotic health infrastructure in the country. The policies to manage the COVID-19 pandemic can not be politicized, and a new leader for its Ministry of Health is urgently needed or “recalled.” The new minister must listen and embrace health scientists’ suggestions in the design of new guidelines for COVID-19 prevention and treatment. However, nothing will change if Bolsonaro does not listen to field experts and pay attention to other countries’ use or restrictions of drugs such as Chloroquine/Hydroxychloroquine. Brazil’s current scenario is dire; the infection rate as of May 20 is around 16 thousand per day.  Only one month since the minister of health shift, Brazil’s number of deaths grew more than 12x times from 1,947 deaths on April 16 to 15,633 losses on May 16, 2020. There is nothing showing that Brazil will improve and may reach or even surpass US COVID-19 numbers. 

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About Author(s)

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Marilu Nuñez Palomino
Marilu Nuñez is a graduate student of Public and International Affairs with a major in International Political Economy at the University of Pittsburgh. She has a Master's Degree in Accounting for the FEA-USP in Brazil. Currently, she is doing research on International Trade and Mental Health in the Americas.