Brazil President Embraces Unproven ‘Cure’ as Pandemic Surges

RIO DE JANEIRO — The coronavirus was taking root in Latin America when President Jair Bolsonaro of Brazil startled the medical community with a claim: A miracle drug was on hand.

“God is Brazilian, the cure is right here!” the president exclaimed in late March to a throng of supporters. “Chloroquine is working everywhere.”

Since then, the virus has ripped through Brazil. More than 41,000 people have died — Brazil has now passed Britain and has recorded more fatalities than any country other than the United States — and the daily death toll is now the highest in the world, bucking the downward trend that is allowing other major economies to reopen.

Experts point to Mr. Bolsonaro’s rejection of the emerging scientific consensus on how to fight the pandemic — including his promotion of unproven remedies such as chloroquine and hydroxychloroquine — as one of the factors that helped tilt the country into its current health crisis.

Mr. Bolsonaro ordered the armed forces to mass produce it in the military’s pharmaceutical laboratory and ordered a large supply of the drug’s ingredients from India.

“Decisions are being made not based on evidence and empirical data but rather on anecdotal reports,” said Denise Garrett, a Brazilian-American epidemiologist who worked at the Centers for Disease Control and Prevention for more than 20 years. “Bolsonaro invested a huge amount of money into an action that has not been proven to be effective at the expense of increasing testing and contact tracing.”

Between February, when Brazil identified its first coronavirus case, and June, when Brazil’s coronavirus caseload topped 828,000, lagging only behind the United States, the country had months to learn from other nations that had been ravaged by the virus and prepare for the pandemic.

Instead, Mr. Bolsonaro has led the country down what health experts call a perilous path: He sabotaged quarantine measures adopted by governors, encouraged mass rallies and repeatedly dismissed the danger of the virus, asserting that it was a “measly cold” and that people with “athletic backgrounds,” like himself, were impervious to serious complications.

Earlier this week, Mr. Bolsonaro’s administration stopped disclosing comprehensive coronavirus statistics, leaving Brazilians without an official tally showing the trajectory and scope of the outbreak. The data was restored after the Supreme Court ordered the ministry to resume publishing it.

Under his tenure, decisions about medical and scientific protocols became measures of political loyalty. As the coronavirus crisis worsened, Mr. Bolsonaro leaned on the health ministry to embrace widespread use of chloroquine and hydroxychloroquine, straining his relationship with the two physicians who have served as health ministers. One was fired in April and the other one lasted less than a month on the job.

Their successor, an active duty general with no medical experience, agreed to issue guidance encouraging doctors to prescribe the drug widely for Covid-19 patients.

Chloroquine and Hydroxychloroquine are both anti-malaria drugs but they have distinct secondary uses; hydroxychloroquine also treats lupus and rheumatoid arthritis. Both drugs are among the pharmaceuticals being studied as potential remedies for Covid-19, but neither drug has been approved as a reliable treatment for Covid-19 patients.

The United States Food and Drug Administration warned against use of the two drugs in Covid-19 patients outside of hospital settings because they can cause heart problems.

Margareth Dalcolmo, a prominent pulmonologist and researcher at Fiocruz, a government agency that does health care research in Rio de Janeiro, said Brazil’s embrace of the drug set a dangerous precedent — and is hampering the necessary research.

“Today chloroquine became a political panacea, which is harmful for science,” she said in an interview. “What we have, as I see it, is an unfortunate politicization of pharmaceuticals”

The controversy over hydroxychloroquine has also reverberated outside Brazil.

In mid-May, President Trump said he had begun taking the drug as a preventive measure, which generated consternation among doctors.

Later that month, the White House announced it was donating two million doses of the drug to Brazil so it could be used “to treat Brazilians who become infected.”

Representative Eliot Engel, the New York Democrat who chairs the House Foreign Affairs Committee, called that decision appalling. “It’s irresponsible that President Trump and Jair Bolsonaro have put politics over science,” he said in a statement on Twitter.

Studies into the drug’s uses continue. Earlier this month, the first carefully controlled trial of hydroxychloroquine found the drug does not prevent the disease in people who have been exposed to a sick patient.

Also, a prominent medical journal, The Lancet, took the rare step of retracting a widely-read study earlier this month that found the drug could be dangerous in Covid-19 patients. The study, which was withdrawn after its underlying data was called into question, led doctors to halt some clinical trials.

In Brazil, the battle over hydroxychloroquine began in March as doctors were preparing for a crush of patients and testing a variety of drugs based on treatment protocols that had shown promise in other countries.

Marcelo Kalichsztein, a prominent pulmonologist in Rio de Janeiro, began prescribing hydroxychloroquine to coronavirus patients soon after they developed symptoms, along with the antibiotic azithromycin and a zinc supplement. He did so having found the research of the French microbiologist, Dr. Didier Raoult, persuasive. But Dr. Raoult’s research was discredited, and the scientific group that published it said later that the paper had not met its standards.

“This is a brand-new disease and we don’t have a silver bullet,” Dr. Kalichsztein said. “We were all searching for a medication that would stop the virus in the very first stage.”

Dr. Kalichsztein, who contracted the virus in early April and took hydroxychloroquine, said the treatment had been effective in preventing the disease from reaching an inflammatory stage among more than 100 patients whose care he oversaw.

Doctors began sharing their experiences with the drug and tips on how to mitigate the risk of heart complications in Zoom meetings and group chats on WhatsApp.

  • Updated June 12, 2020

    • What’s the risk of catching coronavirus from a surface?

      Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.

    • Does asymptomatic transmission of Covid-19 happen?

      So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.

    • How does blood type influence coronavirus?

      A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.

    • How many people have lost their jobs due to coronavirus in the U.S.?

      The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.

    • Will protests set off a second viral wave of coronavirus?

      Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission.

    • How do we start exercising again without hurting ourselves after months of lockdown?

      Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home.

    • My state is reopening. Is it safe to go out?

      States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.

    • What are the symptoms of coronavirus?

      Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.

    • How can I protect myself while flying?

      If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)

    • Should I wear a mask?

      The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.

    • What should I do if I feel sick?

      If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.

While these discussions were happening out of sight, Nise Yamaguchi, a São Paulo immunologist and oncologist, emerged as a high profile champion for the drug, arguing in television interviews that it had the potential to prevent patients from becoming sick enough to require hospitalization.

Dr. Yamaguchi, who caught Mr. Bolsonaro’s attention and was summoned to meet with him, said she never intended to become embroiled in the heated political debate that has added to Brazil’s polarization.

“The doctors and scientists that act based on academic research can’t allow themselves to be guided by political matters, since the health of the patient is paramount,” she said in an email.

But by mid April, hydroxychloroquine became something of a litmus test among Brazilians who revere and loath the far-right president, who has invested a lot of political capital — and public funds — in the drug.

Staunch supporters of the president clamored for more widespread use of the drug in YouTube videos, memes and tweets that claimed that a lifesaving drug was being maligned by leftists. They promoted their posts with hashtags that included #BolsonaroWasRight, #HydroxychloroquineSavesLives and #HydroxychloroquineNow.

Eduardo Bolsonaro, one of the president’s sons, posted a video on his YouTube channel on April 17 that attacked a study that warned about the side effects of the drug.

“The left is coming together to create fake studies about chloroquine,” he wrote in the video caption. “The objective is to demonize the medicine, even though they know that it’s effective to save lives.”

Mr. Bolsonaro’s minister for human rights, Damares Alves, an Evangelical pastor, called the medication a “miracle.

The charged political debate surrounding the use of the drug could interfere with ongoing trials, said Dr. Garrett, the former C.D.C. expert.

“Either volunteers won’t want to be part of it because they are contaminated by the political debate or the ones who will be part of it may be doing it driven by political ideology,” she said.

And that, she said, would be “very unfortunate for public health.”

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