LIBERIA

Information last updated: 8 April, 2020

Sources: TheWorld Bank and WHO (Population over 65 years old, Informal employment , GDP-PPP , Hospital beds).

Status

No quarantine at the national level, State of Public Calamity.

Response set up and capacity

President Jair Bolsonaro’s stance on coronavirus as a “little flu” has raised questions about his ability to coordinate response to the pandemic, as he continues to contradict social isolation and sanitary measures issues by health officials in Brazil. Local state officials and Brazil’s Health Minister (both federal, and state) have taken on the role of coordinating mitigation actions.

Brazil has a national health system called Sistema Único de Saúde (SUS), and around 75% of the population depend exclusively on it. Currently, SUS has 28,000 ICU beds. However, in 2017, only around 10% of municipalities had this type of bed. Besides this geographical disparity, there is also a difference between the public and private health systems. While, from 2007 to 2019, SUS had a drop of 14.3% in the number of beds, the private system had a 18.2% increase. Due to this unbalance in the system, the Minister of Health, Luiz Henrique Mandetta, declares that it is not possible to predict when the capacity of SUS will become saturated.

Seeking to better prepare the SUS, the Ministry of Health announced the creation of 2,000 ICU beds and will also hire 5, 811 physicians to work during the pandemic at a cost of R$ 1.2 billion. These physicians will be allocated to the primary care field, which is the main area of focus for the Ministry.

In addition to this, the Ministry of Health issued an ordinance that outlines the rules for quarantine and social isolation the country may undertake during the pandemic. However, this measure has not been applied to Brazil as a whole. Some states have determined measures of social isolation where only services considered essential are to be kept open. This is the case of the two states with the highest confirmed cases: São Paulo and Rio de Janeiro. Both have valid isolation measures until April 7th and April 17th, respectively, but may be renewed upon each state government’s assessment.

Stakeholder Mapping

Entities / Organizations

• Brazilian Ministry of Health
• Fiocruz: Research and development institution in biological sciences
• Anvisa: National Health Surveillance Agency is a regulatory agency linked to the Ministry of Health
• Government of the State of São Paulo
• Rio de Janeiro Health Secretariat
• Federal District Health Secretariat

Additional actors

• Rede Solidária: network that brings together NGOs that fight for the implementation of emergency policies during the pandemic.
• Emergência Covid-19: platform created by GIFE gathering the actions created by various philanthropic organizations.
• Segura a Onda: platform that gathers citizen initiatives to tackle the Covid-19 pandemic.

Mitigating factors - What is being done?

For more information, see the timeline below:

February 9: repatriation of 24 Brazilians living in Wuhan. They were quarantined for 14 days at Anápolis Air Base in Goiás.
February 25: first case of covid-19 confirmed in the country, the first one in Latin America. It is a 61-year-old man who returned from a business trip in Italy.
March 28: The Ministry of Health launches a coronavirus prevention campaign on TV, radio and the Internet. The country has 182 suspicious cases in 16 states.
February 29: Ministry of Health announced the adoption of a new workflow for the consolidation of the new coronavirus cases: decentralization by fully adopting the data passed on by local bodies. It also launches the app, “Coronavirus – SUS”, for Android and iOS, where it is possible to get information about prevention, symptoms and nearby health units among other relevant information.
March 5: recorded the first internal transmission.
March 6: Ministry of Health announces expanded measures to strengthen hospital care by reinforcing primary care (in order to prevent people from seeking hospitals); Saúde na Hora Program will allow health units to be open until 10 pm as well as during the weekends; offering telemedicine to assist the care of critically ill patients and increasing the number of beds in Intensive Care Units.
March 12: Ministry of Health launches a public notice with 5,811 vacancies for doctors to work in health posts across 1,864 municipalities in addition to 19 Indigenous Special Sanitary Districts. The Ministry of Health recommends that coronavirus testing should only be done in severe cases.
March 13: Ministry of Health regulates isolation criteria and quarantine to be applied by health authorities in patients with suspected or confirmed coronavirus infection.
March 15: Ignoring health authorities, several Pro-Bolsonaro acts occur in several cities. President Bolsonaro greets supporters at the Brasília act.
March 16: Rio de Janeiro and São Paulo record community transmission. The Ministry of Health announces R$ 432 million for states to reinforce their contingency plan. More than 500 ICU beds will be distributed across the 26 states and the Federal district
March 17: First death from the new coronavirus, a 62-year-old man from São Paulo. He had a history of diabetes and hypertension. The State of Rio de Janeiro decrees state of emergency and defines temporary measures to prevent the spreading of the new coronavirus.
March 18: Ministry of Economy announces it will pay informal workers (41% of the workforce) a voucher of R$ 200. Initial measures included only formal workers.
March 20: Ministry of Health declares that there is community transmission of the new coronavirus throughout the national territory. Only one state, Roraima, does not register contamination. The House of Representatives approved the public calamity decree requested by the federal government (it was the first virtual vote of a parliament in the world). The measure allows for the Union’s spending and targets for 2020 to be loosened.
March 21: 5 million rapid tests are acquired for national distribution by the Ministry of Health.
March 22: President Bolsonaro determines which services are essential and will not stop during the pandemic. Two cases registered in Roraima, so all states have confirmed cases. President Bolsonaro issues a provisional measure authorizing the suspension of employment contracts for up to 4 months. During this period, the company will have to offer the worker an online professional qualification program and maintain benefits such as health insurance.
March 23: Government restricts entry, by air, of foreigners coming from Europe and several Asian countries for the next 30 days. After strong criticism, Bolsonaro revokes the excerpt from the provisional measure that authorizes the suspension of salaries for 4 months.
March 24: In a statement broadcasted nationally, Bolsonaro calls for Brazil to ‘return to normality’, asking commercial establishments to be kept open and for people not to be confined in their homes. He calls covid-19 ‘a little flu’ and speaks of ‘hysteria’ due to the pandemic. A new provisional measure is published suspending the deadline of requests of public information via the Access to Information Act for the duration of the pandemic.
March 25: In a video conference meeting, governors from 25 states discuss emergency actions and maintain isolation measures.
March 26: Alexandre de Moraes, Federal Supreme Court Minister, suspends the effects of the provisional measure that suspended requests of public information via the Access to Information Act for the duration of the pandemic. Bolsonaro issues a decree that includes religious activities among essential activities. The Ministry of Health provides an exclusive channel to receive donations of materials and equipment during the pandemic. A letter signed by 7 former ministers of health condemns the speech made by Bolsonaro on March 24th. The National Congress approves the Basic Emergency Income project, which guarantees aid of R$ 600 for informal workers and R$ 1,200 for solo mothers.
March 31: Ministry of Health updates Coronavirus SUS app. It now sends messages and alerts, even if the app is not being used at the moment, new data is also available that qualifies the user within risk groups and it is also available in English and Spanish. Governor of Bahia and president of the Northeast Consortium, Rui Costa, announces another app for combating the new coronavirus. It allows governors and mayors of the region to monitor people with Covid-19 symptoms. The Ministry of Health prepares to change protocol and recommends that everyone should wear protective masks, which can be made at home from cloth.
April 1: The Ministry of Health announces the remote monitoring of suspected Covid-19 cases from automatic calls. It will use artificial intelligence to identify vulnerable people with signs and symptoms of contamination. The Ministry of Science, Technology, Innovation and Telecommunications announces a public call of R$ 50 million to fund research for new methods of diagnosis, treatment and containment.
April 4: Bolsonaro calls for religious fasting on April 5th against the new coronavirus

Risks, vulnerabilities, obstacles

According to a projection study by Imperial College London, if Brazil undertakes an intense and early restriction measure of social distancing, it will account 11.5 million cases and 44.2 thousand deaths. If no measures are taken, the number of cases can reach as much as 182.8 million and 1.1 million deaths. On March 24th, President Bolsonaro was highly criticized for defending vertical isolation, if such a measure was to be adopted, the study points that the country might have 113 million cases and 471,7 thousand deaths.
One of the biggest challenges the country is currently facing is its inability to have massive testing for the population. Although the government has ordered more than 4 million tests and another 10 million are under negotiation, it is still not enough to reach the target of carrying 50,000 tests a day during the peak of the pandemic. A further problem is that labs apt for processing the test already have their capacity exceeded. In some areas, for every case reported to the federal government, 30 might go unnoticed.
Another pressing issue is the millions of Brazilians who make up the informal workforce and were forced to stop their economic activities during the quarantine. In order to counter this, the National Congress approved an emergency assistance package of up to R$ 1.200 for three months (this measure can be extended) at a total cost of R$ 98 billion to the federal government.

Potential actions and demands

In Brazil, the pandemic is being lived with high tensions among President Jair Bolsonaro, the Health Minister Luiz Henrique Mandetta, and the governors of various states. The President has ignored the quarantine and social distancing measures recommended by the Health Ministry by encouraging citizens to keep working and has called the Covid-19 a ‘little flu’. On March 25th, governors from 25 states presented a unified letter to President Bolsonaro asking for support and ‘good sense’ but not to much avail.
Regarding the quarantine, as April 7th approaches, date when it is supposed to end in São Paulo, the state with the most cases, Governor Doria will most likely extend it for another 15 days. Similar measures are expected from other governors.
Feeling the pressure of the economy coming to a halt, and considering that Brazil will go through a second wave of coronavirus infection, Paulo Guedes, the Minister of Economy, has suggested that the country should use immunity passports. This means that people who are not infected by Covid-19 can return to work.

Key resources

Panel with number of beds and medical materials per state
Epidemiological Bulletins edited by the Health Surveillance Secretariat. Has monthly and weekly periodicity for cases of monitoring and investigation of specific seasonal diseases
Panel of coronavirus cases in Brazil by the Ministry of Health
Brasil.io daily newsletter and coronavirus cases per municipality
Reddit with constant update on the new coronavirus in the country
Article: “Using Misinformation as a political weapon: COVID-19 and Bolsonaro in Brazil”

Contributor(s): Silvia Rodrigues Follador.