Pill-Popping Bolsonaro Sows Covid Chaos at Brazil’s Hospitals

(Bloomberg) -- Brazil’s public hospital doctors say they’re being pressured into handing out hydroxychloroquine by both patients and colleagues, even as a debate rages over its efficacy and safety.

“I was called in several times to stop fights,” said Joao Assy, an infectious disease specialist in Santarem, a coastal city in the hard-hit northern state of Para. He and fellow doctors circulated a petition urging medical professionals in the city not to prescribe hydroxychloroquine and its sister drug, chloroquine. But some colleagues disagreed strongly, and quarrels with his patients turned ugly.

Jair Bolsonaro’s recent Covid-19 diagnosis is only adding to the confusion, with the president popping a pill in a social media video this week and asking his followers: “I believe in hydroxychloroquine. Do you?” As the virus has spread, the Bolsonaro administration has imported millions of doses, ramped up local production and shipped batches across Brazil.

According to a recent survey by the Sao Paulo medical association, nearly half of almost 2,000 doctors interviewed across the country said they’ve also felt pressured to administer treatments unbacked by scientific evidence.

Months into the deadly pandemic, the global medical community is still split on whether the cheap anti-malaria drugs represent the best hope for Covid-19 patients or a false one.

The effectiveness of the two treatments has been hotly debated ever since Donald Trump touted them as potential game changers against the virus. The U.S. Food and Drug Administration last month revoked emergency use authorization after determining the drugs may have deadly side effects, and the World Health Organization last week announced it would discontinue its own tests of hydroxychloroquine.

But one study that demonstrated links to an increased risk of death and heart ailments was retracted last month. And the treatment is getting another chance to prove it works, as a trial led by Bangkok-based Mahidol Oxford Tropical Medicine Research Unit recruits up to 40,000 health workers in contact with Covid-19 patients to determine if it can prevent infection.

The controversy over the drugs use has been particularly heated -- and politicized -- here in Brazil. Critics of Bolsonaro, 65, say his reliance on the drug instead of more widely accepted deterrents, like social distancing and lock-downs, has left local governments fending for themselves and confused the population. Brazil trails only the U.S. with almost 70,000 confirmed deaths and over 1.76 million total cases.

Bolsonaro has lost two health ministers since the country’s first confirmed case in February: The first was fired in April after demanding more aggressive social-distancing measures to the pandemic and criticizing the use of unproven treatments as counter productive; the second quit after less than a month on the job, allegedly because Bolsonaro wanted him to issue a blanket use policy for the family of chloroquine drugs.

Under the active-duty military general with no health care experience who is now filling the post temporarily, the administration quietly expanded production and use of hydroxychloroquine. According to the Health Ministry, some 4.3 million doses have been distributed to health systems throughout Brazil, nearly half of which were donated by the U.S. government.

The ministry stops short of prescribing the treatment out right. It recommends it for mild cases, which include symptoms like coughing and fever, to severe ones, involving difficulty breathing and low blood pressure. In June, it began recommending it to pregnant women and children, and last week it released guidelines highlighting over a dozen studies that defended its use.

Regardless of its efficacy, the drug gives Bolsonaro credence to claims it’s now safe for Brazilians to start working again, says Anya Prusa, an analyst at the Wilson Center’s Brazil Institute. “When trying to mitigate economic fallout, having unproven treatment that he can offer is convenient,” she said.

Meanwhile, confusion -- and chaos -- continues in Brazil’s rickety public health-care system.

“A patient with mild symptoms shouted at me and demanded a prescription, but I refused,” said Camila Louise, a doctor working at a Santarem field hospital. “It’s contrary to our protocol and my ethical conduct.”

Elsewhere in Latin America:

• Colombia reported a record daily rise of 5,335 confirmed Covid-19 cases on Thursday as well as 187 deaths. President Ivan Duque said daily tests also rose to a daily record.
• Venezuela’s Diosdado Cabello, a powerful Socialist party leader with close ties to the military, tested positive for coronavirus as did a pro-government governor in Zulia state, showing the pandemic spreading in the country.
• Bolivia’s interim leader Jeanine Anez also announced that she’s been diagnosed with the virus.
• Mexico posted another record day of cases and more Pemex workers passed away from the illness, bringing the total to 191. Authorities insist that the spread is improving.
• China halted shrimp imports from several plants in Ecuador after traces of Covid-19 were detected on the inside and outside of the packaging.

©2020 Bloomberg L.P.