Assessing government responsibility for COVID-19 deaths

Abstract

Pedro Hallal1Hallal PC SOS Brazil: science under attack.Lancet. 2021; 397: 373-374Summary Full Text Full Text PDF PubMed Scopus (50) Google Scholar describes how Brazil's President Bolsonaro has ridiculed the COVID-19 pandemic, hindered scientists, and implemented unreasonable policies. One point, holding the president's policies accountable for the death of 156 582 people, warrants a closer look. The estimate is based on the premise that Brazil should have COVID-19 death rates equal to the world average. However, there are substantial limitations to that assumption. Many of the countries reporting death rates that are less than the world average have authoritarian governments that typically control and censor information.2Mundt AP Question hubris in nations' COVID-19 responses.Nature. 2020; 586: 500Crossref PubMed Scopus (1) Google Scholar These governments can under-report cases to avoid unrest. Furthermore, these countries make use of force, restrictions, and surveillance in a way that is not always viable in democracies in middle-income and high-income countries. The mobility of people in high-income countries might increase the risk of spread. Population risks differ with age distributions, for example in Africa.3Clark A Jit M Warren-Gash C et al.Global, regional, and national estimates of the population at increased risk of severe COVID-19 due to underlying health conditions in 2020: a modelling study.Lancet Glob Health. 2020; 8: e1003-e1017Summary Full Text Full Text PDF PubMed Scopus (527) Google Scholar Comparisons within regions might be more reasonable to establish expectations for a single country. A look at several South American countries reveals that COVID-19 death rates per 100 000 people by Jan 25, 2021, in Peru (120), Argentina (104), Colombia (102), Chile (94), Bolivia (86), and Ecuador (83) do not substantially differ from those in Brazil (102). Even within regions, the comparison of COVID-19 infections and death rates between countries can be limited because of different testing capacities, that have resulted in 10-times differences within South America. Assessing omissions and delays of specific policy interventions could be a way forward to better understand the links with infection and death rates.4Benitez MA Velasco C Sequeira AR et al.Responses to COVID-19 in five Latin American countries.Health Policy Technol. 2020; 9: 525-559Crossref PubMed Scopus (76) Google Scholar The method presented in the Correspondence,1Hallal PC SOS Brazil: science under attack.Lancet. 2021; 397: 373-374Summary Full Text Full Text PDF PubMed Scopus (50) Google Scholar to hold a government accountable for a precise number of COVID-19 deaths, needs to be refined and can unduly raise expectations that legal consequences will be faced by the government. APM received funding from the Agencia Nacional de Investigación y Desarrollo, Government of Chile, Chile (FONDECYT Regular 1190613 and FONIS SA19I0152). SOS Brazil: science under attackAs of Jan 21, 2021, Brazil ranks second in number of deaths from COVID-19 and third in number of cases seen in any single country. As a scientist, I tend not to believe in coincidence. In March, 2020, President Jair Bolsonaro referred to COVID-19 as a “gripezinha”,1 a little flu. In April, 2020, he declared there were signs the pandemic was coming to an end. A month later, when asked by journalists about the increasing numbers of COVID-19 cases, Bolsonaro responded “So what? What do you want me to do?”2 In response, the Editors3 suggested that “perhaps the biggest threat to Brazil's COVID-19 response is its president, Jair Bolsonaro”. Full-Text PDF