COVID-19 in Brazil: the headlines should be about science
Authors: André Zimerman, Renato D Lopes, André D'Ávila, Luis E Rohde, Leandro I Zimerman
Journal: The Lancet (2020)

We have all heard this story: fuelled by untimely political disputes, COVID-19 spread like wildfire in Brazil. Much attention has been given to these controversies, and understandably so: reports about the president who replies, "So what?" when asked about escalating deaths incite our curiosity and our exasperation. These are the stories everyone hears about, the stories everyone talks about, including the Editors.1COVID-19 in Brazil: "So what?".Lancet. 2020; 3951461Summary Full Text Full Text PDF PubMed Scopus (337) Google Scholar But there is another powerful story to be told about the role of Brazilian researchers during this COVID-19 pandemic. Beyond political disputes, physician scientists from Brazil are working hard to answer relevant questions about COVID-19 in a scientifically robust way. The coalition initiative, for example, encompasses more than 70 centres around the country and has been leading 11 randomised clinical trials with more than 5000 participants. Brazil is a developing country, with a territory comparable to all of Europe and in constant political turmoil, for which this level of coordination is unprecedented. In fact, rarely has it been achieved in developed countries, where COVID-19 arrived earlier and has resulted in more cases and deaths. Still, the public remains unaware of these endeavours, as exemplified by a recent Spotlight2Burki TK Completion of clinical trials in light of COVID-19.Lancet Respir Med. 2020; (published online Oct 1.)https://doi.org/10.1016/S2213-2600(20)30460-4Summary Full Text Full Text PDF Scopus (15) Google Scholar that highlights efforts in the USA but fails to acknowledge cutting-edge research collaborations from low-income countries such as Brazil. So how exactly has Brazilian research helped the world? Or, as the Editors asked,1COVID-19 in Brazil: "So what?".Lancet. 2020; 3951461Summary Full Text Full Text PDF PubMed Scopus (337) Google Scholar "What are the [Brazilian] health and science community and civil society doing?" Brazilian research provided evidence that hydroxychloroquine, with or without azithromycin, did not benefit mild-to-moderate COVID-19 cases (Coalition COVID-19 Brazil I),3Cavalcanti AB Zampieri FG Rosa RG et al.Hydroxychloroquine with or without azithromycin in mild-to-moderate Covid-19.New Engl J Med. 2020; (published online July 23.)https://doi.org/10.1056/NEJMoa2019014Crossref PubMed Scopus (814) Google Scholar that azithromycin also did not benefit patients with severe disease (Coalition COVID-19 Brazil II),4Furtado RHM Berwanger O Fonseca HA et al.Azithromycin in addition to standard of care versus standard of care alone in the treatment of patients admitted to the hospital with severe COVID-19 in Brazil: a randomised clinical trial.Lancet. 2020; 396: 959-967Summary Full Text Full Text PDF PubMed Scopus (239) Google Scholar and confirmed that dexamethasone helps patients with severe cases of COVID-19 (Coalition COVID-19 Brazil III).5Tomazini BM Maia IS Cavalcanti AB et al.Effect of dexamethasone on days alive and ventilator-free in patients with moderate or severe acute respiratory distress syndrome and COVID-19: The CoDEX randomized clinical trial.JAMA. 2020; 324: 1307-1316Crossref PubMed Scopus (850) Google Scholar In the BRACE CORONA trial,6Lopes RD Macedo AVS de Barros e Silva PGM et al.Continuing versus suspending angiotensin-converting enzyme inhibitors and angiotensin receptor blockers: impact on adverse outcomes in hospitalized patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).Am Heart J. 2020; 226: 49-59Crossref PubMed Scopus (100) Google Scholar Brazilian researchers also demonstrated, for the first time in a randomised trial, that suspending angiotensin-converting enzyme inhibitors or angiotensin receptor blockers was not beneficial for mild-to-moderate COVID-19. Several additional multicentre randomised studies testing different interventions such as hydroxychloroquine in the pre-hospital setting, direct oral anticoagulants for in-hospital patients, tociluzumab and antivirals for severe COVID-19, pre-hospital anticoagulation, and long-term outcomes are ongoing and are expected to yield results in the next 3–6 months. Amid political turmoil, controversial quotes, and plain widespread confusion, Brazilian researchers, through resilience, discretion, and outstanding science, have managed to answer relevant questions related to COVID-19 and continue to do so. And this is a story that also deserves to be told. RDL reports personal fees from Bayer, Boehringer Ingleheim, and Daiichi Sankyo; grants and personal fees from Bristol-Myers Squibb, Glaxo Smith Kline, Medtronic, Pfizer, and Sanofi; and personal fees from Merck and Portola, unrelated to this Correspondence. All other authors declare no competing interests. COVID-19 in Brazil: "So what?"The coronavirus disease 2019 (COVID-19) pandemic reached Latin America later than other continents. The first case recorded in Brazil was on Feb 25, 2020. But now, Brazil has the most cases and deaths in Latin America (105 222 cases and 7288 deaths as of May 4), and these are probably substantial underestimates. Even more worryingly, the doubling of the rate of deaths is estimated at only 5 days and a recent study by Imperial College (London, UK), which analysed the active transmission rate of COVID-19 in 48 countries, showed that Brazil is the country with the highest rate of transmission (R0 of 2·81). Full-Text PDF