Messias’ Influence?

Intra-Municipal Relationship between Political

Preferences and Deaths in a Pandemic
Guilherme Figueiraa , Luca Moreno-Louzadaa,∗
a
Department of Economics, University of São Paulo, Avenida Luciano Gualberto, 908, São Paulo - Brazil

Abstract
Previous studies have shown that percentage of votes for Jair Messias Bolsonaro in the 2018 presi-
dential elections is related, at the municipal and state levels, to compliance of distancing measures,
as well as directly to the severity of the COVID-19 pandemic in terms of the number of deaths or
intensity of the second wave. We find the same effects on deaths at the intra-municipal level in the
city of São Paulo. Using geolocation, we associated voting data with number of deaths for the 96
districts in the city. We analyze excess deaths to mitigate underreporting issues and to control for
exogenous determinants of mortality, as well as restrict our sample to deaths among those under
60 years and include controls for several indicators of socioeconomic vulnerability. The results are
significant and indicate the existence of a relationship between votes for Bolsonaro and deaths during
the pandemic — between one and three additional deaths per 100k people for each percentage point
of votes. Several robustness checks support our findings.
Keywords: COVID-19, political persuasion, political polarization, ideology

1. Introduction
Brazil is one of the countries most affected by the COVID-19 pandemic. As of March 31, 2021,
the country had 321,515 confirmed deaths and 12,748,747 confirmed cases of the disease 1 . The
municipality of São Paulo, in turn, accumulated 744,477 cases and 22,068 confirmed deaths on the
same date 2 .
Considering this scenario, the performance of the federal government has been harshly criticized
for its inefficiency in implementing coordinated non-pharmacological measures, widespread disorga-
nization and slow vaccine roll-out (Castro et al., 2021). In addition to these discreditable measures
taken by the federal government at the institutional level, specific actions taken by President Bol-
sonaro were also opposed to the guidelines of global health authorities. On several occasions, the
president has encouraged crowds, undermined the seriousness of the pandemic, promoted treatments
with unproven efficacy, and belittled the need for social distancing (Hallal, 2021; Londoño et al.,
2020). Such speeches have great potential to influence the behavior of the president’s voters, due to
the populist character of his government and the strength of the ideological base among supporters,
who have specific political-cultural positions and demographic characteristics (Rennó, 2020).
Thus, the context is conducive to investigating the existence of relationships between support for
the president, as measured by his performance in the 2018 elections, and voter behavior during the

∗
Corresponding author
Email addresses: guilhermefigueira@usp.br (Guilherme Figueira), lucamlouzada@usp.br (Luca
Moreno-Louzada)
1
Coronavirus Panel of the Ministry of Health. Available at: https://covid.saude.gov.br/ . Accessed 04/29/2021
2
São Paulo City Government. COVID-19 Daily Bulletin of March 31, 2021. Available at: https://www.
prefeitura.sp.gov.br/cidade/secretarias/upload/saude/20210331_boletim_covid19_diario.pdf. Accessed
04/29/2021

Preprint submitted to Elsevier August 2021

coronavirus pandemic. Ajzenman et al. (2021) showed that, after Bolsonaro’s main demonstrations
against social distancing, isolation rates dropped in places with the highest number of voters for
the president. Other analyses also identified that municipalities with the highest percentage of
votes in Bolsonaro had more confirmed cases and deaths by COVID-19 when taking into account
socioeconomic factors of the population (Roubaud et al., 2020), and experienced an acceleration in
the incidence of the disease and in hospitalizations and deaths after the president delivered speeches
(Mariani et al., 2020). Furthermore, it was identified that there are differences even between the cities
where he won: municipalities where Bolsonaro’s margin of victory was greater had more cases and
deaths than municipalities where the margin was tighter (Cabral et al., 2021). Finally, Rache et al.
(2021) documented the existence of a correlation between acceleration of deaths from the disease in
2021 and the percentage of votes in Bolsonaro in the 2018 elections, for state and municipal levels.
The studies mentioned above were all carried out on a municipal scale or larger. In order to
contribute to the literature that analyzes the relationship between support for President Bolsonaro
and pandemic severity metrics, we aimed to investigate whether the correlation is present at the
intra-municipal level. As these data are not available for many cities at this level of disaggregation,
we chose to analyze the city of São Paulo, which is the most populous in the country. We extracted
COVID-19 mortality data for each of the city’s 96 districts from the City of São Paulo government.
As this district division is specific to the municipality’s government, we had to adopt a strategy to
obtain electoral data by district. For this, we use electoral data by polling location of the Superior
Electoral Court (TSE) and, using the Google Geocoding API service, we associated the coordinates of
each polling place with the corresponding district. We also collect other information by district, such
as population distribution by age group, average household income and various indicators associated
with vulnerability and social inequality.
Initially, we observed that there is a strong positive correlation between the percentage of votes
in Bolsonaro in the first round and confirmed deaths of COVID-19 per inhabitant. However, as votes
are also correlated with other factors that may be determinant for deaths, we used controls by income
and age group and performed the main analyses with excess deaths during the pandemic, rather than
using the number of deaths confirmed by the disease. This approach is often used in studies on the
topic (Brandily et al., 2020; Orellana et al., 2021), as it alleviates the problems of under-reporting and
also serves to control for exogenous determinants of mortality in comparative analyses. Importantly,
that in all our analyses we considered only deaths of people under 60 years of age, in order to avoid
that the results were influenced by the heterogeneous distribution of the population by age group.
Still, to consider other social inequalities between districts, we took into account the intra-municipal
Paulista Social Vulnerability Index (IPVS) to exclude from the analysis the most unequal districts
that have high average income while also having a high percentage of people living in vulnerability.
Additionally, we included other controls for socioeconomic characteristics, such as access to the water
network, travel time on public transport and basic medical care coverage.
In addition to adding controls, we conducted several robustness checks to support our results.
We restricted the sample to exclude districts with a high disparity between income and social vul-
nerability, compared samples with selected districts according to Bolsonaro’s margin of victory, and
created a variable that uses votes in other right-wing candidates to take into account predetermined
ideologies. The results remain positive and significant under all these specifications, suggesting the
existence of a relationship between support for the president measured by votes in the election and
mortality during the pandemic. We also found a positive correlation when using the same metric as
Rache et al. (2021), considering a second wave severity measure as the dependent variable — votes
in Bolsonaro are associated with a greater acceleration of deaths from COVID-19 in 2021.
However, despite all the controls considered, there may be other relevant factors for which data
is not available, or which are unobservable variables, and therefore it is not simple to infer causality
from these observations. Still, the documentation of correlation at various geographic levels — states,
municipalities, districts — relies on evidence from the aforementioned quasi-experimental studies that
support the proposed channel to explain this relationship. Together, they point to causality and mean
our findings are of great interest. Our contribution to the literature that investigates the effects of
leaders on the behavior of the electorate is due to on the innovation of focusing on a much smaller
unit of analysis that allows for comparisons less influenced by inter-municipal heterogeneities.
In the following sections, we contextualize some important information about the COVID-19
pandemic and briefly discuss the relevant political economy literature and the results already found
in similar studies in Brazil. We then present our results and discuss the limitations and implications
of our findings.

2. Context and background

2.1. The COVID-19 pandemic in Brazil
The first case of the disease caused by the new coronavirus in Brazil was confirmed in São Paulo
on February 26, 2020. A little less than a month later, on March 17, the first death from the disease
was reported 3 . Since then, the country has been one of the most affected by the pandemic, having
suffered a significant worsening in the number of cases and deaths in 2021.
In this scenario, several possibilities for combating and preventing the new coronavirus have been
studied and adopted as public policies around the world. In addition to potential drug interventions
under study and immunization through vaccines, essential actions are social isolation and the use of
masks (Chu et al., 2020). Such measures are called non-pharmacological interventions, and are the
main prophylaxis mechanism recommended by medical authorities 4 . These measures are extremely
necessary to fight the pandemic, considering the limited offer of vaccines and the still limited scientific
knowledge about the virus, especially with regard to new variants.
Therefore, several studies have investigated the determining factors for the severity of the disease.
In one of the first and most extensive studies on hospital survival by COVID-19 in the country, Baqui
et al. (2020) characterized the main risk factors for the disease in Brazil. The main factor observed
is age, which brings a pattern of expressive increase in mortality, especially for patients over 60
years of age. Then, the next most relevant were ethnicity and presence of obesity or neurological
and pulmonary medical conditions, and the authors mention that most of the effects of race and
pre-existing conditions are associated with regional socioeconomic inequalities. Many other studies
have identified differences in access to testing and quality of hospital care among black, mixed
and white populations (Li et al., 2021). Most of these racial disparities, however, are caused by
socioeconomic differences that affect the likelihood of gaining access to private ICU beds, rather
than racial discrimination by hospitals per se (Bruce et al., 2020) .
Regarding specifically the city of São Paulo, Ribeiro et al. (2021) compared age-standardized mor-
tality rates and identified effects on mortality of numerous indicators associated with socioeconomic
inequality, such as differences in education, low income, household density and presence of subnormal
agglomerates. São Paulo, as well as large Brazilian cities in general, has huge intra-municipal income
disparities, in addition to a very complex distribution of demographic characteristics between the
city’s subregions that affect health outcomes (Chiavegatto Filho et al., 2013). Taking these differ-
ences into account, Bermudi et al. (2021) showed that, at the beginning of the pandemic, areas with
better socioeconomic conditions in the capital had a worse performance in terms of disease severity
indicators, but this pattern changed throughout the pandemic as there was a shift of high risk of
death to the most vulnerable places in the city.

3
G1 - Globo . Coronavirus: see the chronology of the disease in Brazil. Available at: https://g1.globo.com/
bemestar/coronavirus/noticia/2020/04/06/coronavirus-veja-a-cronologia-da-doenca-no-brasil.ghtml.
Accessed 05/01/2021.
4
World Health Organization. Coronavirus disease (COVID-19) advice for the public. Available at: https://www.
who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public. Accessed 05/01/2021.
2.2. From votes to deaths
A recurrent theme in recent political economy literature has been investigating the effects that
politicians, through example and discourse, can have on the behavior of their voters. Empirical
evidence from different scenarios supports the theory that attitudes and beliefs are largely shaped
by dynamic social norms, in turn affected by the actions and positions of leading figures in each
community (Acemoglu and Jackson, 2015). For example, Bursztyn et al. (2020) identified that
Donald Trump’s election affected the likelihood of individuals to publicly express their xenophobic
views. Likewise, in assessing the role of leadership influence through example, Ajzenman (2021)
demonstrated that revelations of corruption scandals in Mexico were followed by significant increases
in cheating among high school students, and a similar study in Italy found increases in supermarket
thefts: the probability of costumers to under-report items in a self-service checkout system rose as
corruption scandals were made public (Gulino and Masera, 2021),
Along these lines, when rulers’ speeches carry anti-scientific views, there can be effects on be-
haviors directly related to public calamities. With an increasing polarization in the United States,
partisanship affected important individual decisions amid Hurricane Irma, with Republican voters
more likely to remain skeptical of the risks and thus more likely not to follow evacuation guidelines
(Long et al., 2020). It is not surprising, therefore, that similar impacts have been found in numerous
studies in the context of the COVID-19 pandemic.
In the UK, political polarization related to Brexit is associated with skepticism regarding the need
for lockdown, as well as perceptions of risk regarding contamination by the virus (Sturgis et al., 2020;
Maher et al., 2020). Similar results were seen in New Zealand, where people who identify further
to the right on the political spectrum are less likely to obey distancing measures, but no differences
were found in European countries (Becher et al., 2020). As such, there is an ideological effect on
opinion formation, but there are variations between countries on how much this effect translates into
actual changes in behavior. Soderborg and Muhtadi (2020) theorize that a determining factor is the
degree of ideological alignment in each region, and show that, in Indonesia, the intensity of variation
in the adoption of disease prevention measures is proportional to the magnitude of political-party
conflicts in local governments. That is, as long as denial is more associated with one of the political
groups, areas with greater polarization in politics will also have clearer distinctions in behavior in
response to the pandemic. Hence, it has been widely reported that, in the United States, Republican
voters are more likely to neglect the risks of contamination and not adhere to isolation instructions
(Painter and Qiu, 2021; Allcott et al., 2020), and this behavioral variation is followed by an increase
in deaths and infections in pro-Trump regions (Gollwitzer et al., 2020).
Brazil has, therefore, all the factors that the literature shows are necessary for us to expect to see
the same effects as in the countries mentioned above. First, the country has high rates of ideolog-
ical polarization (Layton et al., 2021). The political orientation of the population varies regionally
(Amaral, 2020) and support for the Bolsonaro government is associated with very specific cultural
profiles: its voters tend to be more conservative (Rennó, 2020) and support is greater in areas with
better socioeconomic and educational indicators (Gomes de Souza et al., 2019). Finally, Bolsonaro
is frequently engaged in anti-scientific attitudes, either through numerous denialist speeches (Chaib
and Machado, 2021), or through institutional actions contrary to the recommendations of global
health authorities (FSP/USP, 2021).
Consequently, the same patterns of ideological alignment in issues related to the pandemic ob-
served in other countries are also seen in Brazil. Individuals who consider themselves on the right
declare having less support for isolation measures (Ramos et al., 2020), and the pro-government
political orientation in the country is related to greater disbelief in the severity of the disease (Calvo
and Ventura, 2021).
Therefore, the channel we intend to explore in our study seeks to associate votes with deaths
through this behavioral variation explained by political position. The relationship on which we
are based was also observed in previous publications (Rache et al., 2021) and had its mechanism
explained in studies with different identification strategies (Ajzenman et al., 2021; Mariani et al.,
2020; Cabral et al., 2021).

3. Data and empirical strategy

We extracted electoral data from the repository of the Superior Electoral Court (TSE) 5 . The
database contains the absolute total of valid votes per candidate in both rounds of the 2018 presi-
dential elections, disaggregated by polling station. Additionally, the addresses of the polling stations
were obtained from the same source, with respective numbers of zones and sections in each address.
Following the methodology of similar studies, we considered first-round votes in our main analysis
— the literature argues that voters tend to vote with greater ideological sincerity during the first
round (Piketty, 2000).
In order to group votes by district, which is the aggregation for which there are health data
available, we obtained the geographic coordinates of each polling station. Some locations already had
coordinates disclosed by TSE itself, but we chose to geolocate them all again to maintain consistency.
For this, we used Google’s geocoding API 6 . With each location’s name (school name, for example),
street name and zip code, coordinates for 2039 of the city’s 2041 polling stations were successfully
assigned. For the remaining 2 cases there was an error due to name inconsistencies and for these we
only used the address. From the repository of the city of São Paulo 7 , we obtained the shapefile with
the official geographic limitations of the municipality and located each polling station in one of the
96 districts. Finally, we aggregated the totals, calculating the percentage of votes in Bolsonaro by
district (see Figure 3b).
We then extracted data on cases and deaths confirmed by COVID-19 by age group (10-year
intervals) and month, as well as total deaths (from 2017 to 2021), also from the city government
8
. From these numbers, we constructed the variable of excess of deaths, given by the difference
between the total deaths from April 2020 to March 2021, by age group, and the average of deaths
in the three previous years, from April to March. It is worth mentioning that the most recent
death records (2019 onwards) do not contain deaths from external causes, due to the slow nature
of the updating procedures of these official data systems. Our excess deaths estimates are therefore
relatively conservative.
To transform the numbers into per capita indices, we collected demographic data of population
distribution by age group by district. The numbers are from 2017, the most recent available in the
official statistics 9 . Average household income figures by district were taken from the 2020 Map of
Inequality 10 .
In addition to controlling for average income and for exogenous mortality determinants when
using excess deaths, we also take into account other inequalities that can affect health outcomes.
Thus, also from the Inequality Map, we obtained the average travel time spent in public transport to
go to work. With this proxy of mobility, we seek to capture the unequal effects of the possibilities of
isolation, as naturally it is more difficult for those who live in remote areas to follow the guidelines

5
TSE. Electoral Data. Available at: https://www.tse.jus.br/eleicoes/estatisticas/repositorio-de-
dados-eleitorais-1/repositorio-de-dados-eleitorais
6
See https://developers.google.com/maps/documentation/geocoding/overview
7
São Paulo City Government Open Data. Districts of the Municipality of São Paulo. Available at: http://dados.
prefeitura.sp.gov.br/dataset/distritos
8
DATASUS / São Paulo City Government. SIM/PROAIM and SIVEP - Flu. Available at: https://www.
prefeitura.sp.gov.br/cidade/secretarias/saude/tabnet/. Download on 04/20/2021.
9
São Paulo City Government. Resident Population by Age and Sex Groups. Available at: https:
//www.prefeitura.sp.gov.br/cidade/secretarias/licenciamento/desenvolvimento_urbano/dados_
estatisticos/info_cidade/demografia/index.php?p=260265. Download on 04/21/2021.
10
Rede Nossa São Paulo. 2020 Inequality Map. Available at: https://www.nossasaopaulo.org.br/wp-content/
uploads/2020/10/Mapa-da-Desigualdade-2020-TABELAS-1.pdf. Download on 04/21/2021.
to stay at home for reasons of necessity (Mengue, 2021). Furthermore, this variable is also directly
associated with exposure to the coronavirus, as public transport is often closed, with little ventilation
and very crowded, characterizing an environment of high risk for the spread of the virus. From the
same source, we extracted the percentage of the population covered by Primary Care and Family
Health teams, in order to capture factors related to the health infrastructure of the districts, since
the need for greater coverage of primary care is associated with precarious access to a quality hospital
network. We also included the proportion of households not connected to the water supply network
11
, an aspect also related to structural inequality and the difficulty of preventing infection.
Finally, to consider other socioeconomic aspects not included in the aforementioned controls, we
chose to use the São Paulo Social Vulnerability Index (IPVS), which has already been considered
in studies on COVID-19 lethality in São Paulo (Instituto Pólis, 2020). The index, prepared by
the SEADE Foundation from the 2010 Census, classifies the city’s districts according to the degree
of social vulnerability of the resident population, taking into account several socioeconomic and
demographic dimensions 12 . In our analyses, we considered as a variable for social vulnerability the
percentage of residents considered to be in medium or greater vulnerability. In addition to including
the index in the regressions, we also use the IPVS as a criterion to exclude some districts in certain
specifications for robustness tests.
Our main specification uses the excess of deaths as a dependent variable, as defined above.
We conducted analyses taking into account different age groups, always considering only deaths of
patients under 60 years of age. This approach guarantees greater significance to our conclusions, as
the severity of COVID-19 tends to be greater for the elderly and the distribution of these populations
is heterogeneous among districts. The 20-60 age group is especially relevant for our study, as it only
includes those who were forced to vote in 2018 (aged over 18) and who are not yet elderly. Due to
the mandatory vote, it is the population stratum most susceptible to consuming political content,
thus being more exposed to discourses and guidelines by government officials.
As independent variables, we include the percentage of votes in Bolsonaro and a vector of controls
for each district. Thus, we estimate the following equation by OLS:

Excessi = α + βV otesBolsonaroi + γXi0 + i

where Xi0 is a vector of socioeconomic characteristics of the district such as income, social vulner-
ability and the other indicators mentioned in the previous section. In the equation, the estimated
value of β represents the partial correlation between support for the president within the city of São
Paulo and deaths in the pandemic, conditional on a series of controls. Based on evidence reported
by other authors, the expectation is that β will be positive, indicating that regions with the highest
percentage of votes in Bolsonaro had a higher number of deaths.

4. Results
In Table 1 we present the results of the main model, in columns (1) to (6) for 0-60 years and
in columns (7) to (12) restricting the sample to deaths of people between 20 and 60 years old. In
columns (1) and (7), considering only the percentage of votes and the excess of dead, the coefficients
are negative, and significant in the 20 to 60 age group. However, these results suffer from omitted

11
São Paulo City Government. Indicator Observatory of the city of São Paulo. Available at: http://observasampa.
prefeitura.sp.gov.br/moradia-e-saneamento-basico. Download on 05/12/2021.
12
Government of São Paulo. IPVS — São Paulo Social Vulnerability Index. Available at: http://
catalogo.governoaberto.sp.gov.br/dataset/21-ipvs-indice-paulista-de-vulnerabilidade-social. Down-
load on 04/22/2021.
variable bias. COVID-19 mortality is correlated with exogenous factors associated with socioeco-
nomic inequalities that are heterogeneously distributed among the districts of São Paulo. These
variables are also related to the percentage of votes in Bolsonaro — richer districts with lower IPVS
have higher rates of votes for him (Figure 3 and Figure 4). In columns (2) and (8), when we add the
average income of the districts to the model, the coefficients linked to votes become positive. In these
columns, the income coefficient is negative, indicating that there is in fact an opposite relationship
between average income and excess deaths, which caused a positive bias in the previous specification.
With the addition of the other socioeconomic controls, in columns (3) to (6) and (9) to (12) of
Table 1, the coefficient of votes remains positive and significant in all specifications, increasing in
magnitude as the omitted variable bias reduces. As these variables are correlated with votes and are
associated with mortality, their inclusion as a control reinforces the effect of support for the president
on deaths in the pandemic. In terms of magnitude, the interpretation of the coefficients is that a
percentage point of votes is associated with an increase between 1 to 3 excess deaths per 100,000
inhabitants. For example, considering the difference between the district of Mandaqui (the one with
the highest excess deaths in our analysis period), which had 48% of votes, and the district of Sé (the
one with the smallest excess of deaths), which had 33% of votes, this difference of 15 percentage
points would represent between 16 and 49 deaths attributed to the electoral scenario in the district
of Mandaqui, until March 2021.
As a secondary result, in Figure 1 we present the correlation using the second wave as the
dependent variable, defined as the percentage change in the daily average of deaths from COVID-19
in 2021 compared to the daily average in 2020. Districts with the highest The percentage of votes
in Bolsonaro had a more severe worsening in the pandemic in early 2021. The correlation presented
is already relevant because these are comparisons between the same districts over time, so there is
no need to control for socioeconomic factors. However, we also checked, with multivariate linear
regression, that the results remain unchanged with such controls.
In summary, the coefficients with respect to votes in Bolsonaro of the main model in Table 1 are
almost always positive and in most cases significant, even with controls and with different dependent
variables. We also performed several robustness tests to ensure the validity of the results, which are
presented in the next section.

4.1. Robustness Checks

Our results can be influenced by arbitrary decisions, such as the definition of excess deaths and
the age cut at 60 years. Therefore, we repeated the main analysis using confirmed deaths from
COVID-19, as well as using a 50-year cut-off. The results are robust to these modifications (see
Table A2 and Table A3 in the Appendix).
Another concern is that we fall into an ecological fallacy by generalizing individual behaviors
while analyzing aggregated data. For example, factors such as mobility to work can have a major
influence on the infection by the virus, as it is possible that a resident of one district will need to
travel to another to work and become infected on the way. We tried to get around this problem
by including the mobility proxy in the regression, but we also repeated the analysis by restricting
the sample to districts in the first and fourth quartile of percentage votes, where Bolsonaro’s margin
of victory or defeat was wider. The same procedure was done with districts in the second and
third quartile of votes, where the difference in support for the president was much more subtle. As
expected, the results of the main specification remained with the sample restriction to districts with
a wider margin (Table A4), and the coefficients are negligible and not significant when we restrict
the sample to districts with a tight margin of votes.
To confirm that the results are not influenced by socioeconomic inequalities, we also performed a
sample selection in some specifications using the IPVS value as a threshold. The idea is the same as
including the IPVS as an exogenous variable: avoid that in districts with high average income the
presence of a significant fraction of the population in a vulnerable situation (thus more susceptible
to COVID-19) is masked by the income value, influencing our results through an unwanted channel.
Therefore, we excluded those districts that, among those with an average income above the mean
of the districts, had IPVS greater than or equal to the median of the sample (see Figure 4). We
considered the median in the latter case because the distribution of IPVS values is very heterogeneous.
With this restriction, the results remain positive and significant in several cases (Table 2). We note
that although the cut-off is arbitrary, it is robust to variations: shifting the threshold to lower values
of IPVS does not change the relationship and the results remain significant.
Finally, we constructed another explanatory variable to rule out the possibility that the results
are being caused by some omitted variable that is correlated with votes and behavior — that is,
there could be some factor intrinsic to Bolsonaro voters and their ideologies that made them engage
in risky behavior regardless of the president’s actions. Mariani et al. (2020) analyze population
participation in previous vaccination campaigns to rule out the possibility that behavior in the
coronavirus pandemic is determined by pre-existing health-related behavioral trends. In the same
light, we seek to differentiate the effect of support for President Bolsonaro itself from predefined
individual traits. For this, we build the following variable:

SupportBolsonaroi = (V otesBolsonaroi − V otesBolsonaro) − (Righti − Right)

where the bars represent the average of all districts and Right represents the percentage of votes
for candidates also associated with the right of the spectrum in other elections. We performed the
analysis with three different variables: votes for Aécio Neves in the 2014 presidential elections, votes
for João Dória in the 2016 municipal elections and votes for João Dória in the 2018 state elections.
Then, we repeat the main specification, but using SupportBolsonaroi instead of V otesBolsonaroi
as the dependent variable. With this strategy, we find results that suggest that we can rule out the
possibility that risk attitudes during the pandemic were only caused by predetermined behaviors. In
all regressions with different proxies for right-wing ideology, the Bolsonaro effect is still positive and
significant (Figure 1 and Table A1).

5. Discussion and Conclusion

Our results corroborate the conclusions found by the various aforementioned articles. In addition
to including controls for income and social vulnerability, we also restricted our sample to include
only deaths of patients under 60 years of age. Therefore, our results are not distorted by factors
such as the heterogeneity of age distribution across the city or the age profile of the electorate; it is
possible, for example, that places with more income have a higher share of elderly people and also
vote for more in Bolsonaro, which would affect the results if we did not control for this.
To reinforce our point, we used the excess of deaths which, in addition to working as an adjustment
for underreporting, helps to control for exogenous mortality determinants. COVID-19 mortality
is greatly affected by inequality between districts. Places with more income tend to have better
sanitary conditions, but also a larger share of elderly people in the population. We theorize that
these two factors work together, in the opposite direction, to explain why there is no clear relationship
between income and deaths confirmed by COVID (Figure 4). Using excess deaths, the correlation
is negative. This finding — poorer places have a greater excess of deaths — is in line with what
would be expected in terms of the relationship between socioeconomic conditions and mortality in
the pandemic, and was also observed in other studies at the national level (Duque et al., 2020).
That’s why, ignoring income controls, the relationship between votes and deaths disappears when
we use excess instead of confirmed deaths. Controlling for income is important given the high
correlation between socioeconomic profile and votes, which has also been reported in the political
science literature. In this way, using the excess of deaths and controlling for income, we reach our
main results more robustly, and our findings are also robust to the segmentation by age and to the
inclusion of the different variables of social vulnerability (Table 1 and Table 2).
Another result found is the acceleration of the pandemic in 2021. Following the same methodology
as Rache et al. (2021), we found results that meet the authors’ conclusions (see Figure 2). Districts
with more votes in Bolsonaro had a greater acceleration of deaths by COVID-19 in 2021. In this
case, as the comparison is between each district over time, it is interesting to note the existence of a
positive correlation, without the real need for socioeconomic controls.
However, although we performed several specifications and found results that are supported by
numerous studies with similar conclusions, there are some noteworthy caveats. First, as far as we
know, there are no data on social isolation at an intra-municipal scale. This variable would be impor-
tant to detail the mechanisms behind the studied relationship. Nevertheless, the literature has shown
that distancing is endogenous (Ajzenman et al., 2021) and strongly related to votes in Bolsonaro. To
mitigate possible problems and distinguish the reduction in isolation influenced by political behavior
from the difficulty of isolation due to working conditions, we used the aforementioned pre-pandemic
mobility index. Therefore, our model tries to capture the differences in isolation caused by political
positioning that lead to an increase in deaths.
Moreover, mortality data for years after 2019 do not include external causes of death, which
influences our excess deaths calculation. Also, due to the limited availability of data segregated
by district, we did not include other controls that could be relevant, such as concrete measures of
inequality (such as the GINI index) and indicators of health-related behavior in periods prior to
the pandemic (e.g. adherence to previous vaccine programs). The social vulnerability index tries to
capture these effects, but it also has its limitations, even more so considering that it was calculated
from 2010 census data. Also, the 60-year age cutoff is arbitrary, and the results are somewhat more
dubious when we use the 50-year limit (Table A3). A problem with defining this limit is that, due
to the enormous disparity in the disease’s lethality by age group, when considering smaller intervals,
the sample is quite small, making it more difficult to reach definitive conclusions. Future studies
should include more cities in the sample in order to consider a greater number of observations.
The Brazilian political scenario is challenging and the pandemic aggravates the country’s intrinsic
difficulties even more. However, investigating the nuances of how the behavior of individuals may be
affected by political leaders can be decisive in contributing to reflections on the local scenario and
contributing to the adoption of public measures. This investigation can be expanded in the future
to investigate further impacts of denial and polarization in Brazil, which potentially extend to areas
such as climate change, violence, prejudice and other forms of social instability.

6. Declaration of interest
The authors declare no competing interests.

7. Acknowledgments
The authors would like to thank André Chagas, Fabiana Rocha, Leandro Consentino, Luis Meloni
and Naercio Menezes for valuable comments and encouragement.
8. Tables and figures

Table 1: Results — excess deaths (all districts)

Excess deaths (up to March 2021)

0-60 years 20-60 years
(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12)
∗∗ ∗∗∗ ∗∗∗ ∗∗∗ ∗∗∗ ∗∗ ∗∗∗ ∗∗∗ ∗∗∗
Votes −0.366 1.087 1.607 1.893 1.976 2.077 −1.333 0.928 1.738 2.140 2.259 2.728∗∗∗
(0.394) (0.435) (0.466) (0.504) (0.497) (0.571) (0.548) (0.580) (0.614) (0.662) (0.650) (0.741)

Income (log) −43.762∗∗∗ −33.996∗∗∗ −26.419∗∗∗ −21.925∗∗ −20.651∗ −68.132∗∗∗ −52.931∗∗∗ −42.268∗∗∗ −35.836∗∗∗ −29.940∗∗
(8.003) (8.616) (10.033) (10.116) (10.749) (10.678) (11.340) (13.184) (13.236) (13.943)

Mobility 0.484∗∗ 0.491∗∗∗ 0.688∗∗∗ 0.646∗∗∗ 0.754∗∗∗ 0.763∗∗∗ 1.045∗∗∗ 0.853∗∗∗

(0.185) (0.184) (0.206) (0.236) (0.244) (0.242) (0.269) (0.306)

Coverage 0.202 0.234∗ 0.237∗ 0.284 0.330∗ 0.346∗

(0.139) (0.138) (0.139) (0.183) (0.181) (0.180)

Water −0.588∗∗ −0.608∗∗ −0.842∗∗ −0.935∗∗

(0.291) (0.298) (0.381) (0.386)

IPVS 0.077 0.355

(0.210) (0.273)

Constant 29.031∗ 336.237∗∗∗ 205.613∗∗∗ 118.535 65.545 51.067 88.901∗∗∗ 567.177∗∗∗ 363.869∗∗∗ 241.322∗ 165.480 98.510
(16.451) (57.993) (75.249) (95.933) (97.932) (106.116) (22.894) (77.374) (99.042) (126.057) (128.139) (137.649)

N 96 96 96 96 96 96 96 96 96 96 96 96
R2 0.009 0.250 0.302 0.318 0.347 0.348 0.059 0.346 0.407 0.423 0.452 0.462
∗ ∗∗ ∗∗∗
Significance p<0.1; p<0.05; p<0.01
Note: Votes is the percentage of votes for Bolsonaro in the first round of the 2018
presidential elections. Income (log) is the natural logarithm of average household income. Mobility
is the average time spent in public transport in trips to work. Coverage is the fraction of the
population that is covered by Primary Care and Family Health teams. Water is the fraction of
households not connected to the public water network. IPVS is the percentage of households living
in medium or higher vulnerability according to this index. All numbers are by district.
 Table 2: Results — excess deaths (selected districts)

Excess deaths (up to March 2021)

0-60 years 20-60 years
(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12)
Votes −0.308 1.305∗∗∗ 1.836∗∗∗ 2.035∗∗∗ 2.112∗∗∗ 2.221∗∗∗ −1.313∗∗ 1.214∗ 2.009∗∗∗ 2.285∗∗∗ 2.393∗∗∗ 2.847∗∗∗
(0.408) (0.460) (0.488) (0.521) (0.514) (0.591) (0.572) (0.614) (0.646) (0.689) (0.678) (0.773)

Income (log) −47.198∗∗∗ −36.748∗∗∗ −30.029∗∗∗ −24.830∗∗ −23.167∗ −73.943∗∗∗ −58.311∗∗∗ −48.979∗∗∗ −41.659∗∗∗ −34.708∗∗
(8.615) (9.227) (11.115) (11.266) (12.143) (11.515) (12.205) (14.692) (14.845) (15.872)

Mobility 0.495∗∗ 0.503∗∗∗ 0.699∗∗∗ 0.655∗∗∗ 0.741∗∗∗ 0.752∗∗∗ 1.027∗∗∗ 0.843∗∗∗

(0.188) (0.188) (0.211) (0.242) (0.249) (0.249) (0.278) (0.316)

Coverage 0.160 0.198 0.203 0.222 0.275 0.297

(0.147) (0.146) (0.148) (0.195) (0.193) (0.193)

Water −0.570∗ −0.592∗ −0.803∗∗ −0.895∗∗

(0.296) (0.303) (0.390) (0.396)

IPVS 0.084 0.350

(0.221) (0.288)

Constant 27.238 355.494∗∗∗ 218.111∗∗∗ 144.272 85.434 67.309 89.031∗∗∗ 603.298∗∗∗ 397.775∗∗∗ 295.228∗∗ 212.384 136.655
(17.133) (61.719) (79.282) (104.555) (107.322) (117.974) (23.993) (82.500) (104.868) (138.197) (141.421) (154.200)

N 88 88 88 88 88 88 88 88 88 88 88 88
R2 0.007 0.266 0.322 0.331 0.360 0.361 0.058 0.366 0.426 0.435 0.463 0.472
∗ ∗∗ ∗∗∗
Significance p<0.1; p<0.05; p<0.01
Note: Votes is the percentage of votes for Bolsonaro in the first round of the 2018 presidential elections. Income (log) is
the natural logarithm of average household income. Mobility is the average time spent in public transport in trips to work.
Coverage is the fraction of the population that is covered by Primary Care and Family Health teams. Water is the fraction
of households not connected to the public water network. IPVS is the percentage of households living in medium or higher
vulnerability according to this index. All numbers are by district.
 Figure 1: Votes for Bolsonaro and Excess Deaths

Note: Coefficient estimates are from OLS regressions including indicators for vote decile, omitting
the dummy for districts in the bin with the least percentage of votes for Bolsonaro (below the 10%
quantile). The dependent variable is excess deaths among people under 60 years of age, calculated
as the difference between the number of such deaths between April 2020 and March 2021, and the
average of deaths in the previous three years, always considering this age cut-off. All regressions
include controls for average income and other socioeconomic variables. 95% confidence intervals are
also plotted. N = 96

Figure 2: Acceleration of deaths and Votes

Note: Acceleration of Deaths is defined as the percentage change between the average number of
deaths from COVID-19 per day throughout 2020 and the average number of deaths from
COVID-19 per day in the first three months of 2021. In the chart, R = 0.37 and p < 0.0002.
 Figure 3: Data by district

(c) Monthly income

(a) Votes by polling station (b) Votes by district

(e) Deaths by COVID (f ) Excess deaths

(d) Medium or higher IPVS
 Figure 4: Correlations between relevant variables

Note: Districts excluded in the robustness checks are in red in the last graph. Namely: Jabaquara,
Jaguaré, Morumbi, Raposo Tavares, Rio Pequeno, São Domingos, Vila Andrade and Vila Sônia.
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Appendix

Table A1: Robustness check: ideology

Excess deaths (up to March 2021)

SupportBolsonaro 0-60 anos 20-60 anos

(1) (2) (3) (4)
Right = Aécio 2014 - 1st Round 1.299∗∗∗ 1.732∗∗∗ 2.307∗∗∗ 2.474∗∗∗
(0.219) (0.628) (0.278) (0.809)

Right = Dória 2016 - 1st Round 1.953∗∗∗ 2.617∗∗ 3.544∗∗∗ 3.634∗∗∗

(0.352) (1.059) (0.449) (1.369)

Right = Dória 2018 - 1st Round 3.177∗∗∗ 3.107∗∗∗ 4.855∗∗∗ 4.208∗∗∗

(0.457) (0.682) (0.629) (0.877)

Right = Dória 2018 - 2nd Round 1.994∗∗∗ 2.887∗∗∗ 3.516∗∗∗ 4.087∗∗∗

(0.325) (0.887) (0.412) (1.139)

Controls No Yes No Yes

N 96 96 96 96
∗
Significance p<0.1; ∗∗ p<0.05; ∗∗∗ p<0.01
Note: SupportBolsonaroi = (V otesBolsonaroi − V otesBolsonaro) − (Righti − Right)
Each row corresponds to a different proxy for rightist ideology. The controls used are the same as
in the main specification regressions.
 Table A2: Robustness check — deaths by COVID-19 (with and without sample selection)
Deaths by COVID (per 100k) in 2021
0-50 years 0-60 years 20-60 years 0-50 years 0-60 years 20-60 years
(1) (2) (3) (4) (5) (6)
Votes for Bolsonaro 0.522∗∗∗ 1.221∗∗∗ 1.720∗∗∗ 0.552∗∗∗ 1.197∗∗∗ 1.688∗∗∗
(0.133) (0.183) (0.257) (0.129) (0.175) (0.246)

Income (log) −11.091∗∗∗ −20.324∗∗∗ −28.870∗∗∗ −10.426∗∗∗ −19.912∗∗∗ −28.356∗∗∗

(2.738) (3.761) (5.276) (2.422) (3.297) (4.634)

Mobility 0.088 0.210∗∗∗ 0.307∗∗∗ 0.091∗ 0.210∗∗∗ 0.308∗∗∗

(0.055) (0.075) (0.105) (0.053) (0.072) (0.102)

Coverage 0.066∗ 0.057 0.084 0.065∗∗ 0.058 0.086

(0.033) (0.046) (0.064) (0.031) (0.043) (0.060)

Water −0.191∗∗∗ −0.384∗∗∗ −0.634∗∗∗ −0.202∗∗∗ −0.390∗∗∗ −0.643∗∗∗

(0.068) (0.094) (0.132) (0.067) (0.091) (0.128)

IPVS −0.050 −0.028 0.036 −0.036 −0.027 0.036

(0.050) (0.068) (0.096) (0.047) (0.064) (0.091)

Constant 74.583∗∗∗ 126.116∗∗∗ 178.029∗∗∗ 67.347∗∗∗ 123.651∗∗∗ 174.956∗∗∗

(26.599) (36.543) (51.261) (23.912) (32.548) (45.743)

N 88 88 88 96 96 96
R2 0.466 0.612 0.644 0.460 0.615 0.645
∗ ∗∗ ∗∗∗
Significance p<0.1; p<0.05; p<0.01
 Table A3: Robustness check — excess deaths (50 years cut-off )

Excess deaths (up to March 2021): 0-50 years

Selected districts All districts
(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12)
Votes 0.176 0.921∗∗ 1.016∗∗ 1.341∗∗∗ 1.472∗∗∗ 1.505∗∗∗ 0.110 0.758∗ 0.842∗ 1.236∗∗∗ 1.374∗∗∗ 1.390∗∗∗
(0.329) (0.412) (0.455) (0.479) (0.445) (0.512) (0.315) (0.385) (0.427) (0.454) (0.424) (0.488)

Income (log) −21.799∗∗∗ −19.932∗∗ −8.964 −0.033 0.469 −19.529∗∗∗ −17.959∗∗ −7.492 −0.082 0.122
(7.730) (8.601) (10.208) (9.744) (10.511) (7.080) (7.890) (9.052) (8.630) (9.176)

Mobility 0.088 0.101 0.438∗∗ 0.424∗∗ 0.078 0.086 0.411∗∗ 0.404∗∗

(0.175) (0.173) (0.183) (0.209) (0.170) (0.166) (0.176) (0.201)

Coverage 0.260∗ 0.326∗∗ 0.327∗∗ 0.279∗∗ 0.331∗∗∗ 0.332∗∗∗

(0.135) (0.127) (0.128) (0.126) (0.118) (0.119)

Water −0.980∗∗∗ −0.986∗∗∗ −0.969∗∗∗ −0.973∗∗∗

(0.256) (0.262) (0.248) (0.254)

IPVS 0.025 0.012

(0.191) (0.179)

Constant −8.265 143.346∗∗ 118.800 −1.730 −102.812 −108.284 −5.571 131.520∗∗ 110.524 −9.777 −97.139 −99.459
(13.820) (55.378) (73.899) (96.026) (92.823) (102.116) (13.167) (51.301) (68.914) (86.554) (83.544) (90.590)

N 88 88 88 88 88 88 96 96 96 96 96 96
R2 0.003 0.089 0.091 0.130 0.262 0.262 0.001 0.077 0.079 0.126 0.253 0.253
∗ ∗∗ ∗∗∗
Significance p<0.1; p<0.05; p<0.01
Note: Votes is the percentage of votes for Bolsonaro in the first round of the 2018 presidential
elections. Income (log) is the natural logarithm of average household income. Mobility is the average
time spent in public transport in trips to work. Coverage is the fraction of the population that is
covered by Primary Care and Family Health teams. Water is the fraction of households not connected
to the public water network. IPVS is the percentage of households living in medium or higher
vulnerability according to this index. All numbers are by district.
 Table A4: Robustness check — districts in the 1st and 4th vote quartiles

Excess deaths (up to March 2021)

0-60 years 20-60 years
(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12)
Votes −0.214 1.401∗∗ 2.167∗∗∗ 2.660∗∗∗ 3.357∗∗∗ 4.158∗∗∗ −1.111∗ 1.182 2.267∗∗∗ 2.845∗∗∗ 3.760∗∗∗ 5.200∗∗∗
(0.437) (0.582) (0.635) (0.800) (0.800) (0.959) (0.589) (0.771) (0.833) (1.052) (1.053) (1.233)

Income (log) −48.593∗∗∗ −38.027∗∗∗ −32.033∗∗ −21.156 −16.049 −69.027∗∗∗ −54.064∗∗∗ −47.025∗∗ −32.773∗ −23.585
(13.101) (13.157) (14.424) (14.221) (14.454) (17.358) (17.261) (18.969) (18.713) (18.579)

Mobility 0.665∗∗ 0.693∗∗ 1.246∗∗∗ 1.053∗∗∗ 0.941∗∗ 0.974∗∗∗ 1.699∗∗∗ 1.353∗∗∗

(0.271) (0.273) (0.335) (0.356) (0.356) (0.359) (0.441) (0.457)

Coverage 0.243 0.407∗ 0.487∗∗ 0.286 0.500 0.644∗∗

(0.241) (0.235) (0.238) (0.316) (0.309) (0.306)

Water −0.882∗∗ −1.010∗∗∗ −1.155∗∗ −1.386∗∗∗

(0.344) (0.351) (0.453) (0.451)

IPVS 0.412 0.742∗∗

(0.281) (0.361)

Constant 21.943 361.826∗∗∗ 201.281∗ 115.335 −45.046 −124.682 78.639∗∗∗ 561.452∗∗∗ 334.077∗∗ 233.160 23.007 −120.275
(18.321) (93.060) (109.965) (138.903) (144.921) (152.903) (24.695) (123.297) (144.271) (182.668) (190.689) (196.534)

N 48 48 48 48 48 48 48 48 48 48 48 48
R2 0.005 0.238 0.329 0.345 0.434 0.462 0.072 0.313 0.407 0.418 0.496 0.544
∗ ∗∗ ∗∗∗
Significance p<0.1; p<0.05; p<0.01
Note: Votes is the percentage of votes for Bolsonaro in the first round of the 2018 presidential
elections. Income (log) is the natural logarithm of average household income. Mobility is the average
time spent in public transport in trips to work. Coverage is the fraction of the population that is
covered by Primary Care and Family Health teams. Water is the fraction of households not connected
to the public water network. IPVS is the percentage of households living in medium or higher
vulnerability according to this index. All numbers are by district.