Correspondence
“culture of optimism”4 in previous
outbreaks.
In response to medical populism,
the Lancet COVID-19 Commission
Statement recom­mends that leaders
“prioritise advice from the professional
public health community”, 1 but,
as Donald Trump illustrates, the
subordinate position of public health
officials makes such fiscalisation
difficult.5 How effectively global health
institutions can advise or challenge
political leadership is a question that
demands urgent reflection amid
the sustained popularity of medical
populists, regardless of their countries’
successes in suppressing the pandemic.
I declare no competing interests.
Gideon Lasco
pdlasco@up.edu.ph
University of the Philippines Diliman,
Quezon City 1101, Philippines
1 The Lancet COVID-19 Commissioners,
Task Force Chairs, and Commission
Secretariat. Lancet COVID-19 Commission
Statement on the occasion of the 75th session
of the UN General Assembly. Lancet 2020;
396: 1102–24.
2 Lasco G, Curato N. Medical populism.
Soc Sci Med 2019; 221: 1–8.
3 Lasco G. Medical populism and the COVID-19
pandemic. Global Public Health 2020;
15: 1417–29.
4 Closser S. “We can’t give up now”: global
health optimism and polio eradication in
Pakistan. Med Anthropol 2012: 31: 385–403.
5 Yamey G, Gonsalves G. Donald Trump:
a political determinant of COVID-19. BMJ
2020; 369: m1643.
COVID-19 in Brazil:
the headlines should be
about science
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.1
www.thelancet.com Vol 396 December 5, 2020
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
Spotlight2 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, 1 “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),3 that azithromycin
also did not benefit patients with
severe disease (Coalition COVID-19
Brazil II), 4 and confirmed that
dexamethasone helps patients with
severe cases of COVID-19 (Coalition
COVID-19 Brazil III).5 In the BRACE
CORONA trial,6 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 add­
itional 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, contro­
versial 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.
*André Zimerman, Renato D Lopes,
André D’Ávila, Luis E Rohde,
Leandro I Zimerman
zimerman.andre@gmail.com
Cardiology Division, Hospital de Clínicas de
Porto Alegre, Porto Alegre 90035-903, Brazil
(AZ, LER, LIZ); Duke University Medical Center, Duke
Clinical Research Institute, Durham, NC, USA (RDL);
Harvard-Thorndike Electrophysiology Institute,
Beth Israel Deaconess Medical Center, Harvard
Medical School, Boston, MA, USA (AD’Á); and
Cardiology Division, Hospital Moinhos de Vento,
Porto Alegre, Brazil (LER, LIZ)
1 COVID-19 in Brazil: “So what?” Lancet 2020;
395: 1461.
2 Burki 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)30460-4.
3 Cavalcanti 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.
4
https://doi.org/10.1056/NEJMoa2019014.
Furtado 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
Pedro Vilela/Stringer/Getty Images
clinical trial. Lancet 2020; 396: 959–67.
5 Tomazini 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: 1307–16.
6 Lopes RD, Macedo AVS, de Barros e Silva PGM,
et al. Continuing versus suspending
angiotensin-converting enzyme inhibitors and Published Online
angiotensin receptor blockers: impact on November 10, 2020
adverse outcomes in hospitalized patients with https://doi.org/10.1016/
severe acute respiratory syndrome coronavirus 2 S0140-6736(20)32375-8
(SARS-CoV-2). Am Heart J 2020; 226: 49–59.
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