By PAULO CAPEL NARVAI*
The values and beliefs of Bolsonarism play a fundamental role in the neglect of the fight against COVID-19. It's not just about the many blunders of the federal government
Fernando Haddad warned, recently in an article published in the newspaper FSP (land of trumps), for the fact that the opposition speech to Bolsonaro’s denialism about the COVID-19 pandemic and the possibilities of vaccines, can “give the false impression” that whoever makes it, being a manager, “is doing a good job , which is not true”, referring to the governor of the state and the mayor of São Paulo. And he cited data from the state and the capital as being “uncontroversial”, as the deaths in these locations “reached 909 per million and 1.131 per million, respectively”.
Haddad endorsed the criticism (Plan São Paulo must be revised) who sees in these indicators a “management problem”, since “São Paulo, city and state, did not adopt the measures that allowed countries like China, Vietnam, Australia and New Zealand to obtain satisfactory health and, consequently, economic results: the protocol TRIS (Supported Testing, Tracing, and Isolation)”. Anticipating reactions, he anticipated: “for those who consider the solution utopian, just check the results of the city that adopted [TRIS]. Araraquara, governed by the PT, has around 250 deaths per million”.
That was enough to accuse the former Mayor of São Paulo of distorting numbers and manipulating indicators, using them to support criticisms that would only have political grounds, as they differ from Doria and Bolsonaro. According to these critics, it would not be enough to reproduce, in other words, accusations that also appear on social networks, such as “It is a genocide”; “Bolsonaro is a murderer”, among other expressions. One of Haddad's critics stated that he and the PT "continue to treat voters as retards, in the conviction that rhetoric can replace results." Bolsonaro himself rebuts critics that he does not set good examples, accusing them of being “idiots, imbeciles”.
Genocidal, homicidal, murderer, criminal – critics respond.
These are harsh words, on both sides. Would there be, however, some basis for this, beyond the political and ideological aspects that motivate its use? Wouldn't those terms be exaggerated? Would PT voters be “retarded, idiots, imbeciles”? Would Bolsonaro be a murderer?
No one is unaware of the threats he made on the show open camera (TV Bandeirantes, May 1999), and reiterated when he was a candidate, of “killing around 30” promoting “a civil war”. He said in Acre that he was willing to “shoot the petralha"and "end communism” and corruption in Brazil, assuming that he is a kind of champion of freedoms. If he really wanted that, he didn't get it so far, with allegations of corruption entering the party that elected him and even members of his family.
There are, however, many ways to kill. Bolsonaro’s attitudes and his government’s actions and omissions reveal this, even if it is not clear to many who support him, assuming him to be a “victim of the opposition” – so as not to reproduce the meme that “the PT is to blame”.
Bolsonaro’s decisions – as is widely recognized – stem from disregarding scientific knowledge about the new coronavirus and the epidemiological characteristics of the pandemic. But it is necessary to emphasize that they are based, above all, on ideology, that is, on values and beliefs that could be identified as 'Bolsonarism'. It is a phenomenon that, for many, is broader and deeper than the Bolsonaro government itself. For several of its critics, this is, in fact, the fundamental problem, since it is not just a question of the many blunders of the federal government.
In the pandemic, 'Bolsonarism' kills without firing a single shot - even though Bolsonaro's defenders accuse of exaggeration, of "ideological bias", claiming that Bolsonaro would be a "genocide", "homicidal". It would be irresponsible, they say, to accuse him of deliberately killing people.
It is true that the pandemic is a complex phenomenon, from every point of view and that in Brazil does not concern only the federal government. States and municipalities also have responsibilities regarding the evolution of COVID-19 among us.
But the data on the pandemic indicate that there is no exaggeration and that 'Bolsonarism', as an expression of beliefs and values (an ideology, although restrictions on the use of this term to characterize this phenomenon are admitted), is responsible for deaths resulting from COIV -19.
This is what I seek to demonstrate below, based on data available for Araraquara and 18 other municipalities in São Paulo that have socioeconomic characteristics that allow statistical comparisons, provided by the 'COVID-19 BR Observatory'(https://covid19br.github.io/), by the Superior Electoral Court (https://www.tse.jus.br/), Ministry of Health (https://egestorab.saude.gov.br) and SEADE Foundation (https://iprs.seade.gov.br/) and IBGE (https://www.ibge.gov.br/cidades-e-estados/sp.html).
Araraquara, the municipality cited by Fernando Haddad, has 2020 inhabitants in 238.339. In the first two decades of this century, it has been governed by the PT (2001-2008; 2017-2020) and PMDB (2009-2016).
Data on deaths from COVID-19 registered up to 9/12/2020 in these municipalities were considered, standardized and controlled by age, based on the proportion of inhabitants aged 60 or over, demographic size (municipalities with a population of between 150 and 400 inhabitants, according to the IBGE population estimate) and socioeconomic characteristics (according to the IPRS, São Paulo Social Responsibility Index, including those classified by the IPRS as “Dynamic” and excluding the other groups). The municipality of Araraquara was thus evaluated comparatively with the other 18 municipalities that presented more demographic, socioeconomic and human development similarity with that city. More comprehensive analyses, with the inclusion of all São Paulo municipalities and the use of compatible statistical methods, are necessary to deepen the understanding of the theme and overcome restrictions inherent to the only preliminary approach taken in this article.
Figures 1 and 2 show the mortality attributed to COVID-19 in relation to primary health care (PC) coverage (Figure 1) and in relation to the percentage of voters who, in each municipality, chose to vote for Bolsonaro in the first round of elections. elections-2018 (Figure 2).
It can be seen in Figure 1, by the position of the municipality of São Caetano do Sul (SCS) in the graph, that it is not enough for cities to have good AB coverage. In the specific case of SCS, located in the metropolitan region of São Paulo, the comprehensive coverage of private health plans should be noted, which requires caution in the interpretation of data on PC in the public sector, reported by the City Hall to the Ministry of Health. It is essential, however, to consider the strategic role of both the care model and the health system management standards. They must be compatible and support adequate health surveillance practices, not being restricted to treating patients.
The fact that Marília has had well-organized, comprehensive and consolidated primary care for several decades must be taken into account to understand the low relative mortality due to COVID-19 in that city. In this regard, Figure 1 shows that even though primary care coverage is below the average for the state of São Paulo, Araraquara and São Carlos have comparatively lower mortality rates compared to the other municipalities. It should be admitted, therefore, in line with Marília's condition, that the management characteristics and models of PC in these municipalities may have contributed, in some way, to their relative positions in the scenario of the pandemic in the state of São Paulo.
But the variable that is apparently the most consistently involved in the patterns of mortality from COVID-19 in these 19 municipalities is the percentage of votes obtained by the then presidential candidate, Jair Bolsonaro, in the first round of the 2018 elections. is admitted, in this analysis, as a valid indicator for the ideological phenomenon of 'Bolsonarism', according to which, more than voting and defending this political leader, its supporters share the set of beliefs and values that the current president has been assuming publicly, and which are expressed as denialism regarding the risks produced by the new coronavirus (SARS-CoV-2) and, as a result, the disregard of the protective measures recommended by the World Health Organization and other national and international scientific organizations. The disrespect for scientists and the discredit to science, simultaneously with the repeated recommendations of mystical practices, prayers and medical procedures without foundation in scientific evidence, conform an anachronistic, populist and pathogenic Head of State profile, crowned by an extemporaneous and unusual anti-vaccination preaching that , among other harmful consequences, seriously threatens the National Immunization Program (PNI), one of the Brazilian health successes, recognized and applauded worldwide.
I reiterate that voting for Bolsonaro in the first round, when voters had several options in the wide range of party coalitions, can be admitted as a valid indicator of this ideological profile, whose adoption implies faithfully following the leader's guidelines.
Figure 2 shows that, following the leader, his voters in these 19 municipalities adopted attitudes and practices that contributed to aggravating the spread of the pandemic in their territories and that are at the origin of the deaths that make up the graph. It is also admitted that, despite the known limitations (preventive and therapeutic, given the characteristics of COVID-19), the organization and performance of the SUS in these municipalities may have contributed to mitigate damage, always conditioning this possible effectiveness to the aforementioned characteristics of the model primary care and public management. I am certain that, in due course, more robust analyzes must be produced to confirm or reject the hypothesis presented in this article.
The 19 municipalities can be grouped into four clusters. It is observed that three of these four clusters correspond to municipalities in which the percentages of votes for Bolsonaro in the first round are above the percentage obtained by the candidate in the state of São Paulo. Of these three, one cluster brings together municipalities that have a relatively high mortality rate and another cluster is made up of municipalities that have a high relative mortality rate. The municipality of Marília stands out for the fact that it had a significant vote for Bolsonaro (66,8%) in the first round and, even so, had a comparatively low mortality rate compared to the others analyzed, as mentioned.
The cluster composed of the municipalities of Araraquara and São Carlos is the only one in which the percentages of votes for Bolsonaro were lower than those obtained by the candidate in the state of São Paulo (51,6% and 52,9%, respectively). These municipalities also recorded the lowest mortality rates from COVID-19 in the analyzed set. Not voting for Bolsonaro and, therefore, rejecting the beliefs and values disseminated by him constituted, in these municipalities, an important protection factor, avoiding deaths. It should be noted that all 19 municipalities had mortality rates from COVID-19 lower than those recorded for the State of São Paulo.
It is no exaggeration, therefore, to state that 'Bolsonarism' kills and that, unfortunately, due to its ideological characteristics, it will not be resolved together with the political solution that Brazilians give, at the appropriate time, to the current occupant of the Planalto Palace, because it is a phenomenon whose deepest roots have to be identified, understood and overcome in our social formation.
Finally, a word about São Carlos, whose current mayor was re-elected precisely by the PSL, the party responsible for placing Bolsonaro in the highest position in the Republic: data from São Carlos should not lead to hasty conclusions, which seek to equate the PT (government in Araraquara) to the PSL. São Carlos, it should be noted, was governed by the PT from 2001 to 2012 and by the PSDB from 2013 to 2016. The current mayor (who knew?), was elected in 2016 by the PSB.
All these years certainly left their marks on the São Carlos SUS, whose effects are expressed in data on deaths resulting from the pandemic. If it is to “see” the PT in the Araraquara data, as Fernando Haddad did (in my view, correctly), one can also dialectically “see” it in São Carlos, even though the local government has been shared with the PSDB and the PSB. Numbers, data, quantitative indicators sometimes hide what they should reveal. What SUS is today, in each Brazilian municipality, was not built in 2020, but over several years.
It is not, therefore, about idiocy, imbecility or mental retardation. Quite the contrary: 'Bolsonarism' is indeed an ideology that kills. At least this is what science is demonstrating, whether or not Jair Bolsonaro's supporters like science.
*Paulo Capel Narvai is senior professor of Public Health at USP.
