World can learn from one Brazilian state’s virus response

One of the coronavirus disease’s (COVID-19) paradoxes has been the way in which some wealthy, high-capacity countries (particularly the US and UK) failed to contain the virus, while some poorer countries and regions with less capacity (including Vietnam, Greece and the Indian state of Kerala) swiftly brought it under control.

In the US and UK, ambiguous containment regimes without clear exit plans have resulted in a policy stalemate between maintaining unsustainable lockdowns and recklessly opening up the economy. By contrast, policymakers in the Brazilian state of Rio Grande do Sul have used careful planning to learn to live with the virus.

Five components of Rio Grande do Sul’s response stand out.

First, Governor Eduardo Leite focused from the outset on avoiding the worst possible outcome, rather than simply hoping it would not materialize. Before the pandemic reached Brazil, state officials used data from both

Japan and Singapore (where the virus’s impact was limited) and Italy and Spain (where it was horrific) to generate mathematical projections, and set out to avoid outcomes resembling the latter. The governor then announced restrictions in mid-March before the state had reported its first COVID-19 death, thus buying time to strengthen the health system’s capacity while slowing the virus’s spread.

Second, state officials took a data-driven approach to tracking the virus, investing not only in collecting more data, but also in improving systems and hiring outstanding talent to assess the information. The data committee divided the state into 20 regions, each of which has a main hospital with an intensive-care unit (ICU), and has monitored 11 indicators in each region every week.

The third component of the state’s response is a simple, specific and transparent alert system. Each week, the committee distils the 11 indices into a single figure for each region, which places the region in one of four risk categories. Yellow represents low risk, orange is medium, red is high, and black signifies very high risk, with a full lockdown expected in extreme cases.

Fourth, officials carefully examined how to keep the economy functioning, because the already-indebted state could not afford to support out-of-work people for long.

The committee has clearly segmented jobs and economic activities in terms of worker safety (given social distancing requirements) and their economic importance, giving these factors weights of 70 percent and 30 percent, respectively.

Finally, the state government drew up return-to-work protocols for each industry based on consultations with occupational health experts, industry associations, businesses, and workers. By publishing early drafts of protocols and inviting comments, the committee helped to ensure an open and transparent process.

Rio Grande do Sul’s work-safety policies have now been in place for three weeks.

As of the last week of May, fewer than 20 percent of the state’s COVID-19 ICU beds are in use. The state has 56 cases per 100,000 inhabitants, compared to 720 per 100,000 in Amazonas state, 390 in Ceara state, and 220 in Rio de Janeiro.

Rio Grande do Sul’s leaders have devised a strategy for living with the virus, based on key indicators, expert consultations and enforceable processes. And it has done so in full public view. There are lessons here for governments in richer countries that have yet to develop such a plan.