Letters

Protect Indigenous peoples from COVID-19

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Science  17 Apr 2020:
Vol. 368, Issue 6488, pp. 251
DOI: 10.1126/science.abc0073

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Indigenous peoples in Brazil's Amazon region are at increased risk in a COVID-19 outbreak.

PHOTO: LUCAS FERRANTE

As coronavirus disease 2019 (COVID-19) spreads through Brazil, President Jair Bolsonaro has repeatedly denied the severity of the pandemic and broadcasted misleading information and mixed messages about how to respond, advocating for hydroxychloroquine use and the end of the country's quarantine (1). Current scientific evidence contradicts these recommendations (2, 3), and the president's speech puts the population of Brazil at risk. The public health system in Brazil's state of Amazonas has already “collapsed,” according to a statement by the mayor of the state's capital city (4). The Bolsonaro administration must immediately reverse its current posture of minimizing the threat of COVID-19 and take steps to protect Brazil's vulnerable populations, including its Indigenous and traditional peoples.

The standard risk groups for COVID-19 are elderly people and those with comorbidities (3), but in Brazil it makes sense to expand the risk group designation to include Indigenous peoples. Pathogens have historically been one of the most powerful factors in decimating Indigenous peoples in South America (5, 6). COVID-19 poses a particular threat to these communities given that Brazil's federal government has marginalized and neglected Indigenous peoples even when their rights are guaranteed by law or by international agreements (7, 8).

Indigenous and traditional peoples can be expected to be especially vulnerable to severe acute respiratory syndrome–coronavirus 2 (SARS-CoV-2), the virus that causes COVID-19. In addition to their history of susceptibility to epidemics (6), many of these isolated communities lack medical posts, doctors, and basic medications, to say nothing of the ventilators that would be needed to treat a COVID-19 outbreak. Bolsonaro's administration recently dismissed 8000 Cuban doctors who served small communities in the country's interior (9), which has been especially harmful to Indigenous and traditional communities in the Amazon region.

Brazil's government must take action in the Amazon to protect these people. Instead of allowing evangelical missionaries to enter into contact with isolated Indigenous groups (10), all means of transport to these areas should be restricted. The first Indigenous case of the disease was confirmed on 1 April (11). In line with international guidelines (11), Brazil's government should ensure isolation and monitoring in Indigenous areas as well as for all those who have contact with them. The government must act quickly to provide doctors, personal protective equipment, and testing capabilities in these areas. On the national scale, Brazil must maintain a nationwide quarantine to mitigate the disease's impact. Measures favored by Brazil's president, such as “vertical isolation” or a partial breach of isolation (1), conflict with World Health Organization recommendations and scientific studies (3, 12), thereby putting Brazil's entire population at risk. The effectiveness of hydroxychloroquine has not been confirmed, although its risks have been (2). Protecting Indigenous and traditional peoples from COVID-19 by acknowledging their increased risk and acting accordingly will protect public health for all Brazilians as well as safeguard the sustainability of the Amazon.

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