Журнал. World association for medical law. The COVID-19 pandemic. Volume 39 2

155 Medicine and Law biased by the political crisis, established between the President and the State Governors, the Congress and the Constitutional Court. Strong isolation measures were imposed by the States, among them São Paulo, Rio de Janeiro, Pernambuco, Maranhão, Ceará, and the Federal District. At the time of writing, after almost two months of a not so successful attempts to keep citizens at home, the average isolation rate was around 55%, instead of the necessary rate of 70%. In coastal cities, like Recife and Rio de Janeiro, public parks and beaches were closed to the population, aggravating their anxiety, preventing them from working, and not solving the problem. These States are preparing to re-open the economy, without accomplishing the original goals of flattening the contagion curve, without a solid plan 5 , and preparing to face a possible second wave of the pandemic, with a much more damaged economic structure 6 . The doubling of the rate of deaths is estimated at only 5 days and a recent study by the Imperial College (London, UK) 7 , which analyzed the active transmission rate of COVID-19 in 48 countries, showed that Brazil is the country with the highest rate of transmission (R0 of 2·81). Brazil faces a social and a political crisis at the same time (hence the clash of pandemics highlighted in the title of this brief report). Over 70% of the citizens depend on the public health system which has been vilified by successive administrations, at all levels of government (federal, state and municipal). Brazil ranks among the most unequal countries on the planet. The average monthly income of 1% at the top of the social scale, as of last year, was more than 33 times the average income of 50% at the lowest level 8 . About 13 million Brazilians live in favelas, often with more than three people per room and little access to clean water. Physical distancing and hygiene recommendations are near impossible to follow in these environments— many favelas have organized themselves to implement measures, as best as is possible. Brazil has a large informal employment sector with many sources of income no longer an option. 5 https://jc.ne10.uol.com.br/economia/2020/06/5611361-reabertura-economica--governo- de-pernambuco-diz-estar-aberto-a-discutir---ajustes-necessarios.html 6 https://valor.globo.com/empresas/noticia/2020/05/26/brasil-e-o-unico-a-reabrir- economia-com-contagio-crescendo-diz-magazine-luiza.ghtml 7 https://www.imperial.ac.uk/mrc-global-infectious-disease-analysis/covid-19/report-21-brazil/ 8 https://www.uol.com.br/ecoa/ultimas-noticias/2020/02/20/por-que-brasil-e-o-setimo- pais-mais-desigual-do-mundo.htm