Brazil's Federal Supreme Court, for example, consistently upholds state physical distancing policies that the Bolsonaro administration opposes.1 State-level health systems investments, such as efforts to rapidly expand emergency bed capacity in intensive care units, have also sustained Brazil's universal public health system in the context of weak federal coordination and management.2 Since his election into office in 2018, President Bolsonaro has shown an authoritarian leadership style and emphasised traditional family values, Judeo-Christian morals, and a strong economy.3,4 He has questioned the role, efficacy, and legitimacy of democratic institutions, including the National Congress of Brazil, the Federal Supreme Court, and political parties,5 reinforced by his past history of repeatedly switching parties and currently not having any party affiliation. Bolsonaro has said he views unemployment as worse than COVID-19 itself.6 To prioritise opening the economy sooner and garner support for his views, Bolsonaro stated that there would be chaos from unemployment and food shortages at home due to school and work closures.7 This strategy supports his aims to rejuvenate the economy, sustain business community support, and, above all, secure re-election in 2022. In many cases, this is because state governments have worked to increase intensive care units in the public health system or in emergency field hospitals, transfer cases from metropolitan to other locations where there is a lower demand for health services and vice versa, and even resorted to routing patients with COVID-19 to the private health system where there is additional intensive care unit availability.20 The COVID-19 pandemic is likely to continue to exact a heavy toll on human lives in Brazil during the coming months.