News Release

From Health Affairs: Nonpharmaceutical COVID-19 responses in Brazil

Peer-Reviewed Publication

Health Affairs

When the first cases of COVID-19 appeared in Brazil in late February 2020, the twenty-seven Brazilian states responded by implementing a variety of nonpharmaceutical interventions: restrictions on public events, schools, and nonessential commerce, and somewhat later, masking ordinances. In this study, Louise Russell of the University of Pennsylvania and coauthors estimated the independent effects of seven of these interventions on COVID-19 cases and deaths in twelve Brazilian states, using daily data from March to December 2020. They found that two interventions—restrictions on public events and masking mandates—significantly reduced spread of the disease. Full restrictions on public events reduced the growth rate ratio of COVID-19 cases, which averaged 1.30 before any interventions were introduced, by 0.227. Partial restrictions on public events were equally effective, suggesting that some relaxation was possible without increasing cases. Full masking mandates were also effective, with a 0.060 growth rate ratio reduction. The authors note that the combined effect of suspending public events and imposing full masking mandates reduced the growth rate ratio to almost 1, the point at which cases are no longer increasing. Selective use of nonpharmaceutical interventions is important in all countries to minimize the economic and social burdens of controlling COVID-19 but may be especially important in low- and middle-income countries such as Brazil, which have more workers in informal jobs that lack safety-net services, poor infrastructure for distance learning, and less capacity to stimulate their economies. The authors conclude that their results can help policy makers choose the most effective measures to be adopted when community transmission and incidence of COVID-19 increase.


Health Affairs is the leading peer-reviewed journal at the intersection of health, health care, and policy. Published monthly by Project HOPE, the journal is available in print and online. Late-breaking content is also found through, Health Affairs Today, and Health Affairs Sunday Update.

Health Affairs podcasts go beyond the journal’s pages to bring you insightful discussions on the latest news and research affecting health policy. On our flagship podcast, A Health Podyssey, Editor-In-Chief Alan Weil interviews the leading researchers and influencers shaping the field’s big ideas. Join Health Affairs editors on Health Affairs This Week as they discuss the week’s most pressing health policy news. All in 15 minutes or less.

Project HOPE is a global health and humanitarian relief organization that places power in the hands of local health care workers to save lives across the globe. Project HOPE has published Health Affairs since 1981.

Disclaimer: AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert system.