RT Journal Article SR Electronic T1 A partisan pandemic: state government public health policies to combat COVID-19 in Brazil JF BMJ Global Health JO BMJ Global Health FD BMJ Publishing Group Ltd SP e005223 DO 10.1136/bmjgh-2021-005223 VO 6 IS 6 A1 Michael Touchton A1 Felicia Marie Knaul A1 Héctor Arreola-Ornelas A1 Thalia Porteny A1 Mariano Sánchez A1 Oscar Méndez A1 Marco Faganello A1 Vaugh Edelson A1 Benjamin Gygi A1 Calla Hummel A1 Silvia Otero A1 Jorge Insua A1 Eduardo Undurraga A1 Julio Antonio Rosado A1 , YR 2021 UL http://gh.bmj.com/content/6/6/e005223.abstract AB Introduction To present an analysis of the Brazilian health system and subnational (state) variation in response to the COVID-19 pandemic, based on 10 non-pharmaceutical interventions (NPIs).Materials and methods We collected daily information on implementation of 10 NPI designed to inform the public of health risks and promote distancing and mask use at the national level for eight countries across the Americas. We then analyse the adoption of the 10 policies across Brazil’s 27 states over time, individually and using a composite index. We draw on this index to assess the timeliness and rigour of NPI implementation across the country, from the date of the first case, 26 February 2020. We also compile Google data on population mobility by state to describe changes in mobility throughout the COVID-19 pandemic.Results Brazil’s national NPI response was the least stringent among countries analysed. In the absence of a unified federal response to the pandemic, Brazilian state policy implementation was neither homogenous nor synchronised. The median NPI was no stay-at-home order, a recommendation to wear masks in public space but not a requirement, a full school closure and partial restrictions on businesses, public transportation, intrastate travel, interstate travel and international travel. These restrictions were implemented 45 days after the first case in each state, on average. Rondônia implemented the earliest and most rigorous policies, with school closures, business closures, information campaigns and restrictions on movement 24 days after the first case; Mato Grosso do Sul had the fewest, least stringent restrictions on movement, business operations and no mask recommendation.Conclusions The study identifies wide variation in national-level NPI responses to the COVID-19 pandemic. Our focus on Brazil identifies subsequent variability in how and when states implemented NPI to contain COVID-19. States’ NPIs and their scores on the composite policy index both align with the governors’ political affiliations: opposition governors implemented earlier, more stringent sanitary measures than those supporting the Bolsonaro administration. A strong, unified national response to a pandemic is essential for keeping the population safe and disease-free, both at the outset of an outbreak and as communities begin to reopen. This national response should be aligned with state and municipal implementation of NPI, which we show is not the case in Brazil.Data are available on request. For data request, please contact the corresponding author. All data and replication code will be made publicly available on our site (observcovid.miami.edu) as well as a dedicated repository (Harvard Dataverse) on publication.