Sunday afternoon, as the number of confirmed coronavirus cases in Brazil passed 100, President Jair Bolsonaro left the presidential palace in Brasilia to mingle among thousands of pro-government demonstrators outside.

It was the latest rash and irresponsible move from the far-right president, who was supposed to be in self-isolation even after saying he tested negative for COVID-19.

Bolsonaro has decided that the coronavirus outbreak is just another media conspiracy meant to derail his presidency, rather than a global health pandemic that has caused thousands of deaths, shut down cities, states and countries, and hammered economies worldwide. And he has maintained that view — even as 17 members of his government have now tested positive for COVID-19 after a trip to the United States in early March.

Despite saying that “the virus could turn into a fairly serious issue” on Tuesday, Bolsonaro still told CNN Brazil that calls for bans on sporting events and large gatherings amounted to nothing more than “hysteria.”

“Banning this and that isn’t going to contain the spread,” he said.

Bolsonaro, who has modeled much of his rise to power and his governing style on President Donald Trump, is already repeating U.S. leaders’ worst mistakes.

But in Brazil, experts warn, such a lackadaisical nonresponse could set the stage for an even more devastating outbreak than those that have occurred in North America and Europe.

AP Photo/Silvia Izquierdo Supporters of Brazilian President Jair Bolsonaro rally on Copacabana beach in Rio de Janeiro, Brazil, on March 15, 2020.

Brazil’s public health system offers access to basic coverage and services, especially for the poor, but chronic underfunding has still left it at risk of being quickly overwhelmed. Brazil’s economy is already struggling and it may be even less able to withstand the shock a global pandemic will cause than stronger American and European markets. The country’s high rates and high concentrations of urban poverty are a tinderbox waiting to explode. And its president appears even less prepared to handle a crisis of this magnitude than his global counterparts.

I think it will be much uglier [in Brazil] than it is here. And I think it’s going to be potentially much uglier than it has been in Italy. Monica de Bolle, Peterson Institute for International Economics

The worst-case scenario in Brazil is a widespread pandemic that could, in turn, lead an economic disaster that goes beyond what the U.S. and Europe have experienced, said Monica de Bolle, a Brazilian economist at the Peterson Institute for International Economics in Washington.

“I think it will be much uglier [in Brazil] than it is here,” de Bolle said. “And I think it’s going to be potentially much uglier than it has been in Italy.”

Brazil had confirmed 234 cases of COVID-19 as of Tuesday night, far fewer than in the U.S. or Italy. There have been more than 2,500 deaths in Italy, and more than 80 in the United States. Brazil confirmed its first on Tuesday, and two more on Wednesday.

But Brazilian health experts are already preparing for huge spikes in the next two weeks, thanks to the virus’s exponential spread in other countries and the return of the Southern Hemisphere autumn, when respiratory illnesses become more common. One analysis suggested there could be 4,000 cases by March 26, and more than 30,000 by April 1, HuffPost Brazil reported this week.

Bolsonaro and many Brazilians, however, seem to have adopted the belief that it won’t get so bad. Americans, including Trump, did the same, even as Italians pleaded with them to learn lessons from a country that didn’t move quickly enough.

“There’s a sense that this is a far away thing, in China and Europe,” said Oliver Stuenkel, an international relations professor at the Getúlio Vargas Foundation in Sao Paulo.

A Lack of Urgency

Much like in the United States, Brazil’s health ministry and some of its local officials have tried to move forcefully before an actual crisis explodes.

Health Minister Luiz Henrique Mandetta, a physician, has warned that the outbreak will get worse and that the contingency plans many states have in place are insufficient. He has told Brazil that it is in for “20 hard weeks,” and he asked the Brazilian Congress last week for more resources to purchase medical supplies and tests.

Rio de Janeiro Gov. Wilson Witzel, a right-wing Bolsonaro ally, declared a state of emergency on Monday and ordered bars, restaurants and other public spaces to limit capacity this week as the number of cases in Rio de Janeiro state climbed above 30. Schools and other establishments have begun to close across the city of São Paulo this week.

Photo by SERGIO LIMA/AFP via Getty Images Brazilian President Jair Bolsonaro takes a selfie with supporters in front of the Planalto Palace on March 15, 2020.

But Bolsonaro’s actions have helped undermine those messages. The president’s stoking of conspiracy theories and bad information has perpetuated the idea that there’s nothing to worry about. And he is now reportedly upset with Mandetta because he believes the health minister’s serious and technical response to the outbreak has generated unnecessary “hysteria.”

In the United States, Trump’s initially dismissive response helped turn COVID-19 into another partisan issue. Bolsonaro’s response appears to have had an especially strong effect on his more radical supporters, too. On Friday, he half-heartedly told them to cancel the Sunday demonstrations against Congress and the Supreme Court. But protests blossomed across the country anyway, and demonstrators at one protest even shouted down a pro-Bolsonaro governor who, citing his status as a doctor, urged them to go home.

“I expect the percentage of people who think this is a hoax, even on the pro-Bolsonaro side, to decrease,” Stuenkel said. “But I also think you will have a sizable part of Bolsonaro voters who, until the very end, even if you have lockdowns and a mounting number of deaths, will continue to believe that this is either a hoax or a Chinese conspiracy.”

Bolsonaro faced an impromptu protest on Tuesday night in Sao Paulo when Brazilians went to their balconies to bang pots and pans and call for his removal. Another, larger panelaço, as this type of protest is known, is scheduled for Wednesday night.

"Bolsonaro out!" says downtown São Paulo. pic.twitter.com/KTS2SoYO71 — Euan Marshall (@euanmarshall) March 18, 2020

But Bolsonaro has sown so much mistrust and misinformation in Brazil, Stuenkel said, that even if he were to adopt a more rational tone in response to growing anger, many of his supporters likely wouldn’t take him seriously.

“This has taken on a dynamic of its own,” Stuenkel said. “And I think it will profoundly complicate Brazil’s efforts to contain the pandemic.”

That’s worrying in a country where, as in the United States, the speed and intensity of the spread could make “all the difference,” as one Brazilian public health official told HuffPost Brazil this week.

An Unprepared Health System And A Vulnerable Population

The most immediate threat of a sharp uptick in confirmed cases in Brazil is to the country’s beleaguered public health system. Brazilian hospital capacity fell by nearly 28,000 beds between 2007 and 2019, HuffPost Brazil reported this week, which could leave the already-strained system overwhelmed if the outbreak worsens quickly ― a problem that could, in turn, worsen the outbreak.

“The demand for health services is the main problem that we will have,” University of Brasilia epidemiologist Pedro Tauil told HuffPost Brazil. “We do not have enough [intensive care] beds yet to provide adequate assistance to serious cases that require respiratory assistance.”

Social isolation is hard for the urban poor in the U.S.; for the 1.4 million residents of Rio’s favelas, it is nearly impossible.

The health ministry has promised to expand capacity, but so far hasn’t met those goals. Even if it does, the system may still get swamped by a caseload it can’t handle, especially in poorer and more rural states, Mandetta has said.

The coronavirus outbreak in the U.S. has worsened already-existing medical access problems for the urban poor, a population that is disproportionately Black and Latino and will suffer the worst of COVID-19.

That problem could be even worse in Brazil due to high concentrations of urban poverty. In Rio, more than one-fifth of the city’s residents live in favelas, the informal poor and working-class neighborhoods that span the city. Social isolation is hard for the urban poor in the U.S.; for the 1.4 million residents of Rio’s favelas, who live in small houses that are tightly packed together and often stacked atop one another, it is nearly impossible.

“How can I isolate a family member if they contract the disease, if four people share the same room in my house?” one resident of the Tavares Bastos favela in Rio asked EFE, a Spanish news outlet.

Favela communities, which are inherently intertwined and co-dependent, often lack basic resources and quality sanitation, and they have been hot spots for communicable diseases, including tuberculosis and flu epidemics. Now, they could drive massive and rapid spikes in the number of COVID-19 cases, whenever coronavirus hits. And they are incredibly vulnerable to tourists, who often visit favelas for tours.

AP Photo/Silvia Izquierdo The Rocinha favela stands out from a hillside in Rio de Janeiro, Brazil, on March 16, 2020. Rocinha, Brazil's largest favela, is home to about 70,000 people, as of the latest census. Brazil's neglect of favela residents could make favelas hot spots for outbreaks of COVID-19.

Favela journalists have raised concerns about how their communities may be affected. But there has been no widespread discussion in Brazil about the crisis its poorest people may face, or how Brazil’s long-standing neglect and stigmatization of favela residents may worsen the crisis for the country as a whole.

Another vulnerable population grabbed headlines this week after hundreds of angry inmates busted out of at least four Sao Paulo prisons. Public health officials have warned that prisons and jails could be major hot spots for coronavirus outbreaks in the U.S., but Brazilian prisons are even more overcrowded and decrepit than American ones.

In 2019, Brazil had more than 722,000 people incarcerated in prisons with a stated capacity of roughly 436,000, and nearly 50,000 are housed in facilities without a single doctor’s office, according to Rede de Observatórios, a public security think tank in Rio.

“The State is responsible for the lives of those in its custody, and needs to act firmly to prevent the epidemic from taking deaths from disease in prisons to new and shameful records,” the think tank said Tuesday.

But Bolsonaro, who favors harsh criminal justice policies and views favelas largely as bastions of criminal activity, seems unlikely to lead the way on measures to protect the poor or the incarcerated.

‘It’s Not Even A Recession. It’s A Depression’

The COVID-19 outbreak has hammered economies across the world as markets have plummeted amid the shutdown of cities, states and workforces. Brazil may be even more vulnerable: The crisis hit healthy and growing economies in Europe and the United States, but Brazil’s economy was already growing at its slowest rate since 2016 when the country was in the midst of a deep recession.

The crisis has forced the U.S. to take drastic measures to shore up markets, and U.S. Congress and Trump are now working on various economic stimulus measures to backstop the economy and assist workers amid fears that unemployment could hit 20%.

Brazil likely needs to be even more aggressive, but there are early indications that Paulo Guedes, the country’s conservative economic minister, may not be willing to take the necessary steps.

If government does nothing or does things which are insufficient ... this is an economy that is going to be engulfed by an epidemic and at the same time an economic depression. Monica de Bolle, Brazilian economist

A hero of Brazil’s libertarian movements, Guedes became Bolsonaro’s economic guru because of his promise of deep liberal reforms to the country’s economy. He has remained wedded to that reform agenda and his desire to cut spending, deficits and Brazil’s high levels of public debt even as the crisis unfolds. In the early stages of the outbreak, Guedes suggested his proposed reforms, including privatization of huge state-owned energy enterprises, could help Brazil avoid the worst.

On Monday, Guedes bent ever so slightly when he announced a $34 billion package to bolster the economy and social welfare programs. In announcing the plan, Guedes promised it would have little fiscal effect, a nod to the fact that Brazil enacted hard budgetary caps in order to rein in spending in 2016. The plan included roughly $1 billion to boost public health in a country that already spends far less than its peers on such programs.

And after economists warned that the package would fall far short of what Brazil needs, Guedes on Wednesday announced a new monthly aid package for workers in Brazil’s informal economy. He also said that in the event of economic calamity, he would allow public spending to go beyond the fiscal targets ― a suggestion that his economic ministry may be willing to take the sort of aggressive approach to the crisis and Brazil’s social safety net that economists have said is necessary.

“There are only two scenarios,” de Bolle said. “There’s a scenario where the government does nothing or does things which are insufficient. And if that’s the case, this is an economy that is going to be engulfed by an epidemic and at the same time an economic depression. That’s where Brazil is heading ― it’s not even a recession, it’s a depression.”

“The other scenario is the government spends and does what it needs to do to at least keep the economy running,” she said. “Is that going to blow up debt-to-GDP? Well, to some extent, yeah. But that’s inevitable. Throwing the country into a depression will blow up the debt-to-GDP ratio even more. Plus, you know, throwing the country into a depression also kills people.”

De Bolle, who has estimated that Brazil may need to spend more than 4% of its GDP in the face of the crisis, still doesn’t think Guedes is being aggressive enough. But it’s a start, she said, that could help Brazil avoid the worst-case scenario, at least when it comes to the economy.

Leaders across Latin America have taken dramatic steps to close borders, limit travel and reduce the risk of a widespread outbreak even with only a handful of confirmed cases in their countries. And countries like Singapore and South Korea have demonstrated how an aggressive early response can slow the spread of coronavirus and limit the outbreak.

Brazil doesn’t have to repeat the mistakes that Italy and the United States have already made. But unless Brazil’s leaders start taking the outbreak more seriously, it seems destined to do just that, with immeasurable and devastating consequences.