More stringent policies to combat the COVID-19 epidemic are necessary as the situation worsens in São Paulo. The state government’s zigzag approach has failed to prevent the spread of the virus and maintains it as the epicenter of the pandemic in Brazil

Main Conclusions

  • As we reach early April 2021, the state of São Paulo and the rest of the country remain immersed in a severe health and humanitarian crisis. Given the epidemiological growth dynamics of the pandemic and the overload of the health system, the pandemic’s toll in Brazil is more severe than ever.
  • In several countries, the rapid implementation of strict social distancing measures proved to be essential control strategies for the pandemic. However, that was not the case in the state of São Paulo throughout 2020 and early 2021. In 2020, the state insisted on a zigzag approach, which continued into 2021. The state continues to experience a prolonged and continuous crisis and, for the past year, has significantly struggled to control the dissemination of the coronavirus.
  • In the state of São Paulo, pandemic control measures effective in March 2021 were less strict and less consistent than in March and early April 2020. The most stringent phase of the state government’s containment plan, the so-called “Emergency Phase,” lasted no more than 29 days.
  • As the state of São Paulo insisted on a more flexible containment plan, alongside the lack of a consistent program for testing active infections, tracing contacts, and providing support for isolating people with confirmed or suspected of infection, the state continues to be the epicenter of the pandemic in the country.

Work group responsible


  • Lorena Barberia (USP)
  • Tatiane Moraes (Fiocruz)
  • Brigina Kemp (COSEMS/SP)
  • Vera Paiva (USP)
  • Maria Amélia de Sousa Mascena Veras (Faculdade de Ciências Médicas da Santa Casa de São Paulo)


  • Dara Pinto (USP)
  • Isabel Seelaender (USP)
  • Marcela Mello Zamudio (USP)
  • Pedro Schmalz (USP)
  • Natalia de Paula Moreira (USP)
  • Maria Letícia Claro de F. Oliveira (USP)
  • Luiz Guilherme Roth Cantarelli (USP)
  • João de Oliveira Gusmão (USP)
  • Felipe Vilela (USP)
  • Rebeca de Jesus Carvalho (USP)
  • Maíra Meyer (USP)
  • Gustavo Fernandes de Paula (USP)
  • André Garibe (USP)