The biggest threat to Brazil’s ability to combat coronavirus is its far-right president, British medical journal The Lancet has concluded.

In an editorial, The Lancet said Jair Bolsonaro‘s disregard for lockdown measures was sowing confusion across the South American country,

On Friday, Brazil’s health ministry reported a record 751 Covid-19 deaths, bringing the total confirmed death toll to 9,897. The country also registered 10,222 new cases, for a total of more than 145,000.​

It is the deadliest confirmed outbreak of any emerging market nation.

Mr Bolsonaro, a former army captain, is becoming increasingly hamstrung by a political crisis following his recent sacking of popular health minister Luiz Henrique Mandetta, and the resignation of justice minister Sergio Moro, The Lancet said.

“The challenge is ultimately political, requiring continuous engagement by Brazilian society as a whole. Brazil as a country must come together to give a clear answer to the ‘So what?’ by its president. He needs to drastically change course or must be the next to go,” the editorial said.

In response to a journalist’s question last week about the record number of deaths from coronavirus, Mr Bolsonaro said: “So what? I’m sorry, but what do you want me to do?”

Mr Bolsonaro’s press office declined to comment on the Lancet editorial. On Friday, the president said he planned to have 30 friends over to the presidential palace for a barbecue. Later in the day, he joked that he may extend the invitation to thousands more, including political supporters and members of the press.

A report by Imperial College London published on Friday showed “the epidemic is not yet controlled and will continue to grow” in Brazil, in stark contrast to parts of Europe and Asia, where enforced lockdowns have had success.

“While the Brazilian epidemic is still relatively nascent on a national scale, our results suggest that further action is needed to limit spread and prevent health system overload,” the report said.

In its editorial, The Lancet noted the challenges Brazil faces. About 13 million Brazilians live in shanty town favelas, where hygiene recommendations and physical distancing are near impossible to follow.

The country’s indigenous population was also under “severe threat” even before the Covid-19 outbreak due to the government turning a blind eye to or even encouraging illegal mining and logging in the Amazon rainforest.

“These loggers and miners now risk bringing Covid-19 to remote populations,” it said.

Most of Brazil’s 27 state and district governments are taking the threat of the virus more seriously than Mr Bolsonaro.

On Friday, the government of Sao Paulo, Brazil’s most populous state, extended mandatory quarantine until the end of May. It had been scheduled to expire on 11 May.

Additional reporting by AP