President Jair Bolsonaro fired his health minister, Luiz Henrique Mandetta, after public clashes over the Brazilian government’s disastrous handling of the accelerating spread of the coronavirus in Latin America’s largest country.

The immediate trigger for Mandetta’s sacking was his interview last Sunday on the country’s leading nightly television program, Fantástico, in which he directly criticized the president, declaring: “the people don’t know who to listen to, if it is the health minister or the president.”

Bolsonaro’s choice to replace Mandetta is oncologist Nelson Teich, who was on the short list for the job when the fascistic president was forming his cabinet in 2018. A Bolsonaro loyalist, he was reportedly picked this time around because the initial frontrunner, Claudio Lottenberg, refused to publicly declare that he was opposed to any public discussion of the right to abortion, saying only that he was personally against it on religious grounds.

Teich is also seen as someone with better business connections, having been an aide to the Health Ministry’s Strategic Supplies Secretary Denizar Vianna and having founded and then sold a private cancer treatment firm to one of the country’s leading private health care operators, Amil. Finally, he is considered to be the choice of Bolsonaro’s main business backers and his intelligence chief, Gen. Augusto Heleno.

The decision comes as the number of COVID-19 cases in Brazil reached 30,425, with 1,924 deaths. Health authorities from the four corners of the country acknowledge that these official numbers are a gross underestimation. Both federal and local officials have followed a policy of testing only severe cases, at a rate of only 300 per million inhabitants, with citizens advised not to go near hospitals unless they are suffering breathing difficulties.

A study reported by Reuters on Monday, based only on official death figures and the estimated lethality in other countries, estimates the real number of cases to be 360,000 or more. The country also has more than 15,000 tests waiting to be processed, including those for hundreds of dead patients.

While pundits treat the underestimation of cases in a positive light, the real consequences of the loss of control over the pandemic can be seen in the rapid collapse of the health care system in the remote city of Manaus, the capital of the state of Amazonas.

Manaus is the 10th wealthiest Brazilian capital and the center of an industrial special economic zone established by the 1964-1985 military dictatorship in order to populate the remote northwest of the country. With 1.8 million inhabitants, it is virtually landlocked by the Amazon jungle, mostly accessible only by plane and the wide Amazon River, which connects it directly to the Atlantic Ocean, serving as its main link to world markets.

The collapse of its health system, barely 33 days after the first official COVID-19 diagnosis, is a sharp warning of what the working class in other poorer and larger cities in the country should expect.

Demonstrating full knowledge of what is to come, the ruling class is guaranteeing itself tests—with the governors of both Pará, a poor Amazonian state to the east of Amazonas, and Rio coming up positive—while denying them to the masses of workers.

Farther east, in the impoverished state of Ceará, the capital Fortaleza, Brazil’s fifth largest city, has reached 100 percent of its capacity to treat COVID-19 patients in intensive care, and estimates that deaths will reach 250 a day by May 5 if ventilators currently stranded in China fail to reach the city.

The collapse of health care systems is also rapidly approaching in the richest region in the country, the São Paulo-Rio de Janeiro economic corridor, where 42 million out of 210 million Brazilians live. The cities were the first and second to identify COVID-19 patients 50 days ago. São Paulo now has 12,000 confirmed cases and 850 deaths, but its health authorities admit that the real number of cases is at least 10 times higher. It also reports that 70 percent of intensive care units for COVID-19 patients are already filled. A third of deaths taking place in the city are of confirmed or suspected COVID patients, with most not having been tested. In Rio, official cases and deaths are 4,000 and 300, respectively, with 88 percent of the city’s intensive care units occupied.

The impact of the pandemic on the health system is further compounded by the developing economic crisis, with an intensification of the fall in commodity prices which is already responsible for a six-year economic crisis in the country. The collapse in the price of oil has forced the state energy conglomerate Petrobras to shut down 45 oil rigs because the exploitation of offshore fields has become too costly.

In the auto sector, crucial for the São Paulo-Rio de Janeiro corridor, 65 plants have been shut and 370,000 workers have had their contracts suspended in line with wage and hour reduction schemes authorized by the government.

And the economic impact of the crisis is only beginning. Government officials estimate 1.5 million workers have been subjected to similar deals, and projections are that 70 percent of the 34 million workers hired under the Brazilian Labor Code will face similar, or at least partial, suspensions of their wages and hours. For some 50 million “informal” and “autonomous” workers, those first hit by the retail shutdown decreed across Brazilian states to slow the spread of the pandemic, the government has established R$600 (US$120) monthly compensation, amounting to only 40 percent of their average R$1500 (US$300) wages. Total GDP loss is expected to reach 7 percent.

This catastrophic situation is fueling a spiraling political crisis with constitutional implications, which the ruling class has attempted to escape by relying ever more heavily on the Brazilian military arbiters—chiefly Bolsonaro’s chief of staff, Gen. Water Braga Netto and his vice president Gen. Hamilton Mourão.

Governors across the country, wary of the political consequences of Bolsonaro’s malign neglect of the pandemic among workers, have decreed partial economic shutdowns and set up field hospitals in entertainment venues, including the international football icon, Rio’s Maracanã stadium.

At the same time, the federal government has been attempting to gain an upper hand in pressuring the states to reopen the economy and send adults under the age of 60 back to work.

For weeks, local authorities have reported they have been blocked from buying ventilators and other material from local medical manufacturers, which report that all such items have been requisitioned by federal authorities, who provide no timeline for their distribution. Now, Bolsonaro is threatening to veto a bill being discussed in Congress to compensate local governments for the fall in sales taxes. Economy Minister Paulo Guedes has declared his opposition to the bill on the basis that it would provide a “malign encouragement” to governors, who would be less prone to submit to Bolsonaro’s pressure for the economy to be “reopened” immediately.

For his part, health minister Mandetta had been universally praised by editorial boards and in Congress for offering mild criticism of Bolsonaro’s ignorance and callous indifference to death and suffering. He kept the job until now largely as a result of pressure from the military. The conservative O Estado de S. Paulo summed up the situation in an editorial last week: “The role of the military in the cabinet, such as Gen. Braga Netto, has been to protect the president from himself.”

Mandetta’s sacking has been attributed to the will of the same military, which saw in his Fantástico interview an intolerable public defiance of Bolsonaro. Vice President Mourão, one of those responsible for “protecting the president from himself,” clarified the military’s view, declaring on Monday that Mandetta had “gone offside,” making an analogy to a soccer offense and indicating his imminent dismissal.

It is now unclear what justifications related to the COVID-19 pandemic will be provided for the choice of a new health minister, but governors are giving clear indications of their own plans to “reopen the country” and bury their differences with Bolsonaro in the interests of profits.

This was spelled out by the coordinator of São Paulo’s COVID-19 task force, David Uip, who told Folha de S. Paulo on Wednesday that the government expects the “peak” of the pandemic to be reached in May, but that the government is “still discussing” whether to extend the state quarantine until then. The São Paulo government had criminally advised the population less than two weeks ago to expect 100,000 COVID-19 deaths in six months, four times the per-capita deaths of the worst-hit European countries.

Whatever role the new health minister plays in these affairs, it is certain that the cabinet reshuffling will do nothing to alleviate the crisis gripping the Brazilian ruling class, caught between a sharp drop in an already dismal economic situation and the potentially explosive resistance of workers to being sent back to work and sentenced to die or infect their loved ones.

The sacking of Mandetta has further exposed the treacherous role of the so-called opposition led by the Workers Party (PT), with the support of the Communist Party (PCdoB) and the Socialism and Liberty Party (PSOL), who only last week had cheered the reported intervention of the military command in favor of Mandetta as posing a challenge to Bolsonaro.