RIO DE JANEIRO (AP) -- Faced with overwhelmed hospitals and surging coronavirus deaths, Brazilian state and city governments are lurching forward with mandatory lockdowns against the will of President Jair Bolsonaro, who says job losses are more damaging than COVID-19.
The movements of Brazilians have been completely restricted in fewer than two dozen cities scattered across the vast nation of 211 million -- even though Brazil's death toll stands at more than 12,000, Latin America's highest.
While public health experts are demanding bolder action, most governors and mayors have not imposed mandatory stay-at-home orders. Their apparent reluctance comes amid Bolsonaro's relentless message for Brazilians to defy regional and local public health efforts to stop the virus' spread.
Stricter lockdowns are needed because Brazilian doctors are now being forced to choose who lives and dies and triage situations could generate social unrest if they increase, said Miguel Lago, executive director of Brazil's non-profit Institute for Health Policy Studies, which advises public health officials.
"We need to avoid a total disaster," he said.
Lago said mandatory lockdowns across much of the country would help: "It is late in terms of avoiding hospital collapse, but certainly it isn't too late to avoid a bigger catastrophe."
Brazil had more than 165,000 confirmed cases on Tuesday, with the actual figure believed to be much higher because of limited testing. Many intensive care hospital units are full and cemeteries are increasingly overwhelmed with bodies.
Bolsonaro, who called the virus a "little flu," has insisted for more than a month that governors are stoking economic carnage with voluntary quarantine recommendations and urges Brazilians to go about their everyday. He reiterated criticism of governors Tuesday for ignoring his decree that gyms, barbershops and beauty salons should be treated as essential services.
Amid Bolsonaro's rejection of coronavirus danger, most of the country's 27 governors have criticized his stances but none have imposed mandatory statewide lockdown measures recommended by experts. Instead, the governors have either applied selective lockdowns in cities or deferred to mayors to make those decisions.
Governors had been hoping the virus would not spread in Brazil's warm climate, but their response is also a reflection of Brazil's political landscape because the governors depend on mayors to endorse re-election campaigns.
Many worry that imposing mandatory lockdowns could hurt local leaders in this year's municipal election, decreasing support for incumbent governors in their 2022 campaigns, said Thiago de Aragao, director of strategy of the Arko Advice political consultancy.
But as the death toll rose from less than 7,000 to more than 10,000 last week, local authorities began adopting stricter anti-virus measures.
The riverside community of Tefe in the Amazon region was among the first, with a lockdown decree specifying criminal charges for residents leaving home except for visits to hospitals, pharmacies and supermarkets. The mayor imposed it because only about half of Tefe's 60,000 residents complied with an earlier recommendation by the governor of Amazonas state to take virus precautions.
Those who did not comply "think they're immortal, that they won't get it," Tefe Mayor Normando Bessa de Sa said on Facebook.
Over the next three days, the governors of the northern and northeastern states of Maranhao, Para and Ceara decreed lockdowns for their capital cities as intensive-care units filled with COVID-19 patients.
Despite the new lockdowns, Rio de Janeiro and Sao Paulo still don't have mandatory stay-at-home-orders at the state or city level -- even though they are the hardest hit places in Brazil.
Lockdowns "should have been imposed at least three weeks ago, when the epidemic was already increasing, but not at this speed that it is now," said Margareth Dalcolmo, a respiratory physician and researcher with the widely respected Oswaldo Cruz Foundation biological research group.
"I gave that recommendation more than once," said Dalcolmo, among the experts on a COVID-19 panel that advises Rio's governor.
Rio Gov. Wilson Witzel has decreed non-binding quarantine recommendations and commerce restrictions through the end of May. He pledged to make police available so the state's 92 mayors can enact lockdowns, instead of imposing them himself.
In another example of Brazil's scattershot local lockdowns, Rio de Janeiro Mayor Marcelo Crivella on Monday prohibited non-residents from entering 11 neighborhoods and ordered the closure of all businesses except supermarkets and pharmacies in the teeming slums called favelas.
"People still haven't perceived the need to avoid gatherings, stay home," Crivella complained.
For most people, the new coronavirus causes mild or moderate symptoms including fever and cough. The risk of death is greater for the elderly and people with other health problems.
The cities of Niteroi and Sao Goncalo near Rio on Monday authorized fines and criminal charges for violating stay-at-home orders. Niteroi police took the temperatures of those entering the city, and put a man and his two dogs inside a police van after he allegedly refused to show documents to justify being out of his home.
In Sao Paulo state, Gov. Joao Doria last month urged but did not require residents to self-quarantine while shutting down schools and most businesses. Nearly 70% of the state's 44 million people initially complied, but that dropped below 50% in recent weeks, according to cellphone carrier data provided by the state.
Doria, a presidential hopeful, saw his popularity increase as he challenged Bolsonaro. But police stopped enforcing his recommendations after Bolsonaro criticized the handcuffing and detention of a middle-aged woman exercising in a park who resisted removal.
With noncompliance rising, Doria said last week that "if we need to step up to a lockdown, we will not hesitate."
Sao Paulo's mayor this week limited vehicles circulating in the city to 50% of the normal flow. Television images showed long lines of people entering crammed buses with standing room only in clear violation of social distancing guidelines.
Public health analysts from the Imperial College London, whose COVID-19 research has guided global policymakers, last week called Brazil's anti-virus efforts "partially successful."
"In the absence of the introduction of further control measures that will more strongly curb transmission, Brazil faces the prospect of an epidemic that will continue to grow exponentially," they wrote.