By Lisandra Paraguassu

BRASILIA (Reuters) – Brazil’s health ministry on Wednesday issued new guidelines for wider use of anti-malarial drugs in mild coronavirus cases, a treatment touted by President Jair Bolsonaro in defiance of public health experts warning of possible health risks.

Interim Health Minister Eduardo Pazuello, an active duty army general, authorized the modified protocol after two trained doctors left the ministry’s top job under pressure to promote early use of chloroquine and hydroxychloroquine.

“We are at war. Worse than defeat would be the shame of not putting up a fight,” the right-wing president, a former army captain, tweeted to explain the government decision to put forward the drugs without proof of their effectiveness.

Medical experts, including Marcos Espinal, director for communicable diseases at the Pan American Health Organization, have warned that studies show the drugs are potentially dangerous in treating the novel coronavirus.

Bolsonaro has pushed the drugs’ potential along with his ideological ally U.S. President Donald Trump, who said this week he was taking hydroxychloroquine preventively despite a warning from the U.S. Food and Drug Administration.

The World Health Organization reiterated on Wednesday that hydroxychloroquine has potential side effects and should be reserved for clinical trials.

Brazil’s federal guidelines had previously cited the drug only as an unproven treatment for severe cases of the COVID-19 respiratory illness caused by the novel coronavirus.

The new guidelines suggest dosage for the anti-malarials along with the antibiotic azithromycin at the onset of symptoms. Patients or family members will have to sign a waiver recognizing potential side effects.

Brazil’s daily death toll from the outbreak jumped to a record 1,179 on Tuesday, with more confirmed cases than any country but Russia and the United States.

Bolsonaro has called the virus “a little cold” and suggested last month it was on the decline. He has cited economic concerns in fighting against social isolation orders issued by state governments at the recommendation of medical experts.

An opinion poll published on Wednesday by XP Investimentos brokerage found that 76% of the Brazilians surveyed still favor social distancing as the best way to curb contagion and 57% said it should be maintained until the risk of infection is minimal.

Bolsonaro’s performance in dealing with the pandemic has been bad or terrible for 58% and rated favorably by only 21%, according to the telephone survey of 1,000 people by pollster Ipespe May 16-18.

Amid the president’s persistent attacks and a growing fatigue nationwide, governors and mayors have begun discussing ways to open businesses and relax rules to shelter at home.

Sao Paulo Governor Joao Doria, a critic of Bolsonaro’s handling of the crisis, said in a radio interview on Wednesday that quarantine measures would be lifted gradually in parts of Brazil’s most populous state as of June 1.

At the health ministry, the interim minister Pazuello on Wednesday named four more military officers to administrative and advisory positions, raising to at least 20 the members of the armed forces drafted into the fight against the outbreak.

(Reporting by Lisandra Paraguassu in Brasilia; Additional reporting by Carolina Mandl in Sao Paulo and Anthony Boadle in Brasilia; Editing by Brad Haynes and Marguerita Choy)