Background:
While the title and goal of our conference is a positive response to having lived through the last three years of an infectious disease pandemic that we were promised as recently as the 1980s was part of the world’s past – is public health in any condition to respond? Staff burnout, cuts in health budgets, low vaccine coverage, and a public fatigued with everything but new conspiracy theories and targets to blame is not a propitious start. While technological advances in rapid home tests, vaccines, antivirals, and surveillance methods were brilliant achievements and saved millions of lives, the behavioral and social sciences contributed relatively little to policy and program, and only a few national programs appear to have achieved transmission control goals. This presentation reviews public response to testing, isolation, vaccination, distancing, and mask use in the northeast state of Ceará.

Methods:
Ethnographic case study applying formative research with expert and lay interviewees. A desk review of relevant published and unpublished information describes the chronology of response events, cases, and deaths attributed to COVID-19. Means of promoting recommendations, evaluating responses, and interactions among health authorities and political leaders will be described.

Results:
Early efforts (spelled out in the paper) were successful at slowing epidemic spread and deaths, with little of the animosity experienced in other regions of Brazil. High levels of collaboration among health professionals and political authorities were achieved. As awareness of the magnitude of the pandemic grew, national and international coordination was required to sustain a response. Absent this, local political, rather than epidemiologic facts determined the next steps. Without an effective national response individuals calculated their own risk and acted accordingly.