Manaus, Brazil missed warning after warning until his health system collapsed

For medical personnel, this is a 36-hour shift. For gravel, it is transferring the tons of dirt needed to build more than 20,000 graves.

For the dead, this is “vertical” burial, with bodies exhumed on top of each other in increasingly crowded cemeteries in Manaus, Brazil.

It is the heart of a city whose health care system has collapsed. And this is not the first time – in less than a year, this isolated city at the core of the Brazilian rainforests is seeing its second coronovirus wave, shocking many who thought its first wave was so widespread That herd should be immune results.

Municipal personnel at SOS Funeral extracted the body of 75-year-old Adomar Mendonca Macial from his home in Manaus on January 16, 2021, after the demise of COVID-19.

Missed warnings

Manaus is the capital and largest city in the state of Amazonas. It has more than 30 public and private hospitals, catering to many remote indigenous and small communities around the region. But the logistics of getting there – and supplying those hospitals – can be complicated. Due to limited road connectivity, most of the city’s routes are near Hawaii or the river.

Coronoviruses first erupted in a wildfire like Manaus in April 2020, leading to such an increase of cases that scientists speculated that it may have herd immunity. Politicians seized on the idea, hoping that they would be able to avoid financially damaging lockdowns in the future.

But in September 2020, the Oswaldo Cruz Foundation (FiroCruz), a highly regarded Brazilian research institute for public health, recommended that the city impose agitation and trade restrictions. Manaus was beginning to experience a second wave of illness, it said. But the city did not plant one.

Amazon's Gateway City Struggles to Fight Coronovirus

“We give 13 alerts, and one in mid-December is very dangerous, saying that the situation was getting very serious. Everyone was making fun of studies and warnings, especially President Jair Bolsonaro,” of Fokruz. Researcher Jessam Orellana says.

Orellana said that both the state and federal government used the principle of herd immunity to support their measures of comfort. “They all talked about herd immunity, and an environment was created to crystallize this discourse, and to take measures to relax. This feeling may be responsible for this relaxation of people’s behavior.”

A few months later, by the end of December, the Kovid-19 deaths recorded in Manouj and the increasing number of cases were undisputed. Amazonas State Governor Wilson Lima accepted the expert’s advice, announcing new lockdown measures. But they were fiercely opposed by protesters, who echoed Brazilian Bolsonaro’s urge to keep the country’s economy running. Lima quickly rebounded and celebrated.
In an exclusive interview with CNN, Manaus Mayor David Almeida now attributes the unexpected year-end celebrations to those protest ceremonies and the current spike in cases that brought the city to more than 248,000 cases and more than 7,050 deaths is.

“We are paying the price for this disobedience, these protests have been going on since the end of last year. A lot of people should be held responsible for this,” said Almeida, who took office earlier this month Was handled “During the celebration of the New Year, it was fine for the campaigners of the party who were the vectors for this broadcast, this promotion and the increase in affairs.”

Starting Monday, Amazon will now go into a seven-day lockdown.

Long-term relatives of patients infected with the Kovid-19 queue to refill their oxygen tanks at the Carboxy Company in Manaus, Amazonas State, Brazil, on January 19, 2021.

Running out of oxygen

In early January, it became clear that the city was on the verge of running out of oxygen for patients with severe cases of Kovid-19.

According to a report by the Solicitor General of Brazil, a company called White Martins, which supplied hospitals in Manaus with oxygen, emailed officials from both Amazon and the state ministry until 8 January.
Health Minister Eduardo Pazuelo visited Manaus on 11 January, and the federal government sent supplemental oxygen on 12 January – but it was not enough.
According to the Attorney General’s report, Pazuelo encouraged medical professionals to adopt an “early treatment” kit against Kovid-19, which combines drugs including hydroxychloroquine and everamactin – any of which are effective treatments for Kovid-19 Has not been proved. He has since refused to do so.

The day after he left, there was a crisis. As predicted, the lack of oxygen hit the city’s healthcare system last week, forcing authorities to airlift patients from other states. Local media described patients dying of asphyxia. The initial numbers released by the Federal Prosecutor’s Office, which is investigating the crisis, have so far characterized 29 deaths due to oxygen shortages. This number is expected to increase as the investigation continues.

“The reality is that there is a low supply of oxygen,” Pazuelo later admitted. “Not an obstruction, but a low supply of oxygen.”

Brazilian officials were warned for six days before the oxygen crisis in Manaus

Even today, the shortage remains. Last week, CNN counted about 40 people to buy or replace an oxygen cylinder from a private supplier, some disappointed, others worried.

“There was no preparation from the state for this new surge,” 49-year-old Joséni Costa Vicente told CNN that she tried to buy oxygen for her mother, who is 69 years old and positive for Kovid-19 Have tested. They say 16 hours are spent in the hospital without any oxygen or medical attention before it is decided to take care of them at home.

“It makes me angry. We are really upset and angry with this whole situation.”

Joséni Costa Vicente queues to buy oxygen for her mother, Raxel, 69, in Manaus

Alien Rodrigues, 49, says that many times she had to wait more than 12 hours to buy oxygen. Everyone at her house has tested positive for Kovid-19, and her mother, 71, is in the worst condition.

Tired and stressed as they are, many believe that taking care of the sick at home is better than sending them to the hospital.

“We don’t trust the government,” Rodrigues says, afraid to take his mother to the hospital. “We fear there will be more death than life.”

Hospitals are stretched to the limit. According to Amazonas state health secretary, more than 530 people are still waiting for a hospital bed.

CNN visited three hospitals, stating that they could not accept more patients. People were waiting, some screaming and crying, out of hope of hospitalizing their loved ones.

Health care in the state of Amazon in Brazil;  Fall & # 39;  Kovid-19 grows as infection

At the door of a hospital, staff and a security guard worked to ensure that no one entered without authorization, but were also unable to give basic information to relatives panicked while waiting for updates on patients.

While waiting outside, Amanda da Silva Monteiro told CNN that no one was able to locate her father, 71, for two days after being hospitalized with Kovid-19.

“My father is a working man. I have the right to know if he is alive or dead,” Da Silva Monteiro told CNN. “Every day we are here, but they don’t give us any information.”

Checking and finger pointing

Who is responsible for ending this deadly crisis? The current situation in Manaus has been attributed to inequality and political turmoil. An apparent dissatisfaction between local and federal governments has also led to unrest since the epidemic began last year.

The Office of General Prosecutor Augusto Arras has called for the Ministry of Health’s response to Manas’ warnings about the oxygen shortage, as well as Amazonas State Governor Lima, former Manaus Mayor Arthur Virgio Neto and current Mayor Alameda.

But the federal government denied responsibility for allowing oxygen shortages to reach such severe losses – and instead blamed the government of the Amazon state. Brazilian vice president Hamilton Morrow said earlier this month that – despite several warnings from scientists – there was no way to predict the collapse of Manaus’ health system. Pazuelo himself denied that his ministry had failed to function effectively, and Bolsonaro accused the state government of misusing federal funds.

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The Amazonas state government has, in turn, attributed the logistical challenges of resuming this isolated city. On Sunday, the state’s health department told CNN that it “aided the federal government to overcome difficulties encountered in oxygen supply logistics”, including deploying planes, helicopters and speedboats loaded with more oxygen cylinders. Was making every effort.

For his part, Almeida says the city’s government is not responsible for the current crisis. Although all hospitals have overtaken Kovid-19 cases, they noted that the hospitals operating in the city did not suffer as much oxygen deficiency as the state hospitals.

“His month in office” feels more like a year, he says.

A recipe for destruction

Amazonas state officials say they will soon open two more hospitals, one with federal support, to increase the city’s available bedcount. Pazuelo, the Minister of Health, has returned to Manaus and this time, he will “stay as long as necessary” to get the city’s health system back on track, he says.

But many Manaus residents have little confidence left in authorities to respond to coronovirus – and emerging forms of the virus have additional levels of complexity and potential danger.

Luan Matos de Menezes, a 26-year-old physician from the ICU, has described what he sees today as the worst version of the city last year.

“What is happening is really serious. You can tell that the condition of the patients is a lot more important than the first wave. It is much more serious than in other parts of the country. Deaths are much faster. Serious infections. The number is much higher. Than in the first wave, and the patients are younger. “Says Menezes.

“A 24-year-old man died in my ICU yesterday. I have found patients who are 32 and 29 years old. Young patients who are in very critical condition.”

Taruma Cemetery in Manaus.

Tired and frustrated, Matos de Menezes says he blames both the authorities and the Manaus community for failing to learn the lessons of the past year, and clinging to unproven principles rather than following a scientific recommendation.

“So you have a community that thinks it’s based on a false (principle) herd immunity in addition to a new version, and ineffective drugs for Kovid-19, which are more contagious and more serious that move around in the community. It has been … you had this recipe for destruction. “

And at every stage, Brazilian officials failed to take timely preventive action, he concluded, due to a slow response to the reluctance to harm the economy.

“A vaccine that starts late, a lockdown that started late. It was done in the name of a god, called money in the name of the greed of the shop owners, in the name of the greed of the merchants. Until they realized It is not that they are going. Get sick and there will be no place to get treatment and money will not buy life. “

Correction: This story has been updated to clarify that Amazonas State will be closed for seven days on Monday instead of ten.

Marcia Reverdosa reported from Manaus, Brazil. CNN’s Taylor Barnes and journalist Rodrigo Pedroso contributed to this report.


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