The situation describes a “scene of war”, a collapse in the healthcare system. Manaus, capital of the state of Amazonas in Brazil, is going through a devastating coronavirus outbreak due to the lack of oxygen and the vertiginous multiplication of infections. People dies suffocated. And several patients decided to “flee” the hospitals for fear of drowning alone in an emergency room. There are also no beds.
Two nurses interviewed by the newspaper O Globo stated that the “panic” and the “stress” they seized several patients, who fled the hospitals or asked to be transferred to their homes to die with their families.
A 46-year-old patient with Covid-19 “was amazed seeing how in a few hours some people died in the beds next to his, he was scared and fled, it was horrible, he could not stand the pressure,” said Arlene Loureiro from Albuquerque , a nurse at the Getulio Varas University Hospital in Manaus, capital of the state of Amazonas.
Another nurse, from Hospital 28 de Agosto, in Manaus, who preserved her identity, told O Globo about a patient who “said he wanted to leave because if he was going to die and preferred to do it at home, and hours later he was no longer in unit”.
Despite the shipment of oxygen tanks on Air Force planes and the tubes purchased by donors, input is still scarce in Manaus.
On Tuesday night, five trucks arrived in Manaus from Venezuela with 107 thousand cubic meters of oxygen The lack of this input affects Manaus and other cities in the interior of Amazonas and also the state of Pará, also in the Amazon region. (ANSA)
In a statement sent to Clarín, Doctors Without Borders warned of another problem: with the collapse of the health system in Manaos has stopped receiving serious cases derived from other cities.
The organization warned that this is the second time that the health system in Manaus has collapsed.
People die from suffocation
Although hospitals have been adding bed capacity for COVID-19 cases at an impressive rate, the number of patients has continued to grow faster and faster, which means that the entire healthcare system it is saturated and overwhelmed.
Worryingly, he denounces, the city’s capacity to produce oxygen is working less than a third current needs, leaving some hospitals no ability to ventilate to their patients and this reportedly results in let them die from suffocation.
Doctors Without Borders staff treat covid patients in Manaus. Photo: MSF / Diego Baravelli
The domino effect in upstream cities in the rural Amazon region is beginning to show and It could be just as devastating.
Doctors Without Borders has teams in the Amazonian cities of São Gabriel da Cachoeira and Tefé, both in few days of boat trip upriver from the state capital. With saturated Manaus hospitals and fighting against this situation, there is nowhere to refer the most seriously ill patients.
The anguish of the doctors
Other doctors on the front lines of the fight against covid-19 in Manaus admitted their anguish over aggressiveness of the new wave of the pandemic, which is not ruled out is related to a variant of the coronavirus initially detected in Japan in people returning from the Brazilian Amazon.
A nurse takes the temperature of a patient with covid in a field hospital for indigenous people, in Manaus. Photo: Bloomberg
Another hypothesis attributes the high mortality in recent weeks to explosion of hospitalization demands, which caused oxygen shortages in hospitals.
All ages affected
Dr. Ruy Abrahim, who coordinates the Manaus emergency service, points out rapid evolution of patients towards critical condition and an increase in the number of people who die at home before receiving assistance. It also speaks of the multiplication of severe cases of All ages.
“We are treating many cases with deaths: when the ambulance arrives at the house, the patient he already died. (It happens) much more than last year, “explains Abrahim.
The Manaus emergency service receives about 1,300 calls per day, 80% of them for respiratory problems. In normal times, there are 800 to 1,000 calls, generally for various trauma.
People line up to carry oxygen tubes. Photo: Bloomberg
With 37 ambulances for the city of 2.2 million inhabitants, it currently only manages to attend 15% of calls.
“It is very distressing, especially for the doctor who receives the calls and knows that the patient needs urgent help, but has no way to help “says Abrahim, his voice thick with emotion.
Choose who to save
“There are times when the doctor has to choose (who to attend to), it is a very tense situation.”
“Patients are arriving with a critical saturation oxygen, at levels almost incompatible with life, “confirms a nurse from a public hospital, who asked not to be identified.
The epidemiologist Julio Croda warns that in Manaus there is a mass reinfection after the wide spread of the virus last year, without ruling out that it is potentiated by the new variant.
“We are quite concerned because this mutation may be associated with greater transmission,” he says.
Funeral home workers remove a body from a home. Photo: Reuters
A September 2020 study involving researchers from the University of São Paulo suggested that the Amazonian capital may have achieved herd immunity after the first wave.
But Croda stresses that to date there are only uncertainties about the duration of the antibodies and its eventual effectiveness against a variant of the virus.
“We know that something very serious and very different happened in the transmission between November and December,” says researcher Jesem Orellana, from the Fiocruz-Amazonía Foundation.
But the epidemiologist ask for caution before drawing conclusions about a new, more lethal and contagious variant.
“Manaus only found out that it had a strain because Japan called. That means we are not doing the tracking or we are doing it very badly. Probably we have more variants and we don’t know, “he adds.
“The only thing we know is that on January 14 they died 100 people suffocated due to lack of oxygen, “he says, clarifying that the number is not official, but rather a calculation made from hospital reports.
A scene of war
The crisis led many Manaus residents to improvise treatments at home.
“It may not necessarily be a more lethal strain, but we are in a war scene,” says Orellana.
Relatives of a patient admitted to the 28 de Agosto hospital cry inconsolably. Photo: Reuters
The researcher points out the possibility that patients are arriving very late to the hospital and that treatments at home, with oxygen administration by non-specialized people, are “shot in the foot.”
At the entrance of the August 28 hospital, a reference center for the treatment of covid-19, the stories of relatives are repeated: the majority only decided to come when the oxygen ran out.
The stress on the public system is so great that medical bulletins are released every 48 hours in front of the hospital.
“My dad is being treated in a wheelchair because there are no beds, “laments Luiza Pereira, 34, who has been without news for two days.
Ambulances go in and out incessantly.
Brazil, a country of 212 million inhabitants, has already lost more than 211,000 lives by covid-19, more than 4,000 of them in Manaus.
Croda warns that the situation in Manaus may be replicated elsewhere and that “if it really (the new variant) is more contagious, we will see an even greater increase in cases and deaths.”
Source: AFP, ANSA and Doctors Without Borders