The security guard in a bulletproof vest who runs followed by a woman holds the blue cylinder with extreme delicacy, as if it were a baby. It is oxygen. They both advance under a scorching sun towards a car. “It’s for my mother,” responds Afra Benedito, 46. She tells anguished that the bottle will help Mrs. Fatima breathe for four more hours. At 71, the coronavirus left her a widow a few days ago and is now extinguishing her life in Manaus, the capital of the Brazilian Amazon, where the nightmare of dying by suffocation has become a harsh reality in hospitals and homes.
The Prosecutor’s Office investigates more than 50 deaths in these terrible circumstances. “An extremely conservative figure,” warns epidemiologist Jesem Orellana, of Fiocruz, a public health institute. Since the Christmas holidays, hospitalizations for covid-19 have been increasing, but suddenly they skyrocketed. On the night of January 14-15, the accumulation of patients was such that several health centers were literally left without oxygen in this remote city of two million residents embedded in the most precious tropical forest in the world.
“With the flu of the rainy season and the rallies of the (municipal) electoral campaign, we already expected the increase in infections, but not the oxygen,” explains the nurse Yuri, 24, from the 28 de Agosto hospital, in reference for covid. Choose that pseudonym to speak freely about what happens in your workplace. “Some die from lack of oxygen, others because they are very serious and are rapidly getting worse. We had to reduce oxygen to everyone because almost 90% of those admitted need it, “he explains. He estimates that more than 30 patients have died. A few steps away, desperate relatives await news about the hospitalized.
This is a land of monopolies, caciques and deep-rooted corruption that lives largely in a free zone with multinationals that requires meticulous logistics. Parts arrive to Manaus from all over Brazil and abroad that, assembled, go out to the local or international market converted into motorcycles, mobiles or laptops. But it runs out of oxygen.
Manaus is, as in the first wave, the most serious example of the chaotic management of the pandemic in Brazil. President Jair Bolsonaro has continued to sabotage the governors’ efforts to contain the virus. He dismissed two ministers of Health. He has only acted forced by other powers. Vaccination has just begun, behind its neighbors, and with a stock far below the needs of the 210 million Brazilians. An academic study accuses him of leading “an institutional strategy to spread the virus.”
Those who can have launched into the race to get oxygen on their own, lighting a new market in the Amazon capital. Benedito overcame the first challenge — getting the bottle — thanks to a neighbor. Every day he comes to supply his mother with Carboxi, a family industrial gases company that began to attend to distressed individuals who knocked on the door. An evangelical pastor has raised money to fill nine cylinders and donate them. The logistics are complex and the 400 reais of the minimum recharge (60 euros, 70 dollars) represents a fortune.
In Manaus and the rest of the state of Amazonas, the second wave is even more devastating than the first, when the health and funeral system collapsed. The city buried 213 of its neighbors the day after the fateful night without oxygen. There were never so many in one day. In the cemetery they only remember similar avalanches after some prison riot.
Venezuela was one of the first to respond to the SOS launched by the governor of Amazonas, Wilson Lima, a former anchor of tabloid shows allied with Bolsonaro. The government of Nicolás Maduro hastened to dispatch aid in trucks. Three days it took them to transfer oxygen for three days.
The Amazon health network has always been fragile. It is the worst funded in Brazil, but it was the first state to reopen schools, the extra beds for covid were dismantled and the warnings from White Martins, the only company that supplies oxygen to health centers, that the demand was increasing well above of its production capacity were ignored. When he was in Manaus days before the deadly night, the Minister of Health, Eduardo Pazuello (general and supposed logistics expert), was informed of the shortage through official channels, and by a sister-in-law, according to him. He did not react; his endeavor was to advertise the vaccine and promote a supposed early treatment against covid.
Doctors ration oxygen because demand triples supply in the capital, the only city in the Amazon with intensive care. Some families are looking for cylinders because they do not want to take their patients to the crowded hospitals with patients in hammocks. Not even the toilets trust. “When my family got sick, I didn’t bring them to the hospital. I know our situation, the doctors are overloaded, I treated them myself at home. I bought the medicines, inhalers… ”, says the nurse Yuri.
Érica Nogueira, 44, arrives with two huge cylinders in search of salvation for her father-in-law, her husband, and her brother-in-law. Overflowing with indignation: “What you see is not even half of what is happening. I have doctors, family physiotherapists on the front line, ”he warns journalists. “All this is an immense failure of management of the public administration. The great responsibility lies with the governor, the mayor, the Government, who did not surround themselves with competent people. My sister-in-law has saved more lives by phone than all of them! ” The networks burn with people crying out for help.
The epidemiologist Orellana, from the Fiocruz public health institute, is one of the voices in Manaus that most strongly denounces the catastrophic management of the epidemic. “Oxygen will serve to prolong the life of those who are seriously ill, but it does not solve the covid problem,” he explains over the phone in a Spaniard who learned working on the border with Bolivia. “I have no hope that we will be able to control the virus without a strict confinement of 21 days with tracking of infections,” he says. “Without radical measures, we are going to have a third wave in three months.”
The masks are gaining followers, but the newly imposed night curfew is broken. Cars circulate and speakeasies operate. The 60 soccer fans discovered this week watching Flamengo-Palmeiras received a warning, not even a fine. The governor announced this Saturday a series of restrictions starting next Monday and for 10 days that amount to a total confinement with only essential activities, although he did not pronounce the cursed word.
Authorities are also looking for oxygen here and there while they evacuate patients to other states in military planes to alleviate hospital overload. Another logistical challenge because from Manaus you can only reach the rest of Brazil by boat or plane. As so often in this country, celebrities, companies or people of good will rush to make donations. After the crisis, the structural problem is still there. Until next time.
As at the beginning, this second contagion rises upriver towards small cities and indigenous villages scattered over a territory three times larger than Spain that do not have an intensive care unit. In a domino effect, the lack of oxygen is felt in the clinics in the interior of Amazonas, explains the coordinator of Doctors Without Borders (MSF) in Brazil, Pierre van Heddegem, who has teams in São Gabriel da Cachoeira and Tefé over the phone. Only in the undersupplied capital can the bottles be refilled. And the transfers of seriously ill patients to Manaus were suspended for days. Now they start again, but “the waits are long and there is a risk of losing patients,” he explains.
A new Amazonian strain discovered in travelers from Manaus to Japan led the United Kingdom and other countries to suspend flights from Brazil, the rest of Latin America and Portugal. The epidemiologist explains what is known about this variant that shares genetic characteristics with the British and South African strains. “Its capacity to infect cells is greater than the other eleven strains that we know of in the state of Amazonas,” he explains, but emphasizes that at the moment it cannot be said that it causes greater damage. The increase in young people who become seriously ill may be because the strain causes greater damage or because the health system has collapsed. The second wave would deny that Manaus achieved herd immunity months ago, as a preliminary scientific study pointed out. Orellana considers that article “the result of bad science. It was always an absurd thesis and alien to reality ”.
Among those who died this Friday from covid, the director of health surveillance of Amazonas and the father of Paulo de Assis, 46 years old. He comes to the cemetery to bury him in an express burial with two more relatives in the area reserved for victims of the coronavirus. He says that his father was 70 years old and in good health until five days ago “he found himself tired and without air.” He was hospitalized. “At night they lowered the amount of oxygen. The second day it was fine, then it got worse. And today he passed away ”. Gravediggers continue to open graves, but now with bulldozers because they can’t cope. In this reddish land surrounded by Amazon rainforest there is almost no space left. And they build vertical niches, a novelty that locals dislike. They are brand new.
Information about the coronavirus
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