It took just 60 minutes at daybreak for the seven patients to die, asphyxiated as coronavirus swept back into the Brazilian Amazon with nightmarish force.
“Today was one of the hardest days in all my years of public service. You feel so impotent,” sobbed Francisnalva Mendes, the health chief in the river town of Coari, as she remembered the moment on Tuesday when its hospital’s oxygen supply ran out.
“We need to get back to the fight – to carry on saving lives,” Mendes insisted as she digested losing a third of her town’s 22 Covid-19 patients in one fell swoop – four of them in their 50s. “But we all feel broken. It was such a hard day.”
Coari was at the centre of Latin America’s latest coronavirus catastrophe last week after a surge in infections linked to a new and seemingly more contagious variant overwhelmed hospitals in Brazil’s Amazonas state, leaving many without even the most basic supplies. Circumstances were so bleak oxygen tankers were rushed over the border from Venezuela, the economically collapsed nation next door, with its leader, Nicolás Maduro, decrying what he called “Jair Bolsonaro’s public health disaster”.
“It’s a very chaotic situation. We just can’t keep up with the number of patients coming to us,” said Marcus Lacerda, an infectious disease specialist from Amazonas’s crisis-hit capital, Manaus.
“Private hospitals don’t want to take anyone else in because they’re afraid of admitting a patient and then running out of oxygen again.”
Manaus made international headlines in April after a torrent of Covid deaths forced authorities to carve mass graves out of the city’s rust-red earth. Nine months – and more than 210,000 Brazilian deaths – later, the situation is even worse.
Some days about 200 bodies are being interred in Manaus, compared with the usual 40. Last week many hospitals ran out of the oxygen sustaining Covid patients, apparently because of a catastrophic government failure to foresee the magnitude of the impending disaster.
“Nothing like this as ever happened – not even last year. I never imagined there would be a wave of reinfections as big as the one we’re now seeing in Manaus,” said Lacerda, one of the region’s top infectologists, blaming a variant “that appears to be more contagious”.
Lacerda said he had hoped the scale of last year’s epidemic might have provided the riverside city some immunological protection from such a shattering second wave. “But the truth is there’s just no way. The fall-off in people’s immunity and the changes in the virus mean this second wave is uncontrollable.”
Distressing stories of suffocating patients and the evacuation of premature babies have generated a public revolt against Amazonas’s leaders who critics accuse of failing to plan for, let alone prevent its second cataclysm in a year.
“There’s an atmosphere of disgust, abandonment, despair and impunity,” said one staff member at the Alvorada health clinic in Manaus, where medics were filmed pleading for divine intervention. “What we’re watching is a complete massacre, a desperate situation, a horror film,” added the worker, who asked not to be named.
Much of the anger is directed at the government of Brazil’s far-right president, Jair Bolsonaro, who has trivialized Covid-19 even as his country’s death toll soared to the second highest on earth.
Bolsonaro’s biddable health minister, Eduardo Pazuello – an army general with no medical experience – visited Manaus on the eve of last week’s health collapse but pushed bogus Covid-19 “early treatments” promoted by his leader rather than solving the impending oxygen crisis.
“The president’s bootlicker had days of warning that Manaus’s hospitals were going to run out of oxygen. He did nothing but prescribe useless chloroquine,” the journalist Luiz Fernando Vianna wrote in the magazine Época, blaming Bolsonaro and Pazuello for the “slaughter”.
Lacerda accused the government of trying to distract citizens from its deadly inaction with the “false hope” of ineffectual remedies. “This isn’t happening in any other part of the planet,” he said.
In Manaus, a jungle-flanked city reachable only by plane or boat, public anger has been matched with action. Dozens of volunteer groups, many formed by young manauaras, have sprung up to raise funds and provide the city’s battered health system with oxygen, equipment and food.
“It’s a Dantesque situation … we feel like we’re living in a place with no government,” said Vinícius Lima, 16, who is using Twitter and Instagram to crowdsource cylinders, oximeters and PPE.
“I’m doing what I think is my duty. I couldn’t sleep at night if I wasn’t doing anything to help the city I love,” the student said. “I’m very proud to be from the city at the heart of the Amazon, you know?”
Others use social networks to grieve, flooding Facebook with photographs of loved-ones lost to the punishing second wave. “It’s as if the city’s in a constant state of mourning,” said the clinic worker, who lost an aunt.
Some call Manaus’s latest calamity an aberration, the result of its fragile health service and geographical isolation. Lacerda claimed it actually offered a glimpse of the future for other parts of Brazil since the Amazon’s rainy season meant its flu season came earlier.
“If we don’t immediately put in place a more aggressive vaccine ‘blockade’ what happened in Manaus will happen in the rest of the country,” he warned. “We need to vaccinate people.”
That may not be easy. Inoculation finally began last Sunday, weeks after other Latin American countries such as Chile and Mexico. But Brazil, which has 212 million citizens, has so far secured only 6m doses of China’s CoronaVac shot and 2m of the AstraZeneca/Oxford shot.
“This is absolutely insufficient to halt this disease’s advance,” said Lacerda, who believed Brazil’s “utter international isolation” under Bolsonaro helped explain its failure to acquire sufficient shots.
Last week it emerged that Brazil’s efforts to import from China active pharmaceutical ingredients (APIs) essential for producing vaccines had stalled, with some blaming the China-bashing of Bolsonaro and his backers.
Raissa Floriano, whose 73-year-old father is fighting Covid in hospital, said at least six of his wardmates died after its oxygen ran out.
“With better decisions, this whole tragedy could have been avoided. But every single sensible decision that might have been taken was either shunned or it was mocked,” said the 27-year-old teacher.
“I feel dismay, disappointment and anger – just absolute despondency and fear for the future.”
