Wednesday , March 3 2021

The nightmare of dying asphyxiated in the hospitals of the Amazon society

The security guard with a bulletproof vest running followed by a woman holding the blue cylinder with extreme delicacy, as if she were a baby. It is oxygen. They both advance under a sun of justice towards a car. “It’s for my mother,” says Afra Benedito, 46. She is anxious that the bottle will help Mrs. Fatima breathe for another four hours. At 71, the coronavirus left her a widow a few days ago and now her life is extinguished in Manaus, the capital of the Brazilian Amazon, where the nightmare of suffocating death has become a stark reality in hospitals and homes.

The prosecution is investigating 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 on the rise, but they have suddenly 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 world’s most precious rainforest. .

“With the flu of the rainy season and the rallies of the (municipal) election campaign, we were already expecting an increase in infections, but not the oxygen,” explains nurse Yuri, 24, of the ‘August 28 hospital, of reference for the covid. Choose this pseudonym to speak freely about what happens in your workplace. “Some die from lack of oxygen, others because it is very serious and getting worse quickly. We had to reduce oxygen to all 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 are waiting for news about the hospitalized.

This is a land of monopolies, caciques and ingrained corruption that lives largely on a free zone with multinationals that requires meticulous logistics. Parts from all over Brazil and abroad arrive in Manaus and, when assembled, go on the local or international market converted into motorcycles, mobile phones 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 not stopped sabotaging the governors ’efforts to contain the virus. Dismissal of two health ministers. He has only acted forced by other powers. Vaccination has just begun, lagging behind its neighbors, and with a stock well below the needs of 210 million Brazilians. An academic study accuses him of leading “an institutional strategy of spreading viruses.”

Those who can have embarked on the race to get oxygen on their own, illuminating a new market in the Amazon capital. Benedito overcame the first challenge – getting the bottle – thanks to a neighbor. Every day he comes to for his mother’s supply of carboxy, a family-run industrial gas company that began to cater to distressed individuals who knocked on the door. An evangelical pastor has raised money to fill nine cylinders and give them away. The logistics are complex and the 400 reais of the minimum top-up (60 euros, $ 70) is a penny.

In Manaus and the rest of the Amazon state, 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. They 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 the Amazon, Wilson Lima, 1 presenter of sensationalist programs allied to Bolsonaro. The government of Nicolás Maduro was quick to dispatch aid to trucks. It took three days to move oxygen for three days.

Amazon’s healthcare network has always been fragile. It is the worst funded in Brazil, but it was the first state to reopen schools, extra beds for covid were dismantled and warnings from White Martins, the only company that supplies oxygen to health centers, that demand was rising sharply about their production capacity were neglected. When he was in Manaus days before the lethal night, the Minister of Health, Eduard Pazuello (general and alleged expert in logistics), was informed of the shortage by official channels, and by a sister-in-law, he explained. He did not react; his obstinacy was to announce the vaccine and promote an alleged early treatment for covid.

Doctors are rationing oxygen because demand triples supply in the capital, the only Amazon city with intensive care. Some families are looking for chocolates because they do not want to take their patients to hospitals, crowded, with patients in hammocks. Not even the toilets are trusted. “When my family got sick, I didn’t take them to the hospital. I know our situation, the doctors are overworked, I treated them at home myself. I bought the medicines, inhalers …”, explains 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 reporters. “All this is a huge mistake in the 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 herself by phone more lives that all of them! ” Networks burn with people begging for help.

The epidemiologist Orellana, from the Fiocruz Institute of Public Health, is one of the voices of Manaus who most strongly denounces the catastrophic management of the epidemic. “Oxygen is going to serve to prolong the lives of those who are serious, but it does not solve the problem of covid,” he explains by telephone 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 21-day confinement with contagion tracking,” he says. “Without radical measures, we will have a third wave in three months.”

Masks are gaining followers, but the newly imposed night curfew is being breached. Cars circulate and clandestine bars operate. The 60 footballers 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 coming to be a total confinement with only essential activities, although he did not utter the damn word.

Authorities are also looking for oxygen here and there as they evacuate patients to other states on 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 remains here. Until next time.

As a good start, this second of contagions goes upstream to small towns 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 offices of the interior of the Amazon, explains on the phone the coordinator of Médecins Sans Frontières (MSF) in Brazil, Pierre van Heddegem, who has teams in São Gabriel da Cachoeira and Tefé. Only in the deprived capital can the cylinders be filled. And the transfers of seriously ill people 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 Amazon strain discovered on travelers arriving 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 ability to infect cells is greater than the other eleven strains we know of in the state of Amazon,” he explains, but stresses that at the moment it cannot be said to cause further damage. The increase in young people getting seriously ill may be because the strain is causing more damage or because the health care system has collapsed. The second wave would disprove that Manaus achieved herd immunity months ago, as a preliminary scientific study pointed out. Orellana considers that article “the fruit of bad science. It was always an absurd thesis and alien to reality.”

Among the dead this Friday of covid, the director of health surveillance of Amazon and the father of Paul of Assisi, 46 years. He comes to the cemetery to bury him in an express burial with two more relatives in the area reserved for coronavirus victims. He explains that his father was 70 years old and in good health until five days ago “he found himself tired and out of breath.” He was hospitalized. “At night they lowered the amount of oxygen to him. The second day he was fine, then he got worse. And today he died.” The undertakers continue to open graves, but now with excavators because they do not give scope. In this reddish land surrounded by Amazon rainforest there is almost no space left. And they build vertical niches, a novelty that displeases locals. They are unreleased.

Coronavirus information

– Here you can follow the last hour on the evolution of the pandemic

– This is how the coronavirus curve in the world evolves

– Guide to action in the face of the disease

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