Brazil completes 1 year of collapse in Manaus with fear of new crisis

“Scientists find an unprecedented variant originating in the Amazon”, read the title of a report published in this leaf on January 12, 2021. It was the harbinger of chaotic months, which would begin with patients dying without air in hospitals in Manaus.

A year later, Brazil is once again experiencing the fear of a new crisis, with a new strain of the coronavirus. The rapid spread of the omicron variant is already causing tests to run out, emergency rooms to fill up and hospitalizations to skyrocket in capitals.

On the other hand, the less aggressive strain now finds a country mostly vaccinated and with a faster response capacity to expand beds, factors that contribute to a daily average of deaths eight times lower than at that time.

“But the collapse can manifest itself in different ways in each city. We had the oxygen crisis in Manaus, then the intubation kit crisis in São Paulo. Now, there is concern about the removal of infected health professionals, which can cause a crisis of human resources, for example”, says sanitarian Christovam Barcellos, from Fiocruz.

The scientist also recalls the possibility of outbreaks in less vaccinated regions such as the North. Amapá, Roraima and Acre are at the bottom of the country’s ranking, with less than half of their population having completed the cycle.

In the days that preceded the crisis in Manaus, however, not even a vaccine existed in Brazil. The Butantan Institute and Fiocruz were awaiting approval from Anvisa (National Health Surveillance Agency) to use imported immunizers in an emergency.

European countries, the United States and Argentina were starting to immunize their populations, and pressure on the federal government was growing, with the state of São Paulo threatening to start the campaign on its own – which ended up happening on January 17.

Brazil had just reached the mark of 200,000 deaths from Covid-19 (which would be tripled ten months later), lamented by Jair Bolsonaro (PL) in a live on his social networks in which he added that “life goes on”.

The president had already changed ministers of health twice by this point, leaving Luís Henrique Mandetta (DEM) and Nelson Teich behind. In the chair was General Eduardo Pazuello, who agreed to expand the supply of chloroquine without scientific backing and ignored warnings about the shortage of oxygen in Manaus.

Until then, Bolsonaro had his speech aligned with that of former American President Donald Trump, who in turn saw his country hit the figure of 4,000 deaths a day, following an upward trend worldwide.

The main concerns of the World Health Organization (WHO) at that time were the alpha (emerged in the UK) and beta (South Africa) variants. Delta (India) was not even talked about, and the gamma (Brazil) had just been discovered.

It was she who made the cases, hospitalizations and deaths explode in the Amazon at that moment, before anywhere else. “It was starting to rise in the rest of Brazil. This year, we don’t know, because we’ve had a tremendous data gap since December,” says Barcellos.

Epidemiologist Raphael Guimarães, from Fiocruz’s Covid-19 Observatory, agrees: “There are two very big differences in the two periods. First, vaccination. Second, the blackout of data. We are navigating in the dark and we have no way of predicting scenarios to take the correct decisions”.

That’s because the Ministry of Health’s systems have been unstable for a month, after hacking attacks, and the country still lacks a comprehensive testing policy. THE leaf showed this Saturday (7) that the number of infections could double to 1 million a day in two weeks, considering unreported cases estimated by the University of Washington.

The disease has actually been milder now, but with the high transmission, the risk of hospitals filling up is not ruled out. According to Google displacement data, today the rate of stay at home is much lower than a year ago.

“Think that you have a thousand cases and a hundred progress to hospitalization. But if you have ten times more cases, you will have ten times more hospitalizations”, recalls Guimarães, adding that this pressure on health systems should become clearer in about ten years. days, when there is a worsening of patients who have recently become infected.

He, however, says he finds a scenario as chaotic as the beginning of 2021 difficult, with 90% to 100% occupancy of ICUs in many Brazilian states. Contributing to the feeling of hope is the prospect of delivery of a vaccine produced entirely in the national territory by Fiocruz in early February, after Anvisa’s release on Friday (7th).

Researchers point out that Covid-19 has followed the trajectory of previous years and of common flu, with the emergence of new variants in the northern hemisphere at the end of summer, peaking in winter and then increasing in the southern hemisphere.

Following this logic, the omicron variant could represent a kind of beginning of the end of the pandemic. “It’s a tendency that every epidemic has, to have less aggressive variants so that they can be transmitted more. But it’s still very dangerous. An outbreak like few vaccinated people is a tragedy”, emphasizes public health specialist Barcellos.