Manaus experiences Covid explosion a year after health system collapse

Manaus records a new explosion of Covid cases, with a tendency to continue the acceleration of infections, in the week in which it completes a year of the drama caused by the collapse of the health system and the deaths of patients from suffocation in hospitals.

The disease returned to impact the capital of Amazonas and quickly fills emergency care units. The third wave comes amid reports of mental and physical exhaustion on the part of health professionals, in addition to leaves due to reinfection.

The number of new confirmed cases with tests jumped from 37 on January 1 to 1,659 on Wednesday (13), an increase of more than 4,300%.

The previous day, Amazonas registered 1,219 new cases, a mark it had not reached since March 31, 2021, when the state was still under the effect of the second wave, according to data from the FVS (Fundação de Vigilância em Saúde).

This Wednesday, pharmacies and health posts that offer tests for Covid were crowded all day. About a week ago, the doors of urgency and emergency units repeated the scenario of increased demand. The two situations cause agglomeration in closed environments and risks of infection for those who do not have the coronavirus.

Government and city hall suspended licenses and vacations from the health sector and the SES (State Department of Health) is preparing to reactivate beds.

The numbers of deaths and the occupancy of clinical beds and ICUs, however, have not, at this time, been under pressure like last year — in the first quarter of 2021, there were 6,600 deaths in Amazonas, one of the highest per capita rates. of the world.

At the peak of last year, public and private networks had 753 ICU beds and 1,977 clinical beds occupied, with a waiting list of more than 500 patients. These numbers were recorded on January 31, when the plan to transfer patients to other states was already in operation because of the collapse of the system and the lack of oxygen.

Current data points to 35 ICU beds and 96 clinical beds occupied with patients with Covid, in public and private hospitals. Jessen Orellana, epidemiologist at Fiocruz Amazonas, considers that it is necessary to observe the average daily increase in bed occupancy by Covid-19 in the last 14 days: the increase was 76% in clinical beds and 60% in ICU.

“Urgent and more aggressive measures are needed. Avoidable deaths will soon increase”, he says.

For the nurse Glenda Nascimento de Freitas, director of the José Rodrigues UPA (Emergency Care Unit), in the north of Manaus, the vaccine “safes” the worsening in relation to what happened with the gamma variant last year, but it does not prevent for complete new system pressure nor overload for professionals.

The rainy season is also marked by the increase in the spread of other viruses and the SES records cases of co-infection of Covid and H3N2 influenza.

“Vaccination gives a lot of response. But we don’t have all that we wanted. The severity has decreased, but there is an impact of a lot of patients. We have been able to attend and send them home. Yesterday [dia 11], we did 202 tests, 138 positive. Infections go up in an exponential chain. We are very scared,” he says.

The director of the UPA says that structurally the condition is better than in 2021: the unit now has a tank with twice the capacity for oxygen and more equipment. “There are even more professionals. But it has the weight of the two years, which were not easy. There is fear, insecurity. As a manager I am very worried. The team was not prepared for a new wave.”

Freitas says that this week three nurses and a cleaning worker had to leave the front line because they caught Covid. One of them is admitted to another hospital.

The president of the Union of Nurses and Nursing Technicians, Graciete Mouzinho, says that many professionals have fallen ill in recent days, but there is no accurate data.

The Municipal Health Department says that between December 1, 2021 and January 7, 2022, 278 health workers had to leave due to “respiratory tract infections”.

In an emergency service in the south-central area of ​​Manaus, an employee who asked not to be identified said that volunteers had to take over the X-ray due to the operator’s absence, infected with Covid.

The union president complains that many professionals caught Covid in the first and second waves and remained on the front line with sequels.

“They have sequelae. They have thrombosis, which is a serious disease and they don’t have the resources to undergo treatment. The rulers didn’t even think of that: a team to take care of these professionals, for them to recover and return to the front line.”

Mouzinho says that even without collapse, the system is slow for basic and urgent tests and that health professionals, who faced the waves, submit to the same wait in the public network.

The union president says that the gross salary of nursing technicians is, on average, R$ 1,400, without benefits such as transportation or food assistance. “They call them heroes. Words are not enough. Cherish them. Applause doesn’t pay for appointments, doesn’t give food. Some don’t have money to eat on the 12-hour shift. Do you know what it’s like to work in a hospital and go 12 hours without eating?”

Questioned by the report, the folder replied that it had no information about sequelae of front-line professionals.

out of control

On December 8, the FVS issued an alert about the acceleration of Covid in Amazonas and changed the risk range of the disease from the yellow phase (low risk) to a proximity to the orange phase (moderate risk).

The explosion of the omicron variant in other countries and the one-year anniversary of the collapse put pressure on the Manaus City Hall, which canceled the city’s New Year’s Eve. But gatherings without a mask and distancing were recorded in commerce and at Christmas events throughout the month, in addition to private parties.

For Orellana, errors are repeated associated with the lack of epidemiological and laboratory control in Amazonas. He states that society was informed on January 4 that the omnin was circulating in the city, but that it is likely that the variant had been propagating for a long time.

The epidemiologist says that, since the omicron is more contagious than the gamma and the delta and arrives in the city when the first vaccinated already have more than six months of immunization, the trend is for a growth of cases and possible increase of hospitalizations. For Orellana, it is necessary that the authorities of Amazonas, urgently, adopt measures to reduce the circulation.

“We have to take seriously the restriction of the movement of people and the condition of the health system after two collapses, otherwise we are going to see the authorities fold their arms, not adopt any kind of control and only belatedly publish decrees. fully preventable deaths will occur”, he says. “It’s a sad combination of negligence by health authorities and the population. A combination of death.”

According to data from the FVS, 55.1% of the population of Amazonas have complete vaccination coverage. In relation to the vaccinated population, over 12 years old, the percentage is 71.7%.

According to the Municipal Health Department, 98,868 people over the age of 12 have not taken even a dose of the vaccine. Another 267,173 did not return for the second. The data were updated this Thursday morning (13).

Also sought after, the state government of Amazonas did not respond to the report until publication.