Brazil: COVID-19 crisis in Manaus rips across Amazon region

Medical team holding a woman outside and under an umbrella

Brazil 2020 © Diego Baravelli

With the health system collapsing, the capital of Amazonas state stops receiving serious medical referrals from nearby towns

NEW YORK/RIO DE JANEIRO, JANUARY 20, 2021—The health system has collapsed in Manaus, the capital of the Brazilian state of Amazonas, with hospitals unable to keep up with the number of new COVID-19 patients and people reportedly dying of asphyxiation due to the shortage of oxygen supplies, said the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières  (MSF). Medical teams working in remote towns upriver in the rural Amazon region are now unable to refer critical patients to Manaus, creating devastating knock-on effects in these communities, said MSF.

MSF teams began arriving in Manaus on Monday to reinforce support for the health system. MSF currently has teams in the remote towns of São Gabriel da Cachoeira and Tefé—both a few days’ boat journey upriver from the state capital. However, there is nowhere for MSF teams to refer severe medical cases from these towns because hospitals in Manaus are full and struggling to keep up with the current demand.

“In the last week, no patient could fly from Tefé to Manaus,” said Pierre Van Heddegem, MSF head of mission for Brazil. “We lost three patients who would have had a chance to survive if they had received care in a big city hospital, but their referrals were not possible. Knowing more about the disease, we should be in a better position to save lives. But that is only if we have oxygen and possibilities to refer severe or critical patients to better-equipped hospitals.”

In the first week of January, a third of COVID-19 patients in Tefé, a municipality in Amazonas state, needed oxygen treatment. Last week that number rose to two-thirds of patients. It is not just that the number of people in need of care is increasing, but MSF teams are seeing people arrive to the hospital in Tefé in more severe condition.

As there are no oxygen generator units near Tefé that can recharge oxygen cylinders, they need to be sent to Manaus to be refilled, which is a couple hundred miles away. MSF donated 50 new cylinders to the regional hospital in Tefé at the end of 2020, but there is no way to refill them in Manaus.

“We have only a few days’ oxygen left in Tefé if the admissions continue at this rate,” Van Heddegem said.

MSF is desperately looking for alternative solutions so that critically ill patients in Tefé can be assisted despite the total saturation of the hospitals in Manaus. At the same time, the organization will look into ways to assist in Manaus, where the first members of an MSF team began arriving yesterday.

In São Gabriel da Cachoeira, the other municipality in Amazonas state where MSF is working, the new year saw an immediate increase in cases too; in the first week of January there was a five-fold increase in the number of cases of COVID-19 compared to the last week of 2020. A six-bed observation center for COVID-19 patients has been set up by the Ministry of Health and is being supported by an MSF team. Additionally, there is a small hospital with its own oxygen generation capacity, but if the case numbers increase that could be overwhelmed and health workers could be facing similar devastating conditions as in Tefé.

MSF has been helping improve COVID-19 testing in Sao Gabriel da Cachoeira, specifically using the antigen test that gives a real-time view of the COVID-19 situation rather than the antibody test that is more generally used in Brazil but cannot give a real-time view of the situation. Teams have struggled to understand Brazil’s overwhelming reliance on the antibody tests as they cannot tell if the person currently has and could transmit COVID-19. MSF also donated cartridges to the laboratory in São Gabriel da Cachoeira to use the GeneXpert PCR testing machine in town.

“The test results come out in about an hour and can be done in town without having to send the samples to Manaus, as was the case until now,” said Irene Huertas Martín, coordinator of the MSF project in São Gabriel da Cachoeira.

In addition to testing and treatment, MSF health promotion teams are providing COVID-19 safety information in the two towns and will look into the need to do the same in Manaus. Ensuring people know how to protect themselves and those around them remains one of the most important ways to avoid the spread of the disease in a region where access to adequate healthcare is limited.

In Brazil, in addition to the projects in Tefé and São Gabriel da Cachoeira, MSF works in São Paulo, where it provides palliative care for COVID-19 patients who do not respond to treatment at the Tide Setúbal hospital. MSF recently ended its activities in the state of Mato Grosso do Sul, in rural areas around the towns of Amambaí, Corumbá, and Aquidauana. MSF's response to COVID-19 in Brazil began in April 2020. In addition to the states already mentioned, MSF has carried out activities in Rio de Janeiro, Roraima, Mato Grosso, and Goiás.