Amazonas state endures unrelenting pain after a month of healthcare collapse

RIO DE JANEIRO, BRAZIL – One month after the catastrophic oxygen shortage in hospitals in Manaus and the interior of Amazonas on January 14th, the state has registered almost 4,000 covid-19 deaths.

In this month and a half of 2021, the number of lives lost is close to double the figure recorded throughout the whole of 2020, according to data from the Amazonas Health Surveillance Foundation (FVS-AM), totaling 10,100 deaths since the start of the pandemic.

Although the race for oxygen has slowed down, the situation is still unstable, with hospitals crowded and the daily consumption of medical oxygen reaching an average of 86,000 cubic meters, 10,000 more than at the peak of the crisis.

Nevertheless, last Saturday, February 13th, the state government announced the relaxation of the stricter rules it had implemented, authorizing the opening of trade in the drive-thru system and clearing cargo transport for 24 hours. The measure came into force last Monday, February 15th and will be in effect for the next 7 days.

“Over the past four weeks we reached a social isolation rate of 50%, rising to a little over 60% some days. This is not the ideal, but we understand the strain and appeal to the population to adopt isolation measures on a daily basis,” said the technical director of FVS-AM, Cristiano Fernandes, during a live stream on Saturday, February 14th, to announce the relaxation of measures.

The situation presented by the director points to a “rise in the rate of probable reinfection” and “the surge in cases in two regions of the state’s interior”, which still remain in the purple phase, the most critical in the contingency plan.

Amazonas has reported a 21% downward trend in the rolling average of infections over the past 14 days, but is still in a high plateau of new cases with a transmission rate of 1.01, meaning that every 100 infected people can spread the disease to 101 within a week.

“That typifies high transmission. It is still a worrying epidemiological profile, despite this slowdown. This is not the time to relax, but rather to maintain our prevention measures so that we may further reduce transmission risk. The 61 inland municipalities are still in the purple phase. Manaus reverted to the red phase, which is still critical.” The data presented by FVS-AM’s director Cristiano Fernandes, seemed inconsistent with governor Wilson Lima’s decision, who was seated next to him during the announcement of flexibility in the state’s measures.

Pressured by trade and with ten impeachment petitions against him lodged in the Legislative Assembly, the governor of Amazonas decided to allow the sector to operate, which encouraged a number of establishments to operate irregularly on the very same day, even before the decree was ratified. On Comércio street in Manaus, restaurants were attending customers at tables as usual, and stores were open to the public.

Mass vaccination of at least 70% of Manaus’ eligible population and of the seven surrounding cities, directly impacted by the capital, is the only plausible solution to push the infection curve down, according to epidemiologist Jesem Orellana.

“This is the solution to reduce new cases, to reduce severe cases, and to reduce mortality. This restores dynamism to the economy, the entrepreneur’s chance to think about the coming months with no concerns regarding a lockdown. Today we have hundreds of people going hungry due to the negligence of the authorities responsible for the first and second wave tragedies, who go unpunished,” he said over a live stream on Saturday evening.

He explains that focusing on where the pandemic is most severe, that is, prioritizing regions like Amazonas, is to follow the epidemiological and technical criteria, rather than the political one.

“The criteria currently adopted by the Ministry of Health, as I and dozens of other experts see it, is wrong. When there is a shortage of vaccines and they are distributed too widely, there is no chance of achieving collective immunity or controlling transmission. This is a wasted opportunity to focus on the main problem and then address smaller problems later.”

By Tuesday, February 16th, 214,534 doses of vaccines had been administered throughout the state of Amazonas, with 202.828 first doses and 11.706 second doses.

Crowded facilities

Bar and restaurant waitress Patrícia Pereira Corrêa, 52, spent R$100 on app transport on Sunday afternoon, February 14th, for her husband Sílvio César de Figueiredo, 48, to be attended, rushing to three different healthcare facilities to find one that could see him. She has been unemployed since the start of the pandemic and relied on emergency aid to get by. “Now we rely on the help of one another. I don’t even have that kind of money, but he was very sick, his fingers were purple.”

Currently, 227 patients are waiting for a covid-19 bed, 149 for wards and 78 for ICU beds. According to the State Government, the waiting list has been getting shorter: 18 days ago, 659 people were waiting for a place. According to the agency, 542 covid-19 patients have already been transferred from Amazonas to other states. Of this total, 271 patients (50%) were discharged, 242 returned to the state, and 62 died (11.43%).

The Government says that currently the capital and inland healthcare facilities are supplied with oxygen, but demand is still above average, which means that supplier White Martins must deliver it to Manaus from other states.

The government plans to install 74 oxygen plants, 28 of which are currently operating. “The solution to the problem is to reduce the number of hospitalizations, which will lower oxygen consumption in hospitals. On this front, the government is striving, with the assistance of the Federal Government and municipalities, to expedite immunization of the population against Covid-19 as much as possible,” the agency said in a statement.

Psychological impacts

Faced with so many deaths and the trauma caused by a healthcare system that cannot be trusted, psychological impacts are many, says psychologist Carolina Omena, who has volunteered to assist patients online in Manaus since early this year.

“I recently assisted the son of a 59 year old woman who was hospitalized with Covid-19 after having rotated through several hospitals. Days after finding assistance, he was allowed into the hospital and found out that his mother had been left for four days in the hallway unattended, despite her [oxygen] saturation ranging from 45% to 50%, and had to share oxygen with other people. He said that he would hug his mother so that she wouldn’t see people dying with no oxygen. What really affected him was seeing that there were several people who had been there longer and still hadn’t been assisted,” states Omena.

This patient is traumatized to this day, despite his mother having recovered. She was transferred to Recife (PE) and is awaiting her return to Manaus.

According to the psychologist, the number of cases of people with anxiety, panic and depression disorders, all related to Covid-19, has increased. Losses, the inability to say goodbye, isolation, and a lack of prospects make up the picture of mental illness pointed out by experts and that tends to worsen in the future.

Omena also reports that she attended a 64-year-old emergency worker who had managed to transport his 47-year-old brother with a severe Covid-19 condition. He passed away four days later. Soon after his brother’s funeral, the emergency worker himself became sick and spent a month impaired.

“He had no time to mourn, to experience the pain, and now he is afraid to go back to work. That’s why we see these disorders develop, people don’t have time to deal with the pain,” she explains.

“For people in Amazonas, there is a constant sense of loss: we lost freedom, hospitals, medical care, we lost the primary, secondary healthcare system. Everything has collapsed. There is also the loss of the friend of a friend, of a neighbor, of a colleague. All of this produced sadness, mourning is not just mourning because someone passes away, it is a moment of transition, of when we lose something,” she says.

Because of the great demand, she says she has been trying to persuade her colleagues to broaden the support network, as she realizes that people are unable to get help.

The coordinator of the online psychological support project of the Amazonas State University (UEA), Sônia Maria Lemos, 57, the university’s representative in the Amazonas Mental Health Emergency Network, says that what may seem like an emotional illness is, in most cases, an emotional suffering, which is natural as a result of the moment experienced.

“The problem is if patients maintain these symptoms and this prevents them from moving on with their lives, then we may see mental illness as a result of the pandemic,” she explains.

In order to help, she and other professionals from several institutions created the mental health emergency network, an initiative that resulted in the hiring of 50 professionals to work in the public healthcare system in the state of Amazonas, a fact that she considers historical, given the extremely poor public policy in the area.

“In mental health, the more objective, accurate information I have, the more confident I am in behaving properly to provide care. We have always had an underreporting of cases. The more conflicting information, the higher the level of inconsistent information, the less chance I have of relying on it. Here in Amazonas we can’t trust all levels,” says psychologist Sônia Lemos.

“The person sitting in the presidential chair promotes treatments that don’t work, the state government buys overpriced equipment from places that don’t sell healthcare equipment, the new mayor’s first step was to cheat the vaccination line. Can you imagine how I, as a person, feel about any health information? How am I going to expect people’s mental health to find some consistency where there is no consistency, only sadness and frustration?” she asks.

Source: El Pais