© Provided by The GuardianPhotograph: Bruno Kelly/Reuters
Health workers in Brazil's largest state are begging for help and oxygen supplies after an explosion of Covid deaths and infections that one official compared to a tsunami and said could be linked to a new variant.
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Amazonas, and particularly its riverside capital Manaus, were pummeled by the epidemic's first wave last April, when authorities were forced to dig mass graves for victims.
But at a press conference on Thursday, state governor Wilson Lima admitted the situation was now even more dramatic and declared an immediate 7pm to 6am curfew to slow the outbreak.
"We are facing the most critical movement of the pandemic, something unprecedented in the state of Amazonas," Lima told reporters as he announced the restriction.
As he spoke, horrific details were emerging of a breakdown in Manaus's public health system, with reports of many patients dying after public hospitals and emergency care units ran out of oxygen. More than 206,000 people have now died across Brazil, the second highest total in the world after the US.
"This is an unprecedented calamity," said Jesem Orellana, a local epidemiologist from the Fiocruz public health research centre. "In the coming hours Manaus is going to be the protagonist of one of the saddest chapters of the Covid-19 epidemic in the world."
"There is no [oxygen]," added Orellana, who has been calling for a local lockdown since September. "Colleagues of ours - nurses, doctors and even social workers - are being called in to perform manual ventilation on people. A single human being is only capable of performing manual ventilation for about 20 minutes, so if you want to save one life without oxygen you are going to need at least three or four people per patient."
The director of one of Manaus's most important public hospitals sent health workers a WhatsApp message pleading for their help.
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"The Getúlio Vargas hospital has no oxygen and all patients are being ambuzados (manually ventilated). If anyone can help rotate the ventilation of the patients in the ICU on the fifth floor, please, we need you," he told them. "This is the situation. It is critical. Let's fight. If you can help, please do."
Another health worker at the same hospital told the Guardian employees had been too busy trying to save lives to count the dead. "Manaus is chaos," they said. "We have no oxygen."
One video shared on social media showed a distraught woman emerging from one public clinic shouting: "We're in an appalling state. The whole unit's oxygen has simply run out and there are many people dying. Anyone who has any oxygen available please bring it to the clinic [near the airport]. There are so many people dying, for the love of God." © Photograph: Bruno Kelly/ReutersA Covid patient is taken to hospital in Manaus. More than 206,000 people have now died across Brazil, the second highest total in the world after the US.
Speaking alongside the governor at Thursday's press conference, local health official Tatiana Amorim said the R value in Amazonas state was now 1.3. "This means that for every 100 people 130 are being infected each seven days. This speed was seen in April and May [at the height of the first wave]. This means that we are truly again experiencing a tsunami."
Amorim said there were three possible explanations for the sudden surge in infections: the relaxation of containment measures, increased transmission during Christmas and end-of-year festivities, and the chance that a new coronavirus variant was circulating in Amazonas.
Lima, a 44-year-old television presenter aligned with Brazil's rightwing president Jair Bolsonaro, claimed the federal government was mobilized "so we can overcome this moment as soon as possible".
"We're on a war footing," he said, announcing that coronavirus patients would be evacuated to other states for treatment. Brazil's vice-president, Hamilton Mourão, tweeted photographs of oxygen cylinders being airlifted into Manaus by the airforce.
But many will see such actions as too little, too late. Infectious disease specialists have spent months urging authorities to impose some kind of lockdown to avoid exactly this kind of situation. Their penultimate petition, on 4 January, warned Manaus was again being "plunged into chaos" and implored: "We need to save lives and not repeat 2020's health and humanitarian tragedy in 2021."
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State authorities only took action on 26 December, ordering shops to close for 15 days, before backing away from those measures after street protests from local business people and workers.
"Politics kills," the Getúlio Vargas hospital health worker said on Thursday.
Orellana said the number of burials left no doubt the city was facing its darkest hour.
"Yesterday, we broke a new record for the fourth day in a row with the absurd total of 198 burials. On Saturday there were 130 burials. On Sunday, 144. On Monday, 150. On Tuesday, 166," he said. In normal times the average would be about 30.
"It is a catastrophe, and the coming hours will be the worst you can possibly imagine."