The Challenge of Fighting Covid-19 in Manaus, Where Half the Populace Live in Favelas

RIO DE JANEIRO, BRAZIL – First came the chills, body pain, and fever. Then 48-year-old Maria Auxiliadora Lisboa lost all smell and taste. Faced with the many symptoms typical of Covid-19 for some days, she decided to seek a hospital on May 8th.

“But not the community hospital. It’s so crowded that doctors are unable to see everyone. Many people advised me to remain home, have a cup of tea, prepare a home remedy. But I alone knew what I was feeling, I needed help”, says the unemployed woman from the Redenção favela in Manaus. A test proved that she was one of more than 25,000 people infected with the coronavirus in the city, where 1,620 deaths have been recorded. Amazonas is now the State with the fourth-highest number of infections in the country.

The first thing she did when she returned to her two-room home, already diagnosed with the disease, was to agree with her husband that one would have to sleep in the living room/kitchen and the other in the bedroom to keep her isolated. A few days later, he also tested positive for the virus.

“This was a lot easier in terms of isolation because it’s just the two of us. But my mother-in-law’s neighbor, who also lives here in the neighborhood, got coronavirus and lived with twenty relatives in the house. All together. Some got the disease, and the head of the household died,” says Maria Auxiliadora, who today feels recovered from the illness.

The majority of the population of Manaus lives in similar conditions to Maria Auxiliadora and her neighbors, which could partially explain the escalation in the spread of the disease in the city.

Of the 653,218 dwellings in the city, more than half (53.3 percent) are in the so-called subnormal agglomerations – better known as ‘favelas,’ ‘invasões,’ ‘palafitas’ e ‘loteamentos’ – according to a survey by the Brazilian Institute of Geography and Statistics (IBGE) published last Tuesday.

The Amazonian capital has the highest proportion of favela dwellings (34.59 percent) among all the capitals of the country. The number is alarming because these dwellings hinder social isolation, have substandard sanitation conditions, and favor the spread of the virus that causes Covid-19.

Among the ten states with the highest incidence of contamination by the novel coronavirus, eight also account for the largest share of such irregular dwellings.

Data on subnormal agglomerations are part of a survey generally conducted for the Census, which would take place this year, but was ultimately deferred due to the difficulty in conducting household surveys during the pandemic.

“But we anticipated the release of these data to demonstrate the situation of subnormal agglomerations in municipalities and States, given that in these locations the population is more prone to contagion from the disease caused by the novel coronavirus, due to the high housing density,” explained Maikon Novaes, manager of Regionalization and Territorial Classification at IBGE.

The methodology used in this survey is different from the Census because it is based, among other methods, on satellite imagery to count substandard dwellings.

Jean Faria, president of the Amazonian Council of Architecture and Urban Planning, explains that some neighborhoods in the capital that started as invasions now have shanties with up to ten people living in three-bedroom dwellings.

“This is a serious problem: how to isolate these people if they become infected? Many of these dwellings have toilets outdoors and are not provided with sewage systems; water flows precariously. These very dense regions with little urban planning help to spread the disease quickly,” he says.

He also points out that many of the streets are unpaved. “They are not worried about wearing gloves or masks; they are worried because the place floods. It is impossible to get an ambulance there in case of an emergency”.

According to the Amazonas Health Surveillance Foundation, as in other regions of the country, the first confirmed cases of the disease in the State were from upper-class individuals returning from foreign or domestic locations with the virus. However, in April, the disease reached more densely populated neighborhoods and the peripheral communities.

The spread of Covid-19 led to ICU (Intensive Care Unit) beds in the State almost reaching their maximum capacity, and placed even more pressure on the already debilitated hospital system. Mortuary services collapsed in the capital. In public cemeteries, burials started to be done in mass graves for lack of space, while private funeral services ran out of caskets.

In April, the capital of Amazonas recorded 1,582 more deaths than in the same period last year. With testing bottlenecks, few of these deaths were credited to Covid-19, even though the dead were symptomatic of the disease. The mayor, Arthur Virgílio Neto, admitted that several people were dying at home, without any medical assistance, and would be victims of the virus.

Nildo Lima, president of the Single Favelas Central (CUFA) in the Amazon, said many low-income families were afraid to go to hospitals when they heard about the collapse of the capital’s health care system. “People were afraid to go to the emergency rooms. Some were unable to get care. A lot of people died at home untreated, unsure if it was coronavirus,” he explains.

Manaus shows slight improvement

However, in recent days Manaus has seen a drop in the number of daily burials. According to the city hall, there has also been a reduction in the rate of SAMU (Mobile Emergency Attendance Service) calls. In the state, the ICU beds occupancy rate slackened a little and stood at 79 percent on Monday.

Despite better figures, the Mayor appealed to the population to maintain preventive care and respect social isolation, which is below 50 percent in the State. “There is still no victory at all. There is nothing to celebrate but a small improvement,” said Virgílio Neto.

A survey by the Epidemiological Research Center of the Federal University of Pelotas (UFPel) showed that in the city of Manaus, more than 200,000 people had or have been infected with the novel coronavirus.

“The survey results show that only 11 percent of the population have, or have had, the novel coronavirus, and most are asymptomatic. On the other hand, experts point out that it takes 50 percent of the population to become infected to reach what they call herd immunization; that is, we still have a great fight ahead”, argued Mayor Virgílio Neto.

Disease in the interior

According to Bernardino Albuquerque, professor at the Federal University of Amazonas and an infectologist, after experiencing widespread infection in the capital, the rest of the State is now suffering from Covid-19 cases.

“Although the government banned passenger traffic on boats that carried them to other distant municipalities, there was difficulty in controlling it, which did not prevent its spread inland. The problem is that the only place with ICU facilities is Manaus. Inland there are only intermediate units to stabilize patients. But the most critical patients need to go to the capital. And in some municipalities, it takes seven days to get access. How will the capital withstand its own demand and that of the interior?” he says.

Another concern is the spread of the disease among the indigenous peoples in the most remote parts of the Amazon. “The state is home to the largest indigenous population in the country,” Albuquerque explains. Some in critical condition are being flown to the ICUs in the capital.

“The number of patients with Covid-19 has increased greatly. We’re flying more, it’s the last chance to save their lives,” Edson Santos Rodrigues, a pediatrician who works in air transportation in the state, told Reuters.

“Sometimes we don’t get there in time, because we can’t land at night in remote airfields with no lights,” the doctor said when returning to Manaus with a 26-year-old Tikuna man who was breathing through an oxygen tank aboard the plane.

The Special Indigenous Health Secretariat (SESAI) reported last Monday that at least 23 indigenous people died from Covid-19.

The victims were in remote indigenous lands, 11 of them in the border region with Colombia and Peru.

Source: El País