Brazilian Manaus collapses again. Is a new variant of coronavirus to blame?



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Inside, doctors are performing cardiopulmonary resuscitation on a woman in a futile attempt to save her life. A hospital source told CNN she died shortly after being brought inside.

In the four hours CNN spent outside Hilda Freire Hospital on Tuesday morning, three Covid-19 patients died.

Chaos has become the norm here this month. What is happening in this under-equipped hospital, surrounded by the Amazon rainforest, is a small example of a new massive Covid-19 epidemic engulfing northwestern Brazil.

Not far from Iriduba is the epicenter of this new epidemic, Manaus. The capital of the state of Amazonas is often referred to as the gateway to the Amazon, its main connections with the rest of the world by plane or boat.

If the city’s name sounds familiar, it may be because it was the scene of one of the world’s worst Covid-19 outbreaks in April and May. The healthcare system has collapsed and images of thousands of newly dug graves have become iconic of Brazil’s coronavirus crisis, with its death toll now just behind that of the United States.

The current situation is worse than ever. January was by far the deadliest month in the pandemic in Manaus.

In May, 348 people were buried here, the worst month yet. In the first three weeks of January alone, that number was 1,333.

Although genomic testing is not widespread in Manaus, scientists tell CNN that evidence suggests a new variant of the virus mixed with government inaction to create a tragic perfect storm.

Aerial view of an area of ​​the Nossa Senhora Aparecida cemetery where graves were dug in Manaus in May 2020.

A new variant of coronavirus

Four epidemiologists told CNN that a new variant of the coronavirus, called P.1, is likely behind the new round of devastation that has happened in Manaus.

“I’m not generally alarmist about this stuff, but I’m concerned about what we’re seeing in Brazil right now,” said Scott Hensley, viral immunologist at the University of Pennsylvania.

Scientists say the new version of the virus originated in Brazil, and while there is still much to learn about it, there are multiple reasons for concern.

How a city missed a warning after a warning until its healthcare system collapsed

First, new data suggests that it is more transmissible.

Researchers from Fiocruz, the Brazilian health research institution, are studying those newly infected in Manaus. Of the 90 who have taken part in the study so far, 66 had infections caused by the new variant, according to Fiocruz researcher Felipe Gomes Naveca.

Although inconclusive, experts say it gives credence to the idea that this variant is more easily transmitted.

“If it has the ability to spread more effectively, it is likely to become more and more dominant,” Dr. Anthony Fauci told CNN’s Erin Burnett on Tuesday.

Fiocruz researchers have also documented at least one case of a person who tested positive for the new variant while retaining antibodies from a previous Covid-19 infection. This could suggest that people may be re-infected with the new variant, although one case is far from proof.

“The fact that we are seeing infections right now indicates that the circulating virus is either more transmissible, that it can escape antibodies, or a combination of the two,” Hensley said.

The good news? For now, it appears that current Covid-19 vaccines may still protect against the pattern of mutations seen in the new variant – although all epidemiologists interviewed said more research is needed.

Man with oxygen tanks in Iranduba.

It’s not just the variant

To blame the last outbreak simply on the variant would be to miss the forest for the trees. The emerging new variant is simply part of a larger system that has failed in the state of Amazonas.

Start with the lack of a coordinated federal response, characteristic of the administration of Brazilian President Jair Bolsonaro throughout the pandemic.

After the first wave, it was painfully obvious that Manaus’ healthcare system couldn’t handle another such crisis.

But as the worst days of April, May and June have subsided, the federal government has not doubled down on its response here to ensure the city will never again be short of ventilators, medicine, oxygen. and bed space.

Instead, a sense of complacency set in, as executives like Jair Bolsonaro called the idea of ​​a second wave a lie. In November, he told his people to basically accept the virus and not to fear the virus “like a country of queers.”

Today, critics wonder if a similar complacency may have slowed the federal health ministry’s response to warning signs of a second crisis in Manaus this month.

Federal investigators are examining why Health Minister Eduardo Pazuello failed to send aid to the city faster after a spike in cases was documented in December, then again after an oxygen supplier reported problems in January.

“Although an increase in the number of Covid-19 cases has been verified [in Manaus] in the week of Christmas 2020, the health minister chose to send ministry officials to Manaus only before January 3, a week after being informed of the calamitous situation, “a report from the country’s attorney general said. which was submitted to the Brazilian Supreme Federal Tribunal.

Pazuello has defended his actions, accusing the variant of a disaster he claims no one could have foreseen.

“It was a situation totally unknown to everyone,” he said on Tuesday. “It was too fast.”

The stage was set

But a basic understanding of how viruses evolve would have suggested that this very situation would arise.

As lockdowns were eased towards the end of last year, businesses reopened and people took to the streets. Despite warnings from several experts that the virus is spreading, a more laissez-faire attitude towards the virus has spread to Manaus.

The now patently bogus notion was prevalent that Manaus’ massive first wave of Covid-19 reached enough population to create herd immunity.

Brazilian officials were warned six days ahead of an impending oxygen crisis in Manaus

“People started to live as if we were leading a normal life, without using masks with a lot of people,” said Naveca, the Fiocruz researcher. “We have seen this a lot at Christmas and at the end of the year.”

As CNN previously reported, even as scientific warnings were mounting, officials in the state of Manaus and Amazonas faced pressure – both from the public and Bolsonaro’s own statements – to s’ refrain from imposing strict foreclosure measures.

But all over the world, wherever existing strains of Covid-19 were allowed to continue to circulate, the groundwork was being prepared for the emergence of new variants.

“The virus has the opportunity to sort of explore all of these different genetic types and those that are favored are currently being selected,” Hensley said.

In other words, the more the virus is allowed to spread, the more likely it is to evolve and form new variants.

CNN’s Natalie Gallón and journalists Marcia Reverdosa and Eduardo Duwe contributed to this report.

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