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‘Plan A is over, we are on plan B that saves lives’: The COVID-19 disaster in the Brazilian Amazon

The prospect of a decline to a second COVID-19 catastrophe in the Amazon region of Brazil is happening. In Manaus, the capital of the state of Amazonas, all the beds in the Intensive Care Unit (ICU) are full and the waiting lists for seriously or critically ill patients have remained at a very high level during the last weeks.

Official figures from Manaus show that the number of deaths from COVID-19 in January (2,522) almost equals the combined number of deaths recorded in April and May (2,850) during the previous peak, and it’s more than five times the December statistic (460).

The complete saturation of the health system in Manaus means that other cities upstream are facing delays or simply cannot refer critically ill patients to the largest hospitals in the city, and must take emergency measures to try to cope with a growing number of sick patients.

Our plan A It was trying to help slow the flow of critical patients by pushing intermediate care for moderate and severe cases, but that plan is out of the window now, ”says Pierre Van Heddegem, MSF’s emergency coordinator in Brazil.

“We are now fully on plan B, providing life-saving critical care, in facilities that do not have an intensive care unit and with the daily worry that we run out of oxygen. This second wave of COVID is overwhelming everyone and we are doing everything we can to overcome it. Our fear is that we cannot keep up, “he says.

Mariana Abdalla / MSF

In Tefé, a few days’ boat ride upriver from the state capital, MSF is helping the hospital through some radical changes. They are moving all the medical departments to nearby buildings, like the school, and converting the regional hospital as much as possible at a COVID-19 treatment referral center.

Under normal circumstances, this rural hospital would send all critical patients by air ambulance to Manaus, but with most of the COVID-19 beds occupied in Manaus, the Tefé hospital has to find ways to treat critical patients. So far, the COVID-19 treatment capacity has increased from 27 to 67 beds, but this is exceeding the limit of what is possible.

The MSF team has worked hard to train and empower doctors and nurses who care for critically ill COVID-19 patients with oxygen, but the oxygen supply itself is an ongoing concern.

“We spent our day at Tefé,” says Van Heddegem. “There were days when we were very close to a disastrous situation.”

The authorities have just installed a new oxygen generation plant, but at the current rate of use, even the new plant can not providing enough for all patients. MSF is working on the urgent importation of dozens of oxygen concentrators for individual patients to fill some of the gaps, both for Tefé and Manaus.

In Manaus, MSF is supporting the José Rodrigues Emergency Unit (UPA), which in theory should provide an intermediate level of care, stabilizing patients before they need to go to a higher-level hospital. As in Tefé, with the COVID-19 beds of the Manaus hospital occupied, this center now has to find ways to provide its own high-level treatment.

“The UPA was totally overloaded, with lack of doctors, nurses and intensive care protocols”Says MSF Manaus coordinator Fabio Biolchini Duarte. “When we were there for the first time, the unit had 18 beds and there were 45 patients. Virtually the entire place had been turned into a COVID-19 infirmary. It was one of the health establishments where several patients died from lack of oxygen ”.

Mariana Abdalla / MSF

The staff, both medical and non-medical, working in this Emergency Unit and in the larger hospitals are gradually being crushed because of the emotional charge of having several dead patients every day. MSF has hired mental health specialists to provide psychosocial support, including at Manaus’ largest public health center, Hospital 28 de Agosto, where an MSF medical team provided care to patients during the first wave last year.

“We see the incredibly dedicated employees, but we also realize that they are absolutely exhausted,” says MSF psychologist Andréa Chagas. “In many cases, it is not even possible for them to find relief at home from the anguish experienced at work, since many have sick relatives or have lost loved ones. The speed and intensity of what is happening does not leave room to process so many feelings.

In the Amazon state, MSF manages or supports almost 100 COVID-19 beds. This is taking up most of the emergency team’s capacity, but there are also some initiatives to help with prevention.

The Health Promotion teams prepare to work in strategic points in Manaus, with hygiene and social distance guidelines and tests. The aim is to allow rapid diagnosis and follow-up of patients who test positive to avoid detecting cases when they are already in a serious condition.

MSF is also pushing hard for wider use of the rapid antigen test, which indicates whether a person has the virus active now, in real time. It is a point of amazement and frustration for the team that the antibody test continues to be the basic element used in Brazil. This antibody test can only indicate if you have had the disease at some stage in the past, so it could detect people who had the SARS-CoV-2 virus weeks or months ago, but no longer have it today.

Mariana Abdalla / MSF

Using antigen testing, only sick patients are isolated, resulting in avoids unnecessary hospitalizations at a time of great shortage of personnel and material resources. MSF has successfully encouraged health authorities in Tefé and another rural Amazon town, São Gabriel da Cachoeira, to use this test, and we continue to urge authorities in Manaus and other affected areas to make the switch as well.

MSF also has a team in the rural Amazonian town of São Gabriel da Cachoeira, where the situation seems more stable at the moment, but where continuous vigilance is needed. The team is supporting the health center for the care of patients with the new coronavirus, and health educators are giving hygiene and social distancing guidelines in the barracks, used as accommodation when members of the indigenous population arrive in town. This should allow us to monitor to some extent any trends in indigenous peoples showing symptoms of the disease.

MSF teams are also in an early stage of preparation in the event of a sudden surge of COVID-19 in Boa Vista, the capital of neighboring Roraima state.

This note is from MSF and is published under an editorial alliance with El Financiero to disseminate the work of the institution.

Doctors Without Borders was founded in France in 1971 by a group of doctors and journalists. They won the Nobel Peace Prize in 1999 for their humanitarian work on various continents. MSF has operations in more than 70 countries, including Mexico, where the office was established in 2008.

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