In "Dire" Plea, Brazil's Amazonas State Appeals for Global COVID Assistance

As a catastrophic second wave of the coronavirus deeply threatens Brazil's Amazonas state, creating an extremely serious health crisis, the state government has now sent an urgent SOS on behalf of governor Wilson Miranda Lima to a broad range of recipients, including international NGOs. Mongabay is supporting this extraordinary appeal by publishing the letter (see link here). The plea reads, in part:

[W]e ask for your support in the midst of this emergency fight against COVID-19 in our state. The situation is dire, and our fear is that the same situation we are seeing in the capital Manaus will reach the inland of Amazonas, the traditional and indigenous populations that are in situation of greater vulnerability because of the distance and logistics involved in deploying rapid responses during this crisis. Only a joint [international] effort will allow us to face the pandemic...

With the Amazonas public health service in collapse, there is presently no sign of the crisis abating. Many hospitals have now run out of oxygen, with patients dying as a result not only in the city of Manaus but also in the state's interior.

In a video published this week by the O Globo newspaper, the Amazonas Public Defender (Defensoria Pública), a constitutionally independent human rights body, reported that 30 patients had died due to lack of oxygen or waiting for a bed since 14 January in seven Amazonas interior municipalities – Coari, Parintins, Maués, Tefé, Manacapuru, Itacoatiara and Iranduba. Unofficial sources confirmed 35 deaths due to lack of oxygen. There are no official death figures for Manaus at this time.

The crisis is also expanding into neighboring Pará state. So far this week, in the city of Faro, located 920 kilometers (570 miles) from Manaus on the border between Amazonas and Pará, six people, two from the same family, died in health centers due to lack of oxygen, beds and medication.

"Mayors are doing their best, supplying other municipalities with oxygen if they can," said the Faro mayor. "The state government has made planes available, but the logistics are very complicated."

Fears are growing that a new viral lineage first detected in the Brazilian Amazon and dubbed P.I. by researchers – which may be more virulent and more infectious than the initial coronavirus lineage that ravaged Manaus during April – could now be gaining ground in the second wave. No cases of P.I. have been identified in the municipalities of Faro or Oriximiná so far, but widespread tests have not been carried out.

Federal government help has been insufficient, say critics, even as the region's health systems have been overwhelmed.

Knowing for ten days that oxygen was running out in Amazonas, federal Health Minister and General Eduardo Pazuello, though he went to Manaus, did little but recommend that doctors offer "preventive medicine" – a prescription including chloroquine, azithromycin, and ivermectin, whose efficacies have not been proven, and are not recommended by the National Health Surveillance Agency (ANIVISA), the federal Brazilian regulatory agency. After the crisis hit the headlines, the health ministry sent some oxygen to Manaus, though far from enough to meet the need.

Also, in an extraordinary decision at the end of 2020, taken just before the health system in Manaus collapsed, the Bolsonaro government increased the import duty on second-hand cylinders used to store medicinal gases, including oxygen – vital to COVID-19 treatment. However, public outrage forced the administration to rethink its decision. On 15 January, President Bolsonaro said that the Foreign Trade Chamber (CAMEX) had reversed its ruling, abolishing the import tax on oxygen cylinders, respirators and other essential hospital equipment.

Though no one is saying so, it seems likely that federal negligence in the face of the second coronavirus wave is the reason behind the Amazonas state government's decision to take the extraordinary step yesterday of bypassing the federal administration in appealing directly for international aid.

Meanwhile, prospects for a vaccine, widely seen as the long-term pandemic solution, are not good for Brazil. The country had to stop producing the Sinovac vaccine last Sunday because of a shortage of inputs from China. Another vaccine supplier could be India, but Brazil has been waiting for a shipment of two million doses of the AstraZeneca vaccine, manufactured in India, since last week. It seems that India has prioritized African and Asian shipments over Brazil.

Retired Brazilian ambassador to China and the United States, diplomat Roberto Abdenur told BBC Brasil: "There is a lack of goodwill towards Brazil in Delhi and Beijing that is certainly not helpful when we are in a desperate situation," such as the pandemic. While technical problems may account for some of the vaccine delays, the disrespectful way in which Bolsonaro and the Brazilian government have treated these nations in recent times may be a factor, he added.

Abdenur explained that Bolsonaro's foreign policy "has contributed and is contributing to the worsening of the diplomatic situation because it has squandered the credit that Brazil used to have with the governments of these two big powers."

Among many China criticisms, is the insinuation by Brazilian Federal Deputy,Eduardo Bolsonaro, the president's son, made on Twitter, blaming China for causing the pandemic. As for India, the lack of Brazilian support for an Indian proposal to the World Trade Organization to end temporarily a patent for products related to combatting the pandemic, is seen as one possible reason for the current vaccine impasse.

Now, with dramatic reports in the world's press of "dire" suffering and death in the Brazilian Amazon due to extreme shortages of medical equipment and supplies, state authorities are beginning to work closely with the federal armed forces.

It is to be hoped that effective action will soon be taken to curb the virus in Amazonas state – action that is also vital to the wider world which is concerned over the further spread of the new P.I. COVID viral lineage first detected in Brazil.

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