Coronavirus

No, it just means his prayers were insincere - like everybody else that died of the same thing.

I qualify for a 60 - 64 pilot project so hope to get first jab tomorrow or Monday.

I pity anyone who lives in Fla, Mich , Cal and Texas. Those states lead the potentials for the new wave.

The az clusterfuck has delayed my appt .... again. Still waiting and hoping.

Manaus, a Brazilian city of more than two million that lies hundreds of miles from the Atlantic coast in the midst of the Amazon rain forest, has stood out as one of the world’s leading COVID hotspots. Tragically, it continues to provide the wrong lessons about what should be done to ease the spread of SARS-CoV-2, the virus that causes the disease.

The city and Brazil as a whole have become an exemplar of what happens when a country pursues a strategy of denying the pandemic and embracing herd immunity by letting the virus spread unchecked. Brazil’s president Jair Bolsonaro has promoted the idea of letting the pathogen move throughout the population until most people have been infected. He described proposals for a lockdown in Manaus before a crushing second wave of infections hit as “absurd.” And he has downplayed the severity of the crisis, saying that the nation of 211 million has to recognize that death is an inevitability and so Brazilians should stop being “sissies.” The country is currently recording around a quarter of all weekly COVID-19 deaths despite being home to less than 3 percent of the world’s population.

The legacy of the nation’s approach to countering COVID has meant that the spiraling case numbers and deaths registered in Manaus and the rest of Brazil are now spreading through the world in the form of a new variant of the virus. Studies suggest this variant could spread more than twice as fast. “Manaus was the first city to have its health system collapse in the new wave,” says Brazilian physician and neuroscientist Miguel Nicolelis. “But now there are many ‘Manaus’s all over Brazil’s five regions. Brazil badly needs help from the international community to handle this situation, or new variants from here will continue to spread worldwide!”

Manaus was devastated by a first wave of COVID cases beginning last March. Excess deaths—the 3,457 people in the city who died above the expected mortality figures between March 19 and June 24, 2020—represented 0.16 percent of Manaus’s relatively young population. And 7 percent of men older than 75 died at the peak of the spread.

Infections were so prevalent that researchers at the University of São Paulo and their colleagues concluded that Manaus was the first city in the world to reach herd immunity—the point at which enough people are immune to a virus that the spread of new infections is hindered. Their preliminary preprint study estimated that 66 percent of the population had been infected with SARS-CoV-2 (they later revised their figure to 76 percent as of October). The threshold for COVID herd immunity is unknown, but projections often cited range from 60 to 90 percent. Similarly high rates of infection have also been found in the Peruvian and Colombian Amazon.

After a peak of hospitalizations and deaths last April, numbers dropped to relatively low levels until November 2020, despite the reopening of schools and businesses. Some Brazilian researchers warned that the pandemic was not over. Infections could rise, and the absence of stricter public health measures would condemn the city to a resurgence. The response from public officials, they say, was always the same: herd immunity would protect them. This false sense of security precipitated the new wave of infections, says Jesem Orellana, a Manaus-based epidemiologist at the Oswaldo Cruz Foundation (Fiocruz), a leading Brazilian public health institute.

In December 2020 a second wave did hit. And by January the city’s health system, which serves communities across the Amazon, had collapsed. ICUs were full to bursting, and oxygen supplies became exhausted. Some patients were airlifted to other regions of Brazil. But many died of asphyxiation on makeshift beds in hospital corridors or their home, doctors say.

More severe than the first one, the new wave took Manaus by surprise. Wearing masks and practicing social distancing had been discarded in the belief the city had reached herd immunity. Caseloads surged out of control, and bleak milestones from last year were surpassed. In January alone more than 3,200 excess deaths were logged, Orellana says.

Questions arose as to whether herd immunity had ever been achieved, the number of people infected had been overcounted or immunity to the virus had waned. Another disturbing prospect was that mutations to the virus in the Amazonian city that had spawned what is called the Manaus variant, or more formally P.1, could have caused reinfections in people who had earlier bouts or could have sped the rate of transmission among the still uninfected.

“It’s quite hard to come up with any scenario that can be made to fit Manaus which is not hugely concerning,” says William Hanage, an epidemiologist at the Harvard T. H. Chan School of Public Heath.

Recent studies have corroborated the suspicions that P.1 drove Manaus’s second wave. The exact rate of infection prior to the recent upsurge has not been determined. But Hanage emphasizes that inducing immunity by leaving people to contract the virus unguarded is a mistake. “Following the tragedy of Manaus, I would hope we can put an end to discussion of controlling the pandemic through herd immunity acquired from natural infection,” he says.

Hanage hopes the dire scenes in the Amazon—hospital systems collapsing, grave diggers carving out trenches for mass graves shared by multiple bodies, and families desperately queuing for oxygen supplies—will send a clear message: “Herd immunity through infection, instead of a vaccine, only comes with an enormous amount of illness and death,” Hanage says.

“[People in Manaus] thought, ‘We passed through this big wave, so now it’s fine,’” says Paola Resende, a research scientist at the Laboratory of Respiratory Viruses and Measles at Fiocruz. “Of course, the people relaxed and started to live their life as normal. And of course, it happened again.”

Resistance to new measures persisted for months. Social distancing and mask wearing lagged. On December 26, 2020, when the state of Amazonas ordered businesses closed to slow rising infection numbers, protests by businesses and workers erupted, and the decision was quickly reversed.

The Manaus experience holds a cautionary message for the rest of the world, including the U.S., about maintaining basic public health strictures even as vaccination campaigns progress. And it underlines why only a global approach to immunizations will work.

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