Covid-19: Manaus raises unknowns to herd immunity | Society

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The recent increase in coronavirus infections has disrupted the best plans to have fun and counteract the humid heat of Manaus: going to the golden sand beach in the waters of the Negro River or holding parties in floating houses with loud music is prohibited during a month in this Brazilian city. The rebound in the pandemic casts doubts on the preliminary scientific study that in September pointed out that 66% of the residents of the largest city in the Brazilian Amazon have covid-19 antibodies and thus had achieved the collective immunity that prevents or reduces to minimize the transmission of the virus. It sounded promising. It would be the first major city in the world to contain the virus practically without doing anything, although at the cost of a pile of deaths. Its two million inhabitants entered the radar of virologists around the world.

The pandemic has caused, according to official figures, more than 2,600 deaths and 160,000 infections in Manaus, where conspiracy theories and falsehoods about this 21st century plague proliferate. Hard to forget the collective burials in the municipal cemetery. Although to many neighbors that herd immunity sounds like Chinese, most of them behave as if it were an unquestionable reality and they were not at risk of infection. “Many thought they weren't going to catch it, they weren't worried. Unfortunately, many people died because they were reckless and irresponsible ”, explains a veteran health inspector of the City Council, Luciana Fares.

During a recent river surveillance operation in the face of the increase in infections, Inspector Fares admonishes those who participate in various parties in floating houses, temporarily prohibited, such as bars and discos. It is a most palatable plan —for those who can afford to rent them— when it is over 30 degrees and 70% humidity. All day in a swimsuit, entering and leaving the water, with music to dance or nap in a hammock and cold beer.

Ralf, 20, is bitter about his wife's 29th birthday, which they celebrate as a family in one of those little houses that is a kitchen attached to a huge porch. They were about to get out of the water to cut the chocolate cake when the inspector arrived accompanied by a battalion divided into three boats. They are armed police and military, health and environmental inspectors and a team from this newspaper. About 20 people. "The one who rented it to me told me that we were not going to have problems, that everything was resolved," explains this official who hides under a pseudonym because he works for the State. Despite the cumbersomeness of the inspection, its enforcement power is limited. They are notified of a sanction, which is not even for them, but for the owner, but the representatives of the State cannot close the party either because they lack the means to transfer them to the dock.

The aforementioned study by scientists from the Universities of São Paulo, Oxford, Harvard and others indicates that, despite the return to normality without a vaccine, Manaus has contained the epidemic thanks to the fact that many neighbors have antibodies and the coronavirus constantly runs into alleys dead ends that prevent it from spreading. The research has yet to be reviewed by other scientists. Local specialists rule out that the rebound is a second wave, but they ask for caution. "What we hope to really confirm this percentage of herd immunity is a mass test program of the population, the N (sample) of the research is very small in relation to the population," explains infectologist Antonio Magela in his office Tavares, director of medical assistance for the Tropical Medicine Foundation. Through a military camouflage print mask, he insists that they were aware that the virus would arrive but not with such fury. It caught them off guard.

The other drawback that Tavares puts to the study on herd immunity is that it is based on the analysis of blood donations collected before and during the pandemic among a group that is usually healthy. A very different profile from the elderly, obese, hypertensive and chronically ill in whom the virus is primed. "Unfortunately, among kidney patients, mortality exceeded 90%," he emphasizes.

The pandemic has had three phases in Manaus, the nerve center of a tropical jungle territory 10 times larger than Spain. First, an explosion of cases in April and May with a death peak seven times higher than the average number of burials before the epidemic, and ambulances waiting for hours for their patients to be assigned a bed in the ICU. Second, decrease and stabilization of infections from June to September despite the return to normality with shops, churches, schools, bars and the beach reopened. Third, an increase in cases a couple of weeks ago that translates into a month of restrictions. Again, many ignore them.

Manaus is the most remote capital of Brazil but one of the most international thanks to its industrial free zone. It is suspected that the virus entered the airport with a traveler from abroad, nested in the city and from there it spread rapidly to almost the last corner of the state of Amazonas in crowded ships that make trips of several days in which the outdoors in hammocks. They are the main means of transportation. Thus it caused havoc even in remote indigenous communities.

It is possible that herd immunity has reached the poor because the current regrowth mainly affects neighbors of classes A and B, the rich. People who, fed up with months of remote work, took to the beaches and the festivities on the festive bridge of Independence, on September 7. The poor majority of Brazilians have had to go out on the streets during the crisis to seek their daily livelihood, while the privileged could work from home.

The safety distance is non-existent in the long queues that form every morning in front of the banks to collect emergency aid that has allowed millions to avoid hunger; the few who wear a mask do not cover their mouth and nose. They prefer to wear it around the neck.

Back to the debate on herd immunity, the Spanish virologist Margarita del Val, from the Higher Council for Scientific Research (CSIC), explains that as this "occurs in relatively closed groups that have a homogeneous behavior", the latest data from Manaus could indicate that "now the rich are not benefiting from the herd immunity that perhaps the poorest have acquired." In any case, the scientist warns: “Trying to achieve that collective immunity, as Sweden seemed to try at first, is not a strategy, it is savagery. It is not ethical or realistic ”. Emphasize that those who are immune should continue to wear a mask and keep their distance. "We cannot be sure that they will not transmit the virus if they are reinfected."

Another unknown is how long immunity lasts. The fishmonger Danilo Mendonça assures, while he cuts a huge tambaqui in the market without a mask for a client, that he already had coronavirus although no one made an analysis to confirm it. He says that it lasted two months in which he only drank water, juices and a home remedy: “You put garlic, lemon, ginger, mastruz (a local herb)… The guys who took those other medicines got worse. That is why that lot of people died. The guy arrives there (to the hospital), they intubate him and right there, he dies ”. Lifelong superstitions still sink deep among the less educated but also spread at lightning speed in WhatsApp groups, with which the authorities dedicate a good dose of energy to combat misinformation.

Lia Regina Antunes is an exceptional witness to the seriousness of this health crisis. A basic support nurse in an ambulance, she says that even some of her colleagues insist that all this is nothing more than a political war. The determination of so many not to protect themselves unnerves him: “In 90% of the houses where we go to pick up the elderly, hypertensive, with heart disease …, no one in the family wears a mask. 'We are fine, he is the sick person', they usually tell you and I answer them: 'They are signing his death certificate ”.

The management of the covid in Brazil has been marked by the skepticism of the president, Jair Bolsonaro, and his determination to save the economy. Those who accuse him of having aggravated the epidemic abound, but other millions of compatriots point to his antiscientific stance, disdain the threat and the mask. With 150,000 deaths and five million cases, it is the third most affected country after the United States and India.

Also in Manaus the political dispute poisons the management and accusations of corruption proliferate. The mayor, Artur Virgilio Neto, accuses the Brazilian president of being irresponsible and proclaims in an interview with this newspaper that "the covid has not ended" after recalling his personal experience. He became infected and the disease seized him so hard that he was hospitalized in Manaus and later transferred to São Paulo. He still looks fragile. He emphasizes that he is only guided by science and questions the official figures released by the state authorities of Amazonas. He openly accuses the governor, Wilson Lima, of putting on makeup to minimize the impact of the coronavirus.

Neto bases his accusation on a compelling account: an excess of deaths evident in the numbers of burials. “There is an extraordinary difference in the numbers of burials. If it was 25 before the pandemic, now it is close to 50 and always above 40, it is the average that we see … Something has to explain these deaths. Why? I see it as the makeup of the covid ”. To make matters worse, he recalls that the authorities have admitted that the governor relied on false data when, in July, he declared that Amazonas had defeated the virus.

Another inspection operation closes under the full moon a clandestine party with hundreds of teenagers on a farm – organized by drug traffickers, according to the police – warns several restaurants that at ten o'clock at night they must lower the blinds and closes places of glasses. In the Sensation, with a live band and the clientele clustered around low tables, Bruna Araujo, a physiotherapist who works with covid patients, complains that these police officers with submachine guns, bulletproof vests and face masks are ruining her night. She is outraged, she wants to return to normality. "The buses and the market are really crowded and they don't control there."

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