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BRASILIA / SAO PAULO / MANAUS, Brazil: The death toll from COVID-19 in the worst affected part of the remote Amazon region of Brazil may be three times the official count, according to data from notaries public reviewed by Reuters, such as the The spread of the disease overwhelms the public health system.
Officials in Manaus, capital of the state of Amazonas, said they were out of hospital beds and struggling to keep up with the necessary burials. The largest of nine states in Brazil’s Amazon rainforest, Amazonas has recorded nearly 19.4 coronavirus deaths per 100,000 inhabitants, compared to 4.4 for the whole of Brazil, according to a Reuters calculation based on the number of deaths published by the Ministry of Federal Health on Thursday (May 7)
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The coronavirus killed 422 people in Amazonas in April, according to the ministry. However, data from the death registry of notaries public indicate that the ministry’s statistics may underestimate the actual figure. Officials have previously acknowledged at media briefings that the number is likely to rise as cases go unnoticed due to lack of evidence, without saying how much.
Data from the national association of notaries public as of Thursday showed that 385 people died of COVID-19 in Amazonas in April. However, notaries also recorded another 999 deaths, attributed to pneumonia, severe acute respiratory syndrome, and other respiratory failures, which some state officials believe should be counted as COVID-19 deaths for a total of 1,384. The 999 deaths are four times the 249 deaths attributed to those other diseases in April 2019.
“In Brazil, there is a harmful phenomenon of underreporting. It is absurd to have deaths without a cause,” Manaus Mayor Virgilio Neto told Reuters by phone.
“Deaths from pneumonia, I’d rather call COVID. Deaths from severe respiratory failure, I’d rather call COVID.”
A press representative from the health ministry told Reuters on Thursday that the ministry follows an established procedure to track coronavirus cases and that it cannot be presumed that all respiratory problems are related to COVID-19, but acknowledged that as a result it could have a low count.
“The number could be higher. We have to wait for the investigation process into what was really the cause of the person’s death. The issue of deaths is a delicate one and we have to be sure of the cause of a person’s death.” The representative, who asked not to be named, said, citing the ministry’s policy.
“It could be another respiratory virus, not necessarily the coronavirus,” he said.
TESTS
The representative of the ministry said that it is only possible to know with certainty if a person had coronavirus when testing it. The government plans to increase the evidence later in May, he said, predicting that it would reveal more cases.
The ministry said in a statement Thursday that it has distributed 5.1 million tests. The press representative said the ministry did not know how many had been used.
Brazil had only evaluated 181,000 people as of April 22, the most recent government statistics available. That represents less than 0.1 percent of the population, compared to test rates of 3.5 percent in Italy and 1.2 percent in South Korea.
The Ministry of Health blamed the shortage of materials to make test kits amid high global demand for coronavirus testing.
Brazil is the country most affected by the coronavirus in Latin America, and some public health officials, politicians and other observers around the world say they are concerned that President Jair Bolsonaro will minimize the severity of the crisis.
Bolsonaro, seeing the Brazilian economy damaged by social distancing measures, has said that the economic impact of keeping people at home outweighs the health risk of leaving them to work.
The death toll across Brazil rose by 610 on Thursday to more than 9,100 people, the health ministry said, with more than 135,000 confirmed coronavirus cases.
The ministry’s overall count depends on hospitals evaluating patients, reporting positive cases to municipal authorities, who then pass the data on to state health secretaries and then to the ministry.
SAME PANDEMIC
Manaus, a city of more than 2 million inhabitants, is accessible only by plane or by boat from the rest of Brazil for much of the year. The outbreak began to spread to indigenous communities up and down the Amazon River that flows beyond Manaus, prompting calls by human rights defenders and public figures from Paul McCartney to Oprah Winfrey to protect the tribes.
Three Brazilian doctors and a local official interviewed by Reuters said they had little doubt that the wave of deadly respiratory diseases without a firm diagnosis of coronavirus is part of the same pandemic.
Guilherme Pivoto, head of the Amazonas state infectious disease association, said many patients do not have access to full-service hospitals and die without being examined. The bodies are quickly dispatched for burial or cremation, Pivoto said.
In certain cases, Manaus has resorted to burying five at a time in shared graves, according to a Reuters photographer who has seen more than 50 burials in local cemeteries. Mayor Virgilio Neto said about 120 people are being buried per day.
The SOS Funeral municipal burial service caters to families who cannot afford a private ceremony.
SOS funeral workers, some in white hooded bodysuits, masks and protective gloves, carry coffins in the back of white trucks before picking up bodies from hospitals and homes.
The number of “deportations” of the dead has tripled to between 24 and 36 per day, with 52 collected on the worst day, according to a SOS Funeral spokeswoman, who asked not to be identified.
Virgilio Neto said that his efforts to stem the outbreak through social distancing have been affected by Bolsonaro’s criticism of such isolation orders, estimating that less than 40 percent of the city follows its guidelines.
“It is difficult when the main national leader tells people to get out … he has very strong control here,” said the mayor.
Bolsonaro again defended on Thursday his desire to reopen Brazil’s economy and criticized the business closings and stay-at-home orders issued by some state leaders as too restrictive.
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