Health collapse in Manaus: the burden of not adhering to non-pharmacological measures to reduce the transmission of Covid-19

Abstract

This article aims to compare the evolution of Covid-19 in Manaus and Fortaleza, two epicenters of the pandemic in 2020, analyzing legal measures by local governments and levels of social isolation. An algorithm was defined to calculate the Homestay Index (HSI), using data from the Google Mobility Report. We analyzed the decree’s timeline, the HSI evolution, the Covid-19 incidence and the number of deaths from March/2020 to January/2021. The population of Fortaleza was exposed to more consistent measures of social distancing than that of Manaus. Longer homestay was observed from March to May 2020 and Fortaleza achieved higher and more lasting levels. As of June 2020, the HSI fell, notably in Manaus, reaching levels below zero in late December. As an aggravating factor, the government decreed broad isolation in Manaus on December 23, 2020, but after protests it was repealed on December 26, 2020. A judicial decision determined the complete closure in Manaus on January 2nd 2021, but it was too late: the SUS collapsed with an exponential increase in deaths. In Fortaleza, the demand for health services was high, but under control. We consider that only the strict application of non-pharmacological measures and mass immunization can prevent further deaths.

A framework to assess potential health system resilience using fuzzy logic

“…Manaus had the lowest CoReS (0.37) and the second lowest pandemic efficacy index (0.574), very close to that of Cuiabá (0.568). The local health system in Manaus collapsed in early 2021 because of a lack of basic resources such as oxygen for intensive care and inpatient beds, and harmful working conditions for health workers ( 20 , 21 ).…”

Mortality in children under five years old in Brazil: evolution from 2017 to 2020 and the influence of COVID-19 in 2020

“…MR in children under five years of age by COVID-19 covered all age groups, being higher in the postneonatal period. The low MR in children under five years old from COVID-19 may be the result of non-pharmacological measures 14 implemented during the pandemic and the reduction of fecundity/birth. 15 Among children under five years old, MR of some diseases originating in the perinatal period, in addition to COVID-19 was 0.7 deaths per thousand live births.…”

Working conditions in primary health care in the COVID-19 pandemic: an overview of Brazil and Portugal

“…Collapses occurred in both systems, such as the case in the city of Manaus in Brazil and the high occupancy rate of intensive care unit beds in the North of Portugal, both observed during the second wave of the COVID-19 pandemic, which started between the months of October and November of 2020 [49][50][51] .…”