When last spring Covid-19 struck Manaus, an industrial city of two million on the Rio Negro in Brazil’s Amazon, the outbreak supplied an illustration of just how bad the pandemic could get. Appalling scenes of mass graves and hospitals in collapse were beamed around the world.
As infections finally slowed over the summer, it was speculated that the virus might have ultimately burned itself out there because it was running out of people to infect; that Manaus, as perhaps the most densely infected place in the world, had come close to, or even achieved, herd immunity. According to the US Centers for Disease Control and Prevention, it was estimated that 75 per cent of its population had been infected by October.
Yet the numbers took off again in December and have risen through January, in a new outbreak that has been drastically worse than the first. According to CNN, the number of Covid-19 victims buried in the city in the first three weeks of January alone was 1,333 – up from 348 in May 2020, the worst previous month. Hospitals have run out of oxygen for patients, premature babies have had to be transferred to units in other cities and even the first stages of the city’s vaccine drive were suspended. Hundreds have died without oxygen on hospital beds or at home.
A major factor seems to be a new variant of the virus, known as P1. According to the latest figures by the Fiocruz-Amazonia research institute, there were no recorded cases of P1 in November, but it made up 51 per cent of the total in December and 91 per cent in January. Many countries have consequently imposed travel bans on Brazil, though the P1 variant has already been detected in the US and Japan, and according to experts is probably present in other countries too. The speed of its spread, greater even than that of the new variant that emerged in Britain late last year, is alarming and begs serious questions about herd immunity and the danger posed from new variants.
[See also: International Coronavirus vaccine tracker]
More light was shed on the resurgence in Manaus in a paper published by the medical journal The Lancet on 27 January. In it, the authors suggested four non-mutually exclusive explanations for the virus’s return. In roughly ascending degree of onerousness, they were: that the first wave had been overestimated originally; that immunity among those infected had waned with time; that the new variant is more transmissible; and that it may be able to evade immunity and reinfect people who have already had Covid-19.
With infection rates rising also in neighbouring regions of Brazil, on Wednesday the former health minister Luiz Henrique Mandetta warned in an interview on local television that the P1 variant could cause a “mega epidemic” in Brazil within 60 days. Mandetta, a doctor by background, was fired by Jair Bolsonaro last year after he challenged Brazil’s hard-right president’s laissez-faire response to the pandemic.
Brazil currently has the second highest number of Covid-19 deaths after the US and its overall response to the pandemic was last week ranked the worst of any country in the world by the Sydney-based Lowy Institute (which placed New Zealand first). As Nick Burns, a contributing writer at the New Statesman, wrote, the Bolsonaro government’s latest failings include taking nine days to secure additional oxygen supplies from the US and presiding over delays and rows over vaccine roll-out. Yet astonishingly, Bolsonaro may still be on track to win re-election next year.
The Manaus tragedy is one that should first and foremost horrify the rest of the world for humanitarian reasons, but should also concern it for self-interested ones. Fortunately the vaccines being given do seem to work against new variants. But the longer the pandemic continues, including in countries where mass vaccination may take until 2024 or later, the more new variants are likely to emerge, possibly requiring adjustments to vaccines to keep them current.
That sets up a stark and essentially binary choice between two options. One is for the rich world to vaccinate its populations and impose permanent, draconian travel and quarantine requirements to keep out new variants that rage through populations in the global south; an approach that would be economically ruinous and morally indefensible. The other, as my colleague has Ido Vock discussed, is to speed up the production of vaccines and make them available worldwide far quicker.