The pandemic deteriorated further compared to the previous year. From the beginning of January, a sharp increase in cases in the northern state of Amazonas led to a surge in demand for oxygen. There was not enough local supply to cover all the needs, and many health facilities quickly ran out. As a result, dozens of patients who needed oxygen support died of suffocation.

The health system in the state’s capital, Manaus, collapsed. Because the city was the only place in the state with intensive care unit beds to treat severe cases, people in rural areas were also left without assistance.

Patients who were being treated by Médecins Sans Frontières (MSF) teams working in other areas of the state immediately felt the repercussions of the problems in the capital. Since there were no beds available in Manaus, some of our severely ill patients could not be transferred from a hospital in Tefé (a remote area where we worked for several months during the second wave of the pandemic) and consequently died. In spite of staff shortages and logistical challenges, our staff did their utmost to increase the local capacity to care for a growing number of patients, and helped manage the facility’s very limited oxygen supply.

As the catastrophe in Manaus unfolded, we sent teams to provide support and training to understaffed and undersupplied facilities that had originally provided basic care. These facilities were now being converted into intensive care units overnight, in order to cover the spiralling demand for more complex medical attention. Mental health professionals arrived to assist staff who were physically and mentally overwhelmed, dealing each day with heavy losses.

The disaster was compounded by a lack of coordination by the federal government. That also had a negative impact on vaccination, which had a slow start in January after federal officials initially questioned the efficacy and safety of vaccines and delayed the acquisition of doses. In addition, some authorities even promoted ineffective medicines and shunned infection prevention and control measures, such as the use of masks and practicing physical distancing. Some patients we treated had the illusion that they were ‘protected’ by these medicines and exposed themselves to contamination, exacerbating the spread of the disease.  

The result was that, by the end of 2021, Brazil reached the staggering figure of 620,000 recorded COVID-19 deaths, many of which could have been avoided; it is one of the few countries in the world with a universal public health system which had performed well in managing previous health crises.

During the course of such a difficult year, we tried to respond to misinformation with both health promotion teams in direct contact with our patients, and using our social media channels to counteract the propagation of fake news among the general public.

We made health promotion a priority, tailoring the way we communicated to vulnerable communities. Whenever possible, we hired staff from the communities where we worked and, when necessary, delivered the messages in indigenous languages.

In response to a higher demand for medical attention where the health system was fragile, activities were expanded in regions like Rondônia and Pará states, in northern Brazil, and parts of the northeast, such as urban areas in Ceará state and remote communities in Paraíba and Bahia. Our goal was to try to diagnose the disease in the early stages, so patients would be less likely to require an intensive care unit bed that probably would not have been available.   

Many of our projects also focused on providing training for health professionals, sharing our experience in previous epidemics, especially in infection prevention and control measures. Our aim was to make local teams better prepared to continue delivering assistance to their communities when we were no longer there.

By the end of the year, our teams had worked in eight Brazilian states. The scale of our COVID-19 intervention, in both human and material resources terms, was unprecedented in MSF’s 30-year history in Brazil.  

Assisting migrants and vulnerable communities
Towards the end of 2021, as the roll-out of vaccinations resulted in a reduction in the number of COVID-19 cases and deaths, some of the movement restrictions at Brazil’s borders were lifted. People who were prevented from looking for better life conditions on the Brazilian side were finally able to cross the border to the northern state of Roraima where, since the end of 2018, we have been supporting the local health system to address the needs of Venezuelan migrants.

As the numbers of migrants arriving in the border town of Pacaraima increased, we scaled up our services there, assisting the mostly homeless population with mobile clinics and health promotion at migrant hotspots. We also maintained assistance in the state’s capital, Boa Vista, where we worked in basic healthcare facilities and at both official and informal shelters. In these locations, we provided medical and mental health services and screened people for suspected cases of COVID-19.

Mobile teams also offered basic health services in several municipalities in the state. Towards the end of 2021, we expanded these activities to serve indigenous communities in the Pacaraima area.