Death and denial in Brazil's Amazon capital during pandemic

MANAUS, Brazil (AP) — As the white van approached Perfect Love Street, chatting neighbours fell silent, covered their mouths and noses and scattered.

Men in full body suits carried an empty coffin into the small, blue house where Edgar Silva had spent two feverish days gasping for air before drawing his last breath on May 12.

“It wasn't COVID,” Silva's daughter, Eliete das Graças, insisted to funerary workers.

She swore her 83-year-old father had died of Alzheimer's disease, not that sickness ravaging the city's hospitals.

But Silva, like the vast majority of those dying at home, was never tested for the new coronavirus. The doctor who signed his death certificate never saw his body before determining the cause: “Cardiorespiratory arrest”.

His death was not counted as one of Brazil's victims of the pandemic.

Manaus is one of the hardest hit cities in Brazil, which officially has lost more than 23,000 lives to the new coronavirus. But in the absence of evidence proving otherwise, relatives like das Graças are quick to deny the possibility that COVID-19 claimed their loved ones, meaning that the toll is likely a vast undercount.

As ambulances zip through Manaus with sirens blaring and backhoes dig rows of new graves, the muggy air in this city by the majestic Amazon River feels thicker than usual with such pervasive denial. Manaus has seen nearly triple the usual number of dead in April and May, compared to the same period last year.

Doctors and psychologists say denial at the grass roots stems from a mixture of misinformation, lack of education, insufficient testing, and conflicting messages from the country's leaders.

Chief among sceptics is President Jair Bolsonaro, who has repeatedly called COVID-19 a “little flu”, and argued that concern over the virus is overblown.

Asked by a reporter about the surging number of deaths on April 20, Bolsonaro responded, “I'm not a gravedigger, OK?”

He has resisted US and European-style lockdowns to contain the virus' spread, saying such measures aren't worth the economic wreckage. He fired his first health minister for supporting quarantines, accepted the resignation of a second after less than a month on the job.

The president's political followers are receptive to his dismissal of the virus, as determined as he is to proceed with life as usual.

On a recent Saturday in Manaus, locals flocked to the bustling riverside market to buy fresh fish, unaware of the need for social distancing, or uninterested. And masks seen in the streets frequently covered chins and foreheads rather than mouths and noses.

The new sickness made its way to Manaus in March, in the middle of the rainy season. Deaths have surged since then. But due to a lack of testing, just five per cent of the more than 4,300 burials performed in April and May were confirmed cases of COVID-19, according to city funeral statistics.

To cope, the public cemetery razed a forested area to dig dozens of trenches for burials.

These mass graves sparked anger among families of the deceased. Why did their loved ones' bodies have to be buried in such a way, they asked, if there was no evidence the deaths were caused by COVID-19?

“A person can't even die with dignity,” das Graças, 49, said through tears.

“He's going to spend the night in the freezer when we could be doing his wake at home!” she complained, referring to the cemetery's refrigerated container that stores bodies while they await burial.

Home wakes are no longer permitted. But workers from SOS Funeral, which provides free funeral services to the poor, have found homes packed with relatives touching the bodies of loved ones, hugging each other and wiping away tears with ungloved hands — a potentially contagious farewell.

Overwhelmed emergency services have encountered similar reluctance to acknowledge viral risk. Ambulance doctor Sandokan Costa said patients often omit the mention of COVID-19 symptoms, putting him and his colleagues at greater risk.

“What has most struck me is people's belief that the pandemic isn't real.”

Amazonas Governor Wilson Lima, a Bolsonaro ally, downplayed the virus at first. He told The Associated Press in an interview this month that the unusual surge in deaths can only be explained by the outbreak.

“There's no doubt that the majority [have died] because of COVID-19,” Governor Lima said. “We don't have any other explanation for this if not COVID.”

Although health experts warn that the pandemic is far from over, national polls show adherence to lockdowns and quarantines falling.

“Every day there are different messages coming from the federal government that clash with measures by the cities and states, and with what science says,” said Manaus-based physician and public health researcher Adele Benzaken.

Meanwhile, misinformation and disinformation about the virus is swirling.

“My opinion is that they're making this up and trying to make money from it,” Israel Reis, 54, said outside Manaus' fish market.

He didn't specify who “they” might be.

One recent late afternoon, a group of paunchy middle-aged men seated in plastic chairs on the sidewalk debated measures to fight the virus. The street bar, a few blocks from a police station in downtown Manaus, was operating in violation of State COVID-19 restrictions.

“Put on your mask!” yelled one friend.

“I don't need one!” screamed another, Henrique Noronha.

Noronha, 52, argued that only the elderly and those with health problems should stay home — as Bolsonaro affirms — and the fit should return to normal. Despite his age and full figure, Noronha didn't believe he's at risk.

“This virus came to clean things up,” he said. “But I'll be fine.”