The virus swept through the region like past plagues that have traveled the river with colonizers and corporations.
It spread with the dugout canoes carrying families from town to town, the fishing dinghies with rattling engines, the ferries moving goods for hundreds of miles, packed with passengers sleeping in hammocks, side by side, for days at a time.
The Amazon River is South America’s essential life source, a glittering superhighway that cuts through the continent. It is the central artery in a vast network of tributaries that sustains some 30 million people across eight countries, moving supplies, people and industry deep into forested regions often untouched by road.
But once again, in a painful echo of history, it is also bringing disease.
As the pandemic assails Brazil, overwhelming it with more than 2 million infections and more than 84,000 deaths — second only to the United States — the virus is taking an exceptionally high toll on the Amazon region and the people who have depended on its abundance for generations.
In Brazil, the six cities with the highest coronavirus exposure are all on the Amazon River, according to an expansive new study from Brazilian researchers that measured antibodies in the population.
The epidemic has spread so quickly and thoroughly along the river that in remote fishing and farming communities like Tefé, people have been as likely to get the virus as in New York City, home to one of the world’s worst outbreaks.
“It was all very fast,” said Isabel Delgado, 34, whose father, Felicindo, died of the virus shortly after falling ill in the small city of Coari. He had been born on the river, raised his family by it and built his life crafting furniture from the timber on its banks.
In the past four months, as the epidemic traveled from the biggest city in the Brazilian Amazon, Manaus, with its high-rises and factories, to tiny, seemingly isolated villages deep in the interior, the fragile health care system has buckled under the onslaught. Cities and towns along the river have some of the highest deaths per capita in the country — often several times the national average.
Tyler Hicks, a photographer for The New York Times, spent weeks on the river, documenting the spread of the virus. In Manaus, there were periods when every COVID ward was full and 100 people were dying a day, pushing the city to cut new burial grounds out of thick forest. Grave diggers lay rows of coffins in long trenches carved in the freshly turned earth.
Down the river, hammocks have become stretchers, carrying the sick from communities with no doctors to boat ambulances that careen through the water. In remote reaches of the river basin, medevac planes land in tiny airstrips sliced into the lush landscape only to find that their patients died while waiting for help.
The virus is exacting an especially high toll on Indigenous people, a parallel to the past. Since the 1500s, waves of explorers have traveled the river, seeking gold, land and converts — and later, rubber, a resource that helped fuel the Industrial Revolution, changing the world. But with them, these outsiders brought violence and diseases like smallpox and measles, killing millions and wiping out entire communities.
“This is a place that has generated so much wealth for others,” said Charles C. Mann, a journalist who has written extensively on the history of the Americas, “and look at what’s happening to it.”
Indigenous people have been roughly six times as likely to be infected with the coronavirus as white people, according to the Brazilian study, and are dying in far-flung river villages untouched by electricity.
Even in the best of times, the Amazon was among the most neglected parts of the country, a place where the hand of the government can feel distant, even nonexistent.
But the region’s ability to confront the virus has been further weakened under President Jair Bolsonaro, whose public dismissals of the epidemic have verged at times on mockery, even though he has tested positive himself.
The virus has surged on his government’s disorganized and lackluster watch, tearing through the nation. From his first days in office, Bolsonaro has made it clear that protecting the welfare of Indigenous communities was not his priority, cutting their funding, whittling away at their protections and encouraging illegal encroachments into their territory.
To the outsider, the thickly forested region along the Amazon River appears impenetrable, disconnected from the rest of the world.
But that isolation is deceptive, said Tatiana Schor, a Brazilian geography professor who lives off one of the river’s tributaries.
“There is no such thing as isolated communities in the Amazon,” she said, “and the virus has shown that.”
The boats that nearly everyone relies on, sometimes crowded with more than 100 passengers for many days, are behind the spread of the virus, researchers say. And even as local governments have officially limited travel, people have continued to take to the water because almost everything — food, medicine, even the trip to the capital to pick up emergency aid — depends on the river.
Scholars have long referred to life on the Amazon as an “amphibious way of being.”
The crisis in the Brazilian Amazon began in Manaus, a city of 2.2 million that has risen out of the forest in a jarring eruption of concrete and glass, tapering at its edges to clusters of wooden homes perched on stilts, high above the water.
Manaus, the capital of Amazonas state, is now an industrial powerhouse, a major producer of motorcycles, with many foreign businesses. It is intimately connected to the rest of the world — its international airport sees about 250,000 passengers a month — and, through the river, to much of the Amazon region.
Manaus’ first documented case, confirmed on March 13, came from England. The patient had mild symptoms and quarantined at home, in a wealthier part of town, according to city health officials.
Soon, though, the virus seemed to be everywhere.
“We didn’t have any more beds — or even armchairs,” Dr. Álvaro Queiroz, 26, said of the days when his public hospital in Manaus was completely full. “People never stopped coming.”
Gertrude Ferreira Dos Santos lived on the city’s eastern edge, in a neighborhood pressed against the water. She used to say that her favorite thing in the world was to travel the river by boat. With the breeze on her face, she said, she felt free.
Then, in May, dos Santos, 54, fell ill. Days later, she called her children to her bed, making them promise to stick together. She seemed to know that she was about to die.
Eduany, 22, her youngest daughter, stayed with her that night. In early morning, as Eduany got up to take a break, her sister Elen, 28, begged her to come back.
Their mother had stopped breathing. The sisters, in desperation, attempted mouth-to-mouth resuscitation. At 6 a.m., the sun rising above the city, dos Santos died in their arms.
When men in white protective suits arrived later to carry away her body, the sisters began to wail.
Dos Santos had been a single mother. Life had not always been easy. But she had maintained a sense of wonder, something her daughters admired. “In everything she did,” Elen said, “she was joyful.”
Her mother’s death certificate listed many underlying conditions, including long-standing breathing problems, according to the women. It also listed respiratory failure, a key indicator that a person has died of the coronavirus.
But her daughters didn’t believe she was a victim of the pandemic. She had certainly died of other causes, they said. God would not have given her such an ugly disease.
Along the river, people said similar things over and over, reluctant to admit to possible contagion, even as the health of their siblings and parents declined. Many seemed to think their families would be shunned, that a diagnosis would somehow tarnish an otherwise dignified life.
But as this stigma led people to play down symptoms of the virus out of fear, doctors said, the pandemic was spreading quickly.
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