这完全是一场风暴——一个城市怎么会输给Covid-19? 2021/02/06
A perfect storm How did one city lose so many to Covid-19? 2021/02/06
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2021-02-09 22:36
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火星译客

A perfect storm

一场完美的风暴

How did one city lose so many to Covid-19?

一个城市是怎么输给Covid-19的?

Manaus, in Brazil, suffered one of the world’s most devastating outbreaks. Now, epidemiologists want to know why. Sarah Neweyreports from Amazonas. Pictures by Simon Townsley

巴西的马瑙斯遭受了世界上最严重的暴发之一。现在,流行病学家想知道为什么。 来自亚马逊州的莎拉·纽维报道。图片来自西蒙·汤斯利

This article has an estimated read time of seven minutes

本文预计阅读时间为七分钟

Ulisses Xavier will never forget the noise. At the peak of the pandemic, when workers here were forced to abandon individual graves in favour of long trenches excavated with a faded yellow digger, the cemetery’s tranquility was shattered.

尤利西斯·泽维尔永远不会忘记噪音。在大流行的高峰期,当这里的工人被迫放弃单个坟墓,转而使用褪色的黄色挖掘机挖出的长沟时,公墓的宁静被打破了。

“At that time you could barely hear yourself think,” the 52-year-old gravedigger recalls.

这位52岁的挖墓者回忆说:“那时几乎不知道自己在想什么。”

“There was just the sound of machines working, men digging, families crying. It was relentless.”

“只有机器运转,男人挖土,家庭哭泣的声音。这是无情的。”

On the outskirts of Manaus, a sprawling port-city in the heart of the Amazon rainforest, this new clearing at Parque Tarumã cemetery is a grim reminder of what can happen if Covid-19 spreads uncontrolled.

在亚马逊热带雨林中心一个广阔的港口城市马瑙斯的郊外,塔鲁玛公园墓地的新空地令人不禁想象如果Covid-19不受控制地传播。

On April 10 Francisco da Silva Nascimento was the first to be buried here. Within three days the 63-year-old was joined by 102 others; by April 16 that figure had more than doubled to 250.

4月10日,弗朗西斯科·达席尔瓦·纳西门托被埋葬在这里。三天之内,这位63岁的老人与另外102人一起被埋葬在这里;到4月16日,这一数字增加了一倍以上,达到250。

From there a sea of wooden blue crosses multiplied as the virus spread like wildfire across an isolated city caught off-guard. Dates, names and numbers painted onto the wood in thick black lettering are a sober record of just how quickly fatalities mounted.

蓝色的木制十字架成倍增加,病毒像野火一样散布在一个个偏僻的城市,令人措手不及。画在木头上的黑色粗体字的日期,名字和数字是死亡人数快速增加的令人清醒的记录。

By April 20, 524 people were buried in the tawny earth; on May 5 that figure stood at 1,018. In total, close to 2,000 coronavirus victims are in this graveyard alone.

截至4月20日,有524人被埋在黄褐色的土地中;在5月5日,这一数字为1018。仅此墓地就有总共近2000名冠状病毒受害者。

“I’ve been digging graves for 16 years and I’ve never witnessed anything like it,” says Mr Xavier, who helped bury upwards of 100 people in a single day at the peak of the crisis. “I still can’t stop dreaming about it – well, more like nightmares.”

泽维尔先生说:“我挖掘坟墓已有16年了,但从未见过类似的事情。”他在危机的高峰期一天内埋葬了近100人。 “我仍然不能停止回想,好吧,更像是噩梦。”

Gravedigger Ulisses Xavier buried upwards of 100 people in a single day at Parque Tarumã cemetery

挖墓人泽维尔在ParumTarumã公墓一天内掩埋了100多人

Manaus, home to some 2.2 million people, suffered one of the most devastating outbreaks in the world. On the banks of the Negro River, the city was once an epicentre of the slave-driven rubber trade – then nicknamed “Paris of the Tropics”. 

拥有约220万人的城市玛瑙斯遭受了世界上最严重的暴发的城市之一。在内格罗河河畔,这座城市曾经是奴隶主导的橡胶贸易的中心,后来被人亲切的称为“热带巴黎”。

Today its shabby colonial buildings are a reminder of the disparities the city was built on, divisions that only worsened Covid’s sting.

如今,其破旧的殖民时期建筑提醒着这座城市所建立的差距,这些分歧只会加剧科维德的刺痛感。

By some estimates, two thirds of the population here contracted the disease. And while the city is a fraction of the size of London, its infection rate is four times higher – 2,445 cases per 100,000 people, compared to 615 in the capital.

据估计,这里三分之二的人口感染了这种疾病。尽管这座城市仅是伦敦的一小部分,但其感染率却高出四倍,即每10万人中有2445例,而首都则为615例。

According to data from Amazonas state government, there have been 54,292 cases and 2,662 fatalities in Manaus. But because testing remains limited and cases are often listed as “respiratory disease” rather than Covid-19, experts estimate that there have actually been five times more infections and twice as many deaths.

根据亚马逊州政府的数据,马瑙斯已有54292例病例和2662例死亡。但是由于测试仍然很有限,而且病例通常被列为“呼吸系统疾病”而不是Covid-19,因此专家估计实际上感染人数是五倍,死亡人数是两倍。

“Crowded Manaus hospital lives chaos with lack of respirators and people on the floor”, said one local newspaper headline in late March, cataloguing the crisis. “Manaus has burials in collective ditches”, another lamented in mid April, shortly followed by “Manaus has stock of coffins for just another five days.” 

3月下旬,当地一家报纸的头条对危机进行了分类,他说:“拥挤的马瑙斯医院生活混乱,缺少呼吸器和人员。” “玛瑙斯在集体沟渠中埋葬了坟墓”,又在4月中旬感叹,“玛瑙斯又有五天的棺材库存了。”

A week later Correio Braziliense reported that a video circulating on social media appeared to show patients in one hospital ward lying next to the dead bodies of at least 10 suspected Covid victims. 

一周后,巴西邮件报道说,社交媒体上播放的视频似乎显示一个医院病房中的病人躺在至少10名疑似Covid受害者的尸体旁边。

“Manaus was taken by surprise,” says the city’s Archbishop, Leonardo Steiner, sitting in his residence in the center of town. “There was this denial of the disease, [the government] just said ‘no it doesn’t exist’... Certainly we would have seen fewer deaths had the approach been different.”

“马瑙斯令人大吃一惊,”该市的大主教莱昂纳多·史坦纳坐在他位于市中心的住所中说道。 “对这种疾病的否认,(政府)只是说'不,它不存在'...当然,如果采取不同的方法,我们将会看到更少的死亡。”

Archbishop Leonardo Steiner of Manaus said Manaus was taken by surprise

马瑙斯大主教莱昂纳多·史坦纳说,马瑙斯令人大吃一惊

Researcher Lucas Ferrante said people believed they would be protected from an outbreak

研究员卢卡斯·费兰特说人们相信他们会受到保护以免受疾病爆发

Like so many of the world’s most intense outbreaks, the viral storm here followed a party. In late February, as the first 1,000 infections were confirmed outside China, the city was engulfed in carnival – the Brazilian festival to mark the beginning of Lent.

就像世界上许多最激烈的爆发事件一样,这里的一场病毒风暴也随之而来。 2月下旬,随着在中国境外确认的前1000例感染,同时这座城市被狂欢节所吞噬,这是巴西庆祝大斋节开始的节日。

Just as those skiing in Europe’s soaring Alps felt invulnerable, there was a sense that Manaus would be excluded from the scenes unfolding in faraway places like Wuhan, Iran and Italy.

就像那些在欧洲高耸的阿尔卑斯山滑雪的人感到无敌一样,给人一种感觉,马瑙斯将不会受武汉,伊朗和意大利等遥远的地方的影响。

“People here thought that the climate and the isolated geography would prevent an outbreak,” says Lucas Ferrante, a researcher at the National Institute for Research in Amazonia (INPA). “Even though we saw what was happening around the world, we took too long to take decisions and respond to the threat.”

“这里的人们认为,气候和孤立的地理环境可以防止疫情爆发,”亚马逊国家研究所的研究员卢卡斯·费兰特说。 “即使我们看到了全世界正在发生的事情,我们仍然花了很长时间才做出决定并应对威胁。”

And so the virus – still thought to be thousands of miles away – was the last thing on anyone’s mind as they danced in the streets and crammed into bars, sipping caipirinhas and cold beers as the samba bands played.

因此,当人们在大街上跳舞并挤入酒吧,听着桑巴乐队演奏喝冰镇啤酒时,人们仍认为这种病毒在数千英里之外,仍然不在意它。

Three weeks later, on March 13, the Amazonas government detected the state’s first Covid-19 case in Manaus – a 39-year-old woman with a recent travel history to London. The authorities insisted that they were well prepared, with a contingency plan already in place to “contain flu-like syndromes”.

三个星期后,即3月13日,亚马逊州政府在马瑙斯发现了该州的第一起Covid-19案,一名最近曾到伦敦旅行的39岁妇女。当局坚持认为,他们已经做好了充分的准备,已经制定了“遏制流感样综合症”的应急计划。

On March 16 schools were closed, followed by bars and restaurants five days later. But it was already too late; over the following weeks, growing numbers of people arrived at health clinics and hospitals complaining of a cough and fever.

3月16日,学校被关闭,五天后酒吧和餐馆也被关闭。但是已经为时已晚。在接下来的几周里,越来越多的人因咳嗽和发烧而来到卫生所和医院。

Patients in the ICU ward at Delphina Aziz hospital

德尔菲娜·阿齐兹医院ICU病房的患者

Alessandra Said, a doctor with the federal ambulance service, SAMU

SAMU联邦救护车服务部的医生亚历山德罗·赛义德

A Covid patient is discharged from hospital

一名Covid患者出院

By early April the disease had a firm hold in deprived districts and crowded markets where social distancing was implausible, as well as in the indigenous communities long sidelined by the state.

到4月初,该病已牢牢地占据贫困地区和拥挤的市场中,那里的社会隔离是不合理的,长期处于国家边缘的土著社区中也是如此。

The hospital system was on the verge of collapse with ICU occupancy surpassing 100 per cent, while ambulances were forced to leave stretchers and oxygen canisters at the emergency room alongside their patients as resources grew increasingly scarce.

医院系统正处于崩溃的边缘,ICU占用率超过100%,而随着资源越来越稀缺,救护车被迫将担架和氧气罐与病人一起留在急诊室。

“Our state is no longer an emergency, it is a calamity,” Manaus’s Mayor, Arthur Virgílio, said frankly at the end of the month, by which point excess deaths stood at 815 – a 325 per cent increase compared to the same week last year.

马瑙斯市市长亚瑟·维吉利奥坦率地说:“我们的州不再是紧急情况,这是一场灾难。”到本月底,超额死亡人数为815,与上一年同一周相比增长了325%。

“All day long we were listening to the sound of ambulance sirens and funeral cars,” says Samela Sateré Mawé, who lives with her extended family in a series of narrow buildings in one of the city's poorest districts. “Two of our neighbours, on either side of us, died from Covid and we could barely isolate. It was terrifying.”

“我们整天都在听救护车警报器和丧葬车的声音,”萨梅拉·萨特雷·莫维说,她和她的大家庭一起住在城市最贫困地区之一的一系列狭窄建筑中。 “我们的左右两个邻居都死于Covid,我们几乎无法隔离。太恐怖了。”

The scale of the outbreak in Manaus has attracted the interest of epidemiologists around the world. What made the city so vulnerable? Why did the virus spread so fast? Because the first wave was so explosive, might the city have conferred some protection?

玛瑙斯爆发的规模吸引了全世界流行病学家的兴趣。是什么让这座城市如此脆弱?为什么病毒传播如此之快?由于第一波爆炸性很强,该城市是否可以授予一些保护?

Standing in the glaringly white corridors of the Delphina Aziz hospital – the referral centre for Covid-19 cases in Manaus – the state’s assistant secretary for health, Dr Thales Schincariol, insists that the government “did nothing wrong”.

该州卫生部长助理泰利斯·辛卡洛尔站在德尔菲娜·阿齐兹医院的刺眼的白色走廊上(马瑙斯Covid-19病例的转诊中心)坚持政府“没有做错任何事”。

Most authorities across the globe struggled to contain the virus, he says. But in the Amazonas high rates of comorbidities, including diabetes and hypertension, made infections more severe – it’s no coincidence that all four patients in this wing of the hospital’s ICU are obese, Dr Schincariol notes.

他说,全球大多数当局都在努力遏制该病毒。但是在亚马逊州,并发症(包括糖尿病和高血压)的高发病率使感染更加严重,Schincariol博士指出,医院重症监护病房的所有四名患者都肥胖,这并非巧合。

He adds that much of the population ignored social distancing rules and regulations mandating face masks. This is in part because many here are Jair Bolsonaro supporters – the country’s President has repeatedly downplayed Covid-19 as “little flu”.

他补充说,许多人忽视了强制使用口罩的社会隔离法规。部分原因是这里的许多人都是贾尔·博尔索纳罗的支持者,该国总统一再认为Covid-19是“小流感”。

Dr Alessandro Said transports a Covid patient to hospital

亚历山德罗·赛义德博士将一名Covid患者运送到医院

But the pandemic was also exacerbated by existing disparities; isolating at home was a luxury for the wealthy. For large inter-generational families living together in cramped houses in the poorest districts, social distancing was an almost impossible feat.

但是,现有的差距也加剧了这一流行病。对富人来说,在家隔离是一种奢侈。对于生活在最贫困地区狭小的房屋中的大批跨代家庭而言,社会隔离几乎是不可能的事情。

Infection control was also a challenge. Just 12 per cent of people in Manaus have access to sewage collection, according to the Brazil Institute, while 10 per cent (some 228,000 people) do not have running water.

控制感染也是一个挑战。根据巴西研究所的数据,马瑙斯只有12%的人可以使用污水收集系统,而10%的人(约22.8万人)没有自来水。

Add to that list an already stretched healthcare system and you have a “perfect storm”, says Mr Ferrante. While Brazil has an average of 2.1 doctors per 1,000 people, this drops to 1.2 in Amazonas, where there are just 919 ICU beds for four million people.

费兰特先生说,在该列表中添加一个已经扩展的医疗系统,将遇到“完全的风暴”。虽然巴西平均每千人有2.1名医生,但在亚马孙州下降到1.2名,那里有919张ICU病床,可容纳400万人。

“Even before Covid the biggest hospital was around 80 per cent full,” says Dr Alessandra Said, a doctor with the federal ambulance service, SAMU. “On a busy Saturday night, when there was lots of drinking or accidents, the emergency room would hit 90 to 95 per cent occupancy.

“甚至在Covid之前,最大的医院就已经有80%满了,”联邦救护车服务SAMU的医生亚历山德拉·赛义德博士说。 “在繁忙的星期六晚上,当发生大量饮酒或事故时,急诊室的使用率将达到90%至95%。

“So if we are already that full without a pandemic – imagine how it is with Covid,” she adds. “Even within three to five days of it arriving, hospitals were full.”

她补充说:“因此,如果我们已经没有流感大流行了,那就想象一下Covid的情况如何。” “即使在到达后三到五天内,医院也已满员。”

According to the Archbishop, decades of opportunism are to blame for inadequate resources. “Brazil probably has one of the most complete health systems in the world,” he says, referring to the country's public healthcare system, Sistema Único de Saúde, which was inspired by the UK’s NHS.

根据大主教的说法,数十年的机会主义应归咎于资源不足。他说:“巴西可能拥有世界上最完善的卫生系统之一。”他指的是该国的公共卫生系统,该系统受英国NHS的启发。

“But it doesn’t work because of corruption. If people weren’t robbing the system, we would certainly have seen fewer deaths and cases in Manaus,” he adds.

“但是由于腐败,它不起作用。如果人们不抢劫该系统,那肯定会在马瑙斯看到更少的死亡和案件,”他补充说。

Parque Tarumã cemetery is a grim reminder of what can happen if Covid-19 spreads uncontrolled

塔鲁玛公园墓地令人不禁想起如果Covid-19散布时不受控制会发生什么情况

Burials were relentless at the height of the crisis

在危机最严重的时候,埋葬是无情的

Close to 2,000 coronavirus victims are in this graveyard alone

仅这个墓地就有近2,000名冠状病毒受害者

At least 11 states in Brazil have open investigations into corruption scandals – including Amazonas. The Governor, Wilson Lima, has been accused of misusing emergency purchase powers to buy overpriced ventilators from a wine importer.

巴西至少有11个州对包括亚马逊州在内的腐败丑闻进行了公开调查。总督威尔逊·利马被指控滥用紧急购买权从葡萄酒进口商那里购买价格过高的呼吸机。

Meanwhile disjointed policies between the city and state governments have triggered confusion, not helped by a conveyor belt of health secretaries (three between April and July), the Archbishop adds.

大主教补充说,与此同时,市政府与州政府之间脱节的政策引发了混乱,而卫生秘书的输送带(4月至7月之间有3个)没有帮助。

The authorities have also been accused of neglecting indigenous communities. In Parque das Tribos, an informal settlement on the outskirts of Manaus home to some 450 families from 35 ethnic groups, Joilson Karapana estimates that 60 to 70 per cent of residents had Covid symptoms.

还被指控当局忽视了土著社区。乔尔森·卡拉帕纳估计,在马瑙斯郊区的非正式定居点部落公园居住着来自35个种族的大约450个家庭,据估计有60%至70%的居民患有Covid症状。

Joilson himself lost his father and his closest friend – Messias Kokama, the cacique, or chief of the community. “It hurts,” he says, sat in the school room attached to his small home. “I can’t express how much it hurts. Sometimes it feels impossible to overcome.”

乔伊尔森本人失去了父亲和他的亲密朋友凯西,凯西是这个酋长和社区的负责人。 “很痛,”他坐在小房子旁的教室里说。 “我无法表达这种伤害有多严重。有时感觉无法克服。”

Yet, in spite of little aid from the government, the overall death toll in Parque das Tribos was lower than it might have been. This was partly because the population is relatively young, but the community also took decisive action to stem infections.

然而,尽管政府提供的援助很少,但部落公园的总体死亡人数却比预期的要低。这部分是因为人口相对年轻,但是社区也采取了果断行动来阻止感染。

“I knew we had to look after ourselves,” says Vanda Ortega, a community nurse who led the charge against Covid. In March, she created videos about the importance of handwashing and shared them throughout the neighbourhood. She bought reusable face masks so people with symptoms wouldn’t infect others and treated those she could at their homes.

“我知道我们必须照顾好自己,”领导对Covid进行指控的社区护士万达·奥尔特加说。3月,她制作了有关洗手重要性的视频,并在整个社区中分享。她购买了可重复使用的口罩,使有症状的人不会感染他人,并可以在家里治疗。

When the conditions of patients deteriorated, it was Vanda who convinced them to go to hospital before it was too late.

当患者的病情恶化时,正是万达说服他们在为时已晚之前去医院就诊。

“I feel emotional as, looking back, it was a huge responsibility. Especially because many people here were nervous about going to hospital – I had to persuade them they weren't going there to die,” the 33-year-old says. People here believe that without her, the situation would have been far worse.

回顾过去,我感到非常激动,因为这是一项巨大的责任。尤其是因为这里的许多人都对去医院感到紧张,我不得不说服他们不会去那里送死,”这位33岁的人说。这里的人们相信,没有她,情况将会更加糟糕。

Authorities have been accused of neglecting indigenous communities

当局被指控忽视土著社区

Indigenous community leader Joilson Karapana in the school that he and his wife run

他和妻子经营的学校中的土著社区领袖乔尔森·卡拉帕纳

Along the Amazon many other indigenous communities were less fortunate, as the virus spread from Manaus to isolated towns and villages via crowded boats.

沿着亚马逊河,许多其他土著社区的不幸程度降低了,因为该病毒通过拥挤的船只从马瑙斯传播到偏僻的城镇和村庄。

According to a preprint published on MedRvix , the six Brazilian cities with the highest exposure to Covid-19 are all on the winding river, while indigenous people have been roughly six times more likely to be infected with Covid-19 than white people.

根据发表在MedRvix上的预印本,在Covid-19中接触率最高的六个巴西城市都在蜿蜒的河上,而土著人感染Covid-19的可能性大约是白人的六倍。

Some critically ill patients in these villages made it to an ICU in Manaus via boat or plane, including Marie Amorim. The frail 79 -year-old has spent 13 days in the Delphina Aziz hospital, having travelled five hours along the Amazon in a speed boat.

这些村庄中的一些重病患者包括玛丽·阿莫林坐船或飞机到达马瑙斯的ICU。这位体弱的79岁老人乘坐快艇沿着亚马逊河旅行了五个小时,在德尔菲纳·阿齐兹医院度过了13天。

But for most, accessing care was an “immense” logistical challenge due to the vast distances involved, says Gabriela Romero, a spokeswoman for Médecins Sans Frontières who spent several months working in Tefé – a riverside town some 300 miles west of Manaus.

但无国界医生组织发言人加布里埃拉·罗梅罗表示,对于大多数人来说,获得医疗服务是一个“巨大”的后勤挑战,因为无国界医生在特瑙(马瑙斯以西300英里的河边小镇)工作了几个月。

“Indigenous peoples weren’t more susceptible to Covid, but existing inequalities put them at greater risk once they did contract the disease,” she adds.

她补充说:“土著人民并不太容易患上柯维氏病,但是现有的不平等使他们一旦染上该病,便面临更大的风险。”

Yet, precisely because of the scale of the devastation unleashed across Amazonas, the state’s assistant health secretary is confident that a “second wave” is not imminent.

但是,正是由于整个亚马逊州遭受的破坏规模很大,该州的助理卫生部长对即将到来的“第二波”充满信心。

This theory is based on a study led by the University of São Paulo’s Institute of Tropical Medicine, which tested recent blood bank donations for Sars-Cov-2 antibodies.

该理论基于圣保罗大学热带医学研究所的一项研究,该研究测试了最近血库捐赠的Sars-Cov-2抗体。

Researchers found that the city had an “unusually high” infection rate – from May to August between 44 and 66 per cent of people here contracted Covid-19.

研究人员发现,该市的感染率“异常高”,从5月到8月,这里有44%至66%的人感染了Covid-19。

Vanda Ortega, a community nurse who led the charge against Covid

社区护士万达·奥尔特加领导对Covid的指控

Kathleen Ribero and Maria Alice Ribero are looking after their grandmother who is in isolation

凯瑟琳·里贝罗和玛丽亚·爱丽丝·里贝罗正在照顾自己的祖母

Boat driver Arlen Fernandes on the Rio Negro, whose business has been badly impacted by the pandemic

里昂内格罗的船司机阿伦·费尔南德斯的业务受到大流行的严重影响

According to the paper, which was published as a preprint and is yet to be peer reviewed, “herd immunity played a significant role” in declining cases in August – the virus ran out of people to infect.

该论文以预印本的形式发表,尚待同行审查。根据该报告,“畜群免疫在8月份病例下降中起着重要作用” ,该病毒耗尽了可感染的人群。

“Obviously I’m not comfortable knowing that the virus is still around, but studies suggest two thirds of the Manaus was already infected,” Dr Schincariol says. “We don’t know the exact figure for herd immunity, but because we’ve crossed the 50 per cent mark we don’t expect a second wave.

Schincariol博士说:“显然,我不知道该病毒仍在流行,但研究表明马瑙斯的三分之二已被感染。” “我们不知道畜群免疫的确切数字,但是由于我们已经超过了50%,我们预计不会再出现第二次浪潮。

“Of course we’re preparing, but we don’t have any cases of reinfections in Amazonas.”

“我们当然正在准备,但在亚马逊州没有再感染的情况。”

Yet many experts here are incredulous at what they see as yet another example of government complacency. They stress that São Paulo University’s study makes no mention that the high infection rate could prevent a resurgence and notes that immunity may only be temporary.

然而,这里的许多专家对他们认为政府自满的又一个例子感到怀疑。他们强调说,圣保罗大学的研究没有提到高感染率可以防止死灰复燃,并指出免疫力可能只是暂时的。

“Now we’re seeing complacency take place again,” says Mr Fernate. “But instead of geography and weather, we’re using herd immunity as an argument for why we don’t need to act.

Fernate先生说:“现在,我们看到自满情绪再次发生。” “但是,除了地理和天气之外,我们还使用群体免疫作为为什么我们不需要采取行动的理由。

“It’s absurd – especially when other models, like ours at INPA, estimate the infection rate was more like 20 per cent,” he adds, warning that cases are ticking slowly upwards.

他补充说:“这很荒谬,特别是当像我们INPA的其他模型估计感染率更高达20%时,”他警告说,病例数量正在缓慢上升。

On September 1 the seven-day rolling average for new infections in Amazonas state stood at 565, according to an analysis of data from Brasil.io. By October 1, this average had risen to 850.

根据Brasil.io的数据分析,9月1日,亚马逊州新感染者的7天滚动平均值为565。到10月1日,这一平均值已升至850。

While the weekly average is still well below the peak – Amazonas saw around 1,600 new cases a day in early May – there are growing signs that the health system is already straining under the renewed pressure, while the city and state government are at odds over whether to impose a new lockdown.

尽管每周的平均水平仍远低于高峰期(5月初,亚马逊州每天约有1600例新病例),但越来越多的迹象表明,卫生系统已经在新的压力下承受着压力,而市政府和州政府对于是否应施加新的锁定。

Most victims are memorialised with a simple blue cross while some graves are marked only by a mound of dirt

大多数遇难者都用一个简单的蓝色十字架纪念,而有些坟墓仅用土堆来标记

Iris Goncalves Alves, aged just 54, is the 1,950th Covid burial at the cemetery

艾丽斯·贡萨尔维斯·阿尔维斯现年54岁,是该墓地第1950个科维德墓

The red sirens wail as the ambulance darts across Manaus’s south zone, dodging vehicles and skipping traffic lights. Inside Dr Said and her colleagues, clad head to toe in bright blue PPE, fight to keep a patient’s condition constant.

救护车飞过马瑙斯南部地区时,红色的警报声嘶哑,躲避车辆并跳过红绿灯。赛义德博士和她的同事们从头到脚身穿蓝色防护服,努力保持患者的病情恒定。

The 58-year-old man is struggling to breathe – his symptoms have been worsening for a week. After he walked into a basic health clinic doctors quickly concluded that he needed intensive care.

这位58岁的男人呼吸困难,他的症状已经恶化了一周。他走进一家基本的卫生诊所后,医生很快得出结论,他需要重症监护。

But when the ambulance reaches one of Manaus’s largest hospitals, 28 DeAgosto, doctors there have already run out of the oxygen the man desperately needs.

但是当救护车到达马瑙斯最大的医院之一DeAgosto 28时,那里的医生已经用尽了这个人急需的氧气。

“It feels like we’ve been through this agony before,” says Dr Said. “Now I’m preparing my spirits to do it all again – and again and again and again...”

赛义德博士说:“感觉我们以前经历过这种痛苦。” “现在,我正在准备振作精神,一遍又一遍又一遍...”

At the graveyard, too, the work hasn’t stopped. Harsh scrapes of shovels against the ochre earth reverberate as two men in bright green protective suits unceremoniously bury yet another coronavirus victim.

在墓地,工作也没有停止。两名穿着鲜绿色防护服的男子麻木地埋葬了另一名冠状病毒受害者,坚硬的铲子不断铲着土。

Iris Goncalves Alves, aged just 54, is the 1,950th Covid casualty in this sloping site at Parque Tarumã cemetery. Fallen trees on its perimeter are a reminder that until the pandemic hit, this plot was covered in thick foliage, rather than hundreds and hundreds of graves.

艾里斯·贡萨尔维斯·阿尔维斯现年54岁,是他在塔鲁玛公园公墓的这个坡地中第1950名Covid伤亡者。周围倒下的树木提醒我们,在大流行之前,这片土地被茂密的树叶覆盖,而不是成百上千的坟墓。

While most victims are memorialised with a simple blue cross – which bunch together where the mechanical diggers excavated long trenches for mass burials – some graves are marked only by a mound of dirt. The crosses cost 80 Brazilian reals, roughly £10, and many families couldn’t afford them.

大多数遇难者都用一个简单的蓝色十字架纪念,这些十字架聚集在一起,机械挖掘者开凿了长长的土丘进行埋葬,而有些坟墓则只有一堆土。十字架的价格为80巴西雷亚尔,约合10英镑,许多家庭买不起。

Ms Alves’ relatives, however, have spared no expense. Her burial, for this is barely a funeral, is sparse; there are no comforting words from a priest, no eulogy from her children. But her engraved wooden coffin is polished, with a small perspex window so her family can see her face one final time before she disappears into the ground.

但是,阿尔维斯女士的亲戚不遗余力。她的葬礼很简单,很寥落。牧师没有安慰性的话,她的孩子们也没有颂词。但是她雕刻的木质棺材是经过抛光的,并带有一个小的有机玻璃窗口,因此她的家人可以在她消失在地面前见最后一面。

The site becomes eerily quiet as the gravediggers finish and lay down their shovels, chucking their surgical gloves to one side. The still is punctured only by birdsong and the occasional sob as the family say their final, low-key goodbyes.

当掘墓者完成并放下铲子,将手术手套戴在一侧时,变得异常安静。一家人小声说他们最后的告别时,只有鸟鸣和偶尔的抽泣声。

Mr Ulisses prays for the relative calm to remain. “In April the noise was nonstop, the work was nonstop,” he says, sweat dripping down his brow in the heat. “We can only ask God to spare us now.”

乌利塞斯先生的祈祷保持相对平静。他说:“四月的声音不停,工作不停。”他的汗水在高温中滴落在额头上。 “我们现在只能请上帝饶恕我们。”

Protect yourself and your family by learning more about Global Health Security

通过更多地了解全球卫生安全来保护自己和家人

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