Running against Time: COVID-19 in the Central Amazon

On April 15^th 2020, a 15-year old boy from the Yanomami tribe in the Brazilian Amazon became the first known person to die from COVID-19 among the indigenous people in the country.

Home to more than 180,000 indigenous people, Amazonas is the Brazilian state with the largest indigenous population. Manaus, the capital of the state, is now one of the hardest hit by the COVID-19 pandemic. In Brazil,  the indigenous Health Care Subsystem (SasiSUS) is decentralized, consisting of 34 Special Indigenous Sanitary Districts (DSEI, 2020) based on the geographical occupation of the indigenous communities, not state boundaries. Early contingency plans like the one for DSEI Yanomami assigned risk communication to agents including teachers, tuxauas (chiefs), and shamans, with the aim of them relaying the information to their people. Leaders are responsible for monitoring the entry of people in cordoned areas.  In order to respect the autonomy of isolated people, monitoring posts in the cordoned area await contact from indigenous people for assistance or to report respiratory cases.

Despite these measures, COVID-19 cases are rising in indigenous territories. Official figures from SESAI show that 258 indigenous people tested positive and 19 have died (saudeindigena.net, 2020). However, as these numbers only account for cases in rural areas, the actual number may be higher. The Articulation of Indigenous Peoples of Brazil (APIB), estimated the actual deaths to be reported as high as 77 as of 11^th May (quarentenaindigena.info, 2020). Thousands of indigenous people residing in cities who are testing positive are reportedly being registered as non-indigenous people (amazoniareal.com, 2020).

Indigenous people are at a higher risk of death due to COVID-19 owing to several social, economic, cultural, and historic factors. In the past, contact with outsiders has had devastating effects on them (survival international, 2020). For example, illegal goldmining has left them with diseases like tuberculosis and methyl mercury poisoning (Minamata disease). Increased contact with outsiders has also built reliance on commodities that proved harmful to cultural practices, affecting their health. For example, the Katukina tribe began to suffer from malnutrition, anaemia, and vitamin deficiencies as males started to work farther from their villages to attain these commodities.  Complications arising from weakened immune systems due to malnutrition and repetitive malarial infection were cited among the reasons for the 15-year old’s inability to recover from COVID-19. As the same health problems are faced by other indigenous people, the spread of the disease could be catastrophic.

At present, illegal logging and deforestation continue to threaten increased exposure to the outside world and increase the risk of zoonotic spillover events. Illegal activities have increased during the pandemic and illegal miners are suspected to have transmitted the disease to the Yanomami and possibly other indigenous people too. Long-term exposure to wildfires owing to deforestation – which has risen by almost 51%, according to the space research agency, INPE – have also been linked to a higher death rate from COVID-19 (Friedman, 2020).

In the remote indigenous villages, where up to 400 people live in circular communal houses, transmission can be rapid. To make matters worse, treatment is hindered by limited access to health facilities. For example, São Gabriel da Cachoeira, a famous town for its waterfalls in Amazonas, can only be reached by plane or boat. Roughly 95% of its inhabitants are indigenous. The one hospital in the town has no intensive care facilities and only seven ventilators for 40,000 people.

Indigenous people in urban areas are also facing difficulties. They are among the poorest, face institutional racism that includes attempts to severe the younger generations from their indigenous roots (national geographic, 2020), work in the informal sector, and are unable to afford food while remaining at home. In order to receive the financial support from the government for informal workers (600 real or $115), they require internet access or must join long queues and wait for hours to receive aid.  Furthermore, evictions of indigenous people in cities have resulted in a growing number residing in overcrowded shelters (mongabay.com, 2020). Conditions in these areas are ideal for escalated transmission, as is the case in overcrowded housing for marginalised groups elsewhere (Hameed, 2020).

The health systems in the Amazonas state are already overwhelmed. With the challenges of existing health issues, the inability to access healthcare quickly, the risk of exposure to outsiders, and the risk of transmission from people working in urban areas to their remotely-located relatives, if the transmission of COVID-19 continues to escalate, this may spell yet another disaster for the indigenous people.

By Iman Hameed

A contributor and member of the Public Health Pathways team.

With special thanks to Ana Clara De Querioz in Brasília and Guilherme in Manaus who provided rich content to work with on the situation in Brazil.

18 May 2020

Full list of sources and references

1. CNN. 2020. “A Boy From A Remote Amazonian Tribe Has Died, Raising Concerns About Covid-19’S Impact On Indigenous People”, 2020. https://edition.cnn.com/2020/04/10/world/yanomami-amazon-coronavirus-brazil-trnd/index.html.
2. Amazonia Real. 2020. “Coronavirus: Indigenous People Living In The City Are Classified As “White” In Amazonas”, 2020. https://amazoniareal.com.br/coronavirus-indigenas-que-vivem-na-cidade-sao-classificados-como-brancos-no-amazonas/.
3. “Indigenous Health”. 2020. Saudeindigena.Net.Br. http://www.saudeindigena.net.br/coronavirus/dsei/.
4. International, Survival. 2020. “Yanomami”. Survivalinternational.Org. https://www.survivalinternational.org/tribes/yanomami.
5. “Young Yanomami Dies By Covid-19, In Roraima, Says Sesai”. 2020,, 2020. https://amazoniareal.com.br/morre-jovem-yanomami-por-covid-19-em-roraima-diz-sesai/.
6. “Amazônia Legal Brasileira – Avisos De Desmatamento”. 2020. Terrabrasilis.Dpi.Inpe.Br. http://terrabrasilis.dpi.inpe.br/app/dashboard/alerts/legal/amazon/aggregated/.
7. “New Research Links Air Pollution To Higher Coronavirus Death Rates”. 2020. https://www.nytimes.com/2020/04/07/climate/air-pollution-coronavirus-covid.html.
8. “Evicted Indigenous People In Manaus Struggle To Stay Safe Amid COVID-19 Crisis”.
9. Langlois, Jill, and Flavio Forner. “In Brazil, Indigenous People Are Fighting to Keep Their Children.” National Geographic, April 22, 2020. https://www.nationalgeographic.com/history/2020/04/in-brazil-indigenous-people-fighting-to-keep-children/.
10. 2020,. https://news.mongabay.com/2020/04/evicted-indigenous-people-in-manaus-struggle-to-stay-safe-amid-covid-19-crisis/.
11. Cov360. 2020. “Lessons From Singapore’S Pandemic Response To Marginalised Groups”. https://publichealthpathways.org2020/04/30/too-little-too-late-lessons-from-singapores-pandemic-response-to-at-risk-marginalised-groups/.
12. “How Coronavirus Is Affecting Indigenous People In The Amazon”. 2020. World Economic Forum. https://www.weforum.org/agenda/2020/04/indigenous-people-amazon-coronavirus-pandemic-covid19-support/.
13. Project Amazonia: Solutions – Indigenous Health Care (OPNAH). Accessed May 13, 2020. http://web.mit.edu/12.000/www/m2006/final/solutions/sols_ind_hlt.html.
14. “Chaotic Crowds Vying for Aid Risk Spreading Virus in Brazil …”, n.d. Accessed May 13, 2020. https://www.bloomberg.com/news/articles/2020-04-17/chaotic-crowds-vying-for-aid-risks-spreading-virus-in-brazil.
15. “Casos indígenas | Quarentena Indígena”, n.d. Accessed May 13, 2020. http://quarentenaindigena.info/casos-indigenas/.

Images

1. Berwick, D., n.d. A Yanomami Maloca. The Yanomami Live In Large, Circular, Communal Houses Called Yanos Or Shabonos. Some Can House Up To 400 People. The Central Area Is Used For Activities Such As Rituals, Feasts And Games. [image] Available at: <https://www.survivalinternational.org/tribes/yanomami> [Accessed 13 May 2020].
2. http://www.saudeindigena.net.br/coronavirus/dsei/.
3. http://www.saudeindigena.net.br/coronavirus/dsei/.