In Pictures

In Pictures: COVID-19 ravages Amazon river communities in Brazil

The front lines of the fight against the virus outbreak in Brazil have shifted to poor, remote corners of the country.

Relatives of Andrelina Bizerra da Silva, 49, who died on the way to a health clinic after she experienced days of suffering from shortness of breath and then fainted at her home, carry the coffin hold — Relatives of Andrelina Bizerra da Silva, 49, who died on the way to a health clinic after suffering from shortness of breath for days and then losing consciousness in her home, carry the coffin holding her body into her home before her wake. [Ueslei Marcelino/Reuters]

As the coronavirus outbreak in Brazil rockets past 1 million cases, higher than anywhere outside the US, the front lines have shifted increasingly from modern hospitals in major cities to remote, poor corners of this enormous country.

The cities of Belem and Macapa at the mouth of the Amazon River emerged as major coronavirus hotspots in April and May. The virus has since spread deep into surrounding rural areas.

In isolated settlements built on stilts along the river, most households survive on fishing and harvesting local fruits, earning just a few dollars a day. Social distancing is nearly impossible in wooden shacks built close together. Many lack phones, and it can take a day or more to reach health clinics.

The coronavirus has taken root here, killing scores and infecting hundreds more, public health records show.

Public health professionals keep making house calls and ferrying patients on hours-long boat trips.

“It’s quite complicated because of the difficulty of access,” said Alex Glaison, a medic, after treating a patient in their riverside home. “What keeps us going is getting results.”

For many residents, the pandemic marks their first contact with the public healthcare system. It is a relief for some, but can bring gnawing anxiety as treatment means sending relatives far downriver.

Andreza Lima de Cruz, 25, watched as doctors on a floating ambulance motored away with her father to the hospital in Portel after he tested positive for the coronavirus.

“We know that arriving there, there’s no certainty that he’ll come back,” Lima said. “I honestly want him to stay here. But we have to think of him as well.”

A child looks through the window as the coffin holding Andrelina Bizerra da Silva, 49, who died on the way to a health clinic after she experienced days of suffering from shortness of breath and then — A child looks through the window as the coffin holding Andrelina Bizerra da Silva rests in her home in the municipality of Portel on Marajo island. [Ueslei Marcelino/Reuters]

Dr Jorge Hernandez, 35, stands near Maria Angela, 56, who has tested positive for COVID-19, as healthcare workers carry her on a stretcher at the riverside community Menino de Deus where she lives, to — Dr Jorge Hernandez, 35, stands near Maria Angela, 56, who has tested positive for COVID-19, as healthcare workers carry her on a stretcher at the riverside community in Menino de Deus. [Ueslei Marcelino/Reuters]

Maria Angela, 56, who has tested positive for COVID-19, is transferred by Dr Jorge Hernandez, 35, and health workers from her home at the riverside community Menino de Deus, onto an ambulance boat as — Maria Angela is transferred onto an ambulance boat to be taken to hospital in the municipality of Portel. Healthcare workers continued to visit riverside communities to check on residents during the coronavirus outbreak. [Ueslei Marcelino/Reuters]

Healthcare workers walks in the riverside community Pinheiro, as they visit riverside communities to check on residents during the coronavirus disease (COVID-19) outbreak, in the municipality of Porte — Healthcare workers in the riverside community of Pinheiro to check on residents. [Ueslei Marcelino/Reuters]

Maria de Nazare 80, lies on a hammock as she is checked by Marilia Correa, 38, a nurse, at her home at the riverside community Pinheiro, as healthcare workers visit riverside communities to check on r — Maria de Nazare, 80, lies on a hammock as she is checked by a nurse in her home in the riverside community of Pinheiro. [Ueslei Marcelino/Reuters]

Men wear protective face masks as they sit outside at the riverside community Menino de Deus, as healthcare workers visit riverside communities to check on residents during the coronavirus disease (CO — Men in protective face masks sit outside their community area in Menino de Deus. [Ueslei Marcelino/Reuters]

Jorge Silva, 35, an employee who works at Terra Santa Urns Factory, which manufactures coffins, buffs the wood of a coffin, during the coronavirus disease (COVID-19) outbreak, in the municipality of B — Jorge Silva, 35, buffs a wooden coffin at Terra Santa Urns Factory in the municipality of Breves in Para state. [Ueslei Marcelino/Reuters]

Maria de Jesus, 36, sits with her children in her home at the riverside community Galileia, as she reacts to being told by healthcare workers that she has tested positive for COVID-19, as healthcare w — Maria de Jesus, 36, with her children in her home in the municipality of Melgaco on Marajo island. She is being informed by medical stuff that she has tested positive for COVID-19. [Ueslei Marcelino/Reuters]

A man experiencing severe pain and symptoms of COVID-19, walks with health workers to transfer him from his house at the riverside community Galileia, to be transferred to a hospital, during the coron — A man experiencing severe pain and symptoms of COVID-19 walks with health workers who will transfer him from his house at the riverside community of Galileia to a hospital. [Ueslei Marcelino/Reuters]

A healthcare worker checks a child in front their home at the riverside community Menino de Deus, as healthcare workers visit riverside communities to check on residents during the coronavirus disease — A healthcare worker checks on a child at the riverside community of Menino de Deus. [Ueslei Marcelino/Reuters]

Amadeu Amaral, 7, sails with his father along the Parauau River, during the coronavirus disease (COVID-19) outbreak, in the municipality of Breves, Marajo island, Para state, Brazil, June 7, 2020. REU — Amadeu Amaral, 7, sails with his father along the Parauau River in the municipality of Breves. [Ueslei Marcelino/Reuters]