Bodies are piling up in refrigerated trucks outside overwhelmed hospitals. Doctors are in short supply. Bulldozers are digging mass graves at cemeteries. And the worst of the pandemic is yet to come.
Welcome to Manaus, the now chaotic and desperate riverside capital of vast Amazonas state as it grapples with the highest coronavirus mortality rate of any such city in Brazil.
The daily death rate here has shot up from 20 or 30 pre-pandemic to 100 a day in a matter of weeks after the city recorded its first case on March 13. And an already weak health care system has simply collapsed.
The pandemic has also reached extremely vulnerable indigenous communities in a state so huge it can take days of travel by boat to reach outlying towns and villages.
"It is a scene out of a horror movie. We are no longer in a state of emergency but rather of absolute calamity," Manaus Mayor Virgilio Neto told AFP by telephone.
"People are dying at home, some perhaps because they got no medical care," Neto said. He fears these are coronavirus deaths.
Amazonas is the fifth hardest hit in Brazil by the pandemic, with 2,479 cases and 207 reported deaths as of Tuesday. But Manaus, with a population of 1.7 million, has the highest mortality rate of any of Brazil's 27 state capitals.
President Jair Bolsonaro may have initially downplayed the danger of the virus, as did his political ally US President Donald Trump, but now this giant of a country has more cases of infection and deaths than any other in Latin America: more than 45,000 and more than 2,900, respectively.
Public health experts say the figures could actually be a staggering 15 times higher in reality, because of scant COVID-19 testing.
Hospitals in Manaus are struggling to cope with the rising number of cases. Some have set up refrigerators inside trucks to store bodies.
Outside the Delphina Rinaldi Abdel Aziz Hospital, Rita Alencar is waiting for someone -- anyone -- to tell her if she can collect the remains of her grandmother.
"No one has come to give me an answer as to whether I can take her away and bury her. She did not die of COVID-19," Alencar said.
At a cemetery called Parque Taruma, crews are digging gashes in the earth to make mass graves for coronavirus victims. On orders from the mayor, no more than five relatives can gather to say a quick goodbye.
"We are working hard to bury people. We have had gravediggers fall ill with coronavirus. Some will not make it," said the mayor, who has asked the Bolsonaro government for more resources to tackle the crisis.
"This is a really, really tough fight," said Neto.
Video clips on social media show hearses lining up to get into the cemetery.
- A collapsed health care system-
Local authorities have built a field hospital and the federal government has summoned doctors from around the country to help out in Manaus.
But these measures are too little, too late, as the city accounts for all of the intensive care units in Amazonas and 80 percent of its specialized doctors, said Bernardo Albuquerque, an infectious disease expert at Amazonas Federal University.
The pandemic is expected to peak here starting in May but 90 percent of the city's beds in intensive care units are already occupied. Personal protective equipment for health care workers is in short supply, as are medicine and equipment like X-ray machines and other kinds of scanners.
"The system is truly centralized in the capital," Albuquerque told AFP.
So people in the rest of the state's 61 municipalities, some of them days away by boat, have to come to Manaus for medical treatment.
Only 18 of them are connected to Manaus by roads. The rest only have access by river or plane, said Albuquerque.
And a patient arriving in Manaus from out of town confronts "a deplorable situation or has no guarantee of getting adequate medical are. It is a dramatic situation," said the mayor.
- Concern over indigenous people -
The news gets worse.
Amazonas has more indigenous people than any other state in Brazil, and they are vulnerable to diseases brought in from outside because their immune systems have not been exposed to them. Historically, they have been devastated by viruses they cannot cope with.
So far three indigenous people are known to have died of COVID-19 and 15 of 31 infected with the virus are being treated in Manaus.
The Health Ministry said earlier this month it feared a public health catastrophe in Amazonas.
The health expert Albuquerque said the state needs help yesterday.
"If we could snap our fingers and say, 'let's have it all ready tomorrow,' that would be the ideal timeframe," he said.
© 2020 AFP