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Iquitos, still reeling from a dengue fever outbreak and plagued by poverty, depends on air deliveries for medicine, equipment and oxygen to face a pandemic of the magnitude of COVID-19.
Hemmed in by a sea of jungle, plagued by dire poverty and already reeling from a dengue fever outbreak, Iquitos is now the second major Amazon city – after Manaus in Brazil – to take a brutal hit from the COVID-19 pandemic.
After the impact of the pandemic, Iquitos faces an added obstacle in efforts to contain the disease, as the largest city in the world, which cannot be reached by road; it depends on intermittent air deliveries for essential supplies of medicine, personal protective equipment, and oxygen.
"We are living in a catastrophe," Graciela Meza, executive director of the regional health office in Loreto, the vast Amazon region which surrounds the city of half a million inhabitants, said to The Guardian.
The city's main public hospital was overflowing with nearly five times the number of patients its 180 beds could hold, said Meza, who herself was also recovering from the virus.
"I've never seen anything like this in my life, or even in my dreams," said Meza, a lifelong Iquitos resident, who compared the situation to living in a disaster film.
"Most victims have died from a lack of oxygen; 90 percent have died because of lack of medical supplies," Meza added.
She had counted dozens of dead every day over the last three weeks, including two nurses and three doctors – the latest a junior doctor in his twenties.
Just how bad Loreto's COVID-19 outbreak remains unclear, but few in Iquitos doubt it exceeds the official count of 62 dead and 1,595 confirmed cases as of Wednesday.
Hundreds of critically-ill patients were seated outside in rocking chairs around the hospital grounds or, in the last few days, in three field hospitals erected in football pitches and stadiums in the city.
"There's no oxygen in the lungs of the world," Meza remarked bitterly, referring to the city's Amazon location. "That should be the headline for your story," she added.
Her tone switched to anger as she said: "We only have our dreadful authorities to blame for their corruption and decades of chronic under-investment in healthcare."
The comments reflected growing outrage at the slow response of the regional government amid allegations that private companies were profiteering from a monopoly on oxygen tanks.
The local prosecutor's office in Iquitos has announced an investigation into reports that the Loreto regional government was paying inflated prices for oxygen cylinders – including alleged purchases from a company owned by the daughter of a councilor.
In the final hours before COVID-19 claimed her life, Cecilio Sangama watched helplessly as his eldest sister Edith gasped for breath, while he was unable to purchase a cylinder costing above $1,000.
"Her body could not hold on. She needed oxygen, but we just couldn't afford it," said Sangama, 49, a municipal worker, speaking by telephone from Iquitos.
"I had promised her: 'Don't worry, sister, today I will find you a cylinder,'… but in the end, there was nothing I could do." His voice broke, and he fell silent for a few seconds. "My sister died just a few hours ago; we are trying to find a way to give her a Christian burial."
According to the medical team, much of the disaster that Iquitos is experiencing has to do with the negligence of the government that on Monday promised to bring medical supplies and oxygen as well as replenish the number of medical professionals, as more than a dozen of them infected with COVID-19 were evacuated. But these promises came too late, they claim.
"We asked for the medicine more than a month ago," Agustina Huilca, president of the local doctor's federation, said. They desperately need strong antibiotics, anti-coagulants, and anti-inflammatory drugs to treat COVID-19, she highlighted.
"[As doctors], we feel impotent, frustrated, and isolated. We feel abandoned by the government," Huilca added.
The pandemic could not have come at a worse time since Iquito was already struggling with the end of a dengue outbreak, along with an outbreak of leptospirosis. Both dengue and COVID-19 cause fevers that have complicated diagnoses. At the same time, the warm climate of the city, overcrowded living conditions, poverty, and geographical isolation are the perfect setting for an unprecedented crisis.
"I suspect that in Iquitos the situation is already out of control," Valerie Paz-Soldan, a Peruvian-American social scientist and director of Tulane Health Offices for Latin America, said.