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When the health system first collapsed in the Amazonian city of Manaus, Brazil, and COVID-19 victims were buried in mass graves, the mayor sent a desperate appeal to then-President Donald Trump and other world leaders.

“We are doing our best, but I tell you, it’s still very little in [the] face of the oncoming barbarism” said Arthur Virgílio Neto in a video message. “We cannot be silent. We need all possible help.”

Government human rights workers in municipalities around Amazonas say 30 lives were lost in six days because of a lack of oxygen or the inability to transfer patients. They have begun legal action to try to force state authorities to come up with an emergency plan.

The forest is huge. Communications are poor. Real numbers are likely higher.

“The president always gives excuses”

The chaos in the Amazon is adding to the pressure on Bolsonaro, who now faces a backlash over Brazil’s bungled national vaccination program, his record of scoffing at the virus and his baseless insistence that the anti-malarial drug hydroxychloroquine is effective against COVID-19.

He is using Brazilian Air Force planes to deliver emergency oxygen supplies. The Brazilian Defense Ministry says it made 45 flights in the week after the oxygen crisis began, carrying more than 2,600 cylinders to Manaus and also a dozen oxygen generators. Some of these supplies will be delivered by river barge to communities around the forest.

This will not absolve him from what the medical community views as his deeply negligent response to the pandemic in Brazil, which has so far recorded more than 214,000 COVID-19 deaths, more than any other nation except the U.S.

“The president always gives excuses: ‘It was the mayor’s fault. It was the governor’s fault.’ It was because they were not using chloroquine,” says Dr. Marcus Vinícius Lacerda, an infectious disease specialist at the Dr. Heitor Vieira Dourado Tropical Medicine Foundation in Manaus. “He always has a good excuse to explain why people are dying.”

Bolsonaro has “no clue” about COVID-19, Lacerda says. “People around him repeat whatever he says,” he adds, “it is the craziest thing I’ve ever seen.”

Lacerda is one of the 240,000 people who have so far caught the coronavirus in Manaus and the surrounding state. He is now recovering.

So is the city’s former mayor. Virgílio spent one month in the hospital. He is now back home — wondering what his message would be to world leaders in the face of the pandemic’s second lethal wave, ripping through his city.

“I wouldn’t know how to live if I was responsible for these deaths that are so cruel and nasty,” he said, in a message to NPR this week.

- A word from our sposor -

Coronavirus Crisis Gets ‘Even Worse’ In Brazilian Amazon City Of Manaus