After days suffering from shortness of breath, 49-year-old Andrelina Bizerra da Silva (the coffin holding her body pictured below) fainted suddenly.
10 Jun 2020 . Breves, Brazil. Reuters/Ueslei Marcelino
Relatives of Andrelina Bizerra da Silva carry the coffin holding her body into her home before her wake, by the Camaraipi River where she lived.
Her family, Brazilian acai berry farmers on a tributary of the Amazon River, put her in a small boat with an outboard motor and raced down the winding Acuti Pereira River to the nearest health clinic in the town of Portel.
Without tests to confirm if she had COVID-19 or sufficient facilities to treat her if she did, officials at that outpost directed them further downriver to the biggest hospital nearby, in the town of Breves.
10 Jun 2020 . Portel, Brazil. Reuters/Ueslei Marcelino
A child looks through the window as the coffin holding Bizerra da Silva.
Six hours had passed by the time they reached Breves.
Silva was already dead.
"To be honest, there are a lot of negative thoughts among us," said her nephew Felipe Costa Silva, after making the return trip with her coffin in the same boat. "How long is this going to last for? How many people are going to die?"
7 Jun 2020 . Breves, Brazil. Reuters/Ueslei Marcelino
Amadeu Amaral, 7, sails with his father along the Parauau River.
As the coronavirus outbreak in Brazil rockets past 1 million cases, more than anywhere outside the United States, the frontlines have shifted increasingly from modern hospitals in major cities to poor, remote corners of this massive 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.
6 Jun 2020 . Portel, Brazil. Reuters/Ueslei Marcelino
Healthcare workers Marilia Correa, 38, a nurse, Nizomar Monteiro, 38, a health secretary and Ademilton Valente, 34, a boat driver, walk along a bridge to access a house in the riverside community Pinheiro.
Reuters spent a week accompanying medical professionals in their battle with the pandemic near Marajo Island, which splits the Amazon in two as it approaches the Atlantic Ocean.
13 Jun 2020 . Portel, Brazil. Reuters/Ueslei Marcelino
Children sit by the entrance of their home at the riverside community Pinheiro.
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.
10 Jun 2020 . Breves, Brazil. Reuters/Ueslei Marcelino
Shirley Moraes, 39, who tested positive for COVID-19, is transferred to a hospital on an ambulance boat from Melgaco to Breves.
The coronavirus has taken root here, killing scores and infecting hundreds more, public health records show. Reuters saw that severe infections are often identified and treated late, when odds are against the patients.
Yet public health professionals put on a brave face, making house calls and ferrying patients on hours-long boat trips.
4 Jun 2020 . Melgaco, Brazil. Reuters/Ueslei Marcelino
Healthcare workers check Carmem Silva, 79, Benedeita Vieira Santos, 105, and Manuel Ferreira Santos, 96, at the riverside community Galileia where they live.
"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."
13 Jun 2020 . Portel, Brazil. Reuters/Ueslei Marcelino
Luciendro Costa, 13, whose mother tested positive for COVID-19, bathes in river Acuti Pereira, at the riverside community Menino de Deus.
Some residents live 36 hours from the town center, turning healthcare into a logistical nightmare, said Nizomar Junior, the municipal health secretary in Portel, a small town just across the river from Marajo Island.
He leads a sprawling team of medics that routinely travel hours on end, often battling unpredictable currents and fast-approaching weather fronts.
5 Jun 2020 . Portel, Brazil. Reuters/Ueslei Marcelino
Houses stand along the the river of the riverside community Santo Ezequiel Moreno.
Maria Luiza Costa, a manioc farmer, is one of those isolated residents. She and her mother had come down with headaches and flu-like symptoms, but their coronavirus cases were not confirmed until medical workers visited their home, tucked far up a tributary.
Their sickness had kept them from work. Costa said she was scraping by with a monthly subsidy of 600 reais ($116) from the federal government.
6 Jun 2020 . Portel, Brazil. Reuters/Ueslei Marcelino
Maria de Nazare 80, lies on a hammock as she is checked by Correa, at her home at the riverside community Pinheiro.
For many residents, the pandemic marks their first contact with the public health system. It is a relief for some, but can bring a gnawing anxiety as treatment means sending relatives far downriver.
7 Jun 2020 . Breves, Brazil. Reuters/Ueslei Marcelino
Assembleia de Deus, a church that sits by the Parauau River, stands in the municipality of Breves.
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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."
PHOTO EDITING MARIKA KOCHIASHVILI; Writing Gram Slattery; Text Editing Brad Haynes; LAYOUT JULIA DALRYMPLE