A man cries over his mother's grave in the Nossa Senhora Aparecida cemetery, in Manaus, Amazonas, Brazil, on Sept. 29, 2020. Iris Gonçalves Alves died at age 54 the previous day from COVID-19, according to the information on her burial record. During the worst times of the pandemic in Manaus, only three relatives could attend a burial in its cemeteries.

A man cries over his mother's grave in the Nossa Senhora Aparecida cemetery, in Manaus, Amazonas, Brazil, on Sept. 29, 2020. Iris Gonçalves Alves died at age 54 the previous day from COVID-19, according to the information on her burial record. During the worst times of the pandemic in Manaus, only three relatives could attend a burial in its cemeteries. / Raphael Alves

Brazilian photographer Raphael Alves has been covering the COVID-19 pandemic in his home state of Amazonas since their first lockdown in March 2020.

Through his photography, Alves highlights how the lockdown intensified some of the socioeconomic inequality of the largest state in Brazil.

Alves' project is called Insulae. It reflects on the idea that isolation is not just a consequence of the pandemic. There is another isolation, different from what the World Health Organization recommends: ideological isolation — which goes far beyond the geographical, one that peoples of the Amazon have historically lived with.

Health workers carry a 10-year-old patient in serious condition with COVID-19 from a flight organized by Amazonas state's aerial intensive care unit. The patient was transferred from Santo Antônio do Içá more than 500 miles to Eduardo Gomes Airport in Manaus, Brazil, on May 22, 2020.

Health workers carry a 10-year-old patient in serious condition with COVID-19 from a flight organized by Amazonas state's aerial intensive care unit. The patient was transferred from Santo Antônio do Içá more than 500 miles to Eduardo Gomes Airport in Manaus, Brazil, on May 22, 2020. / Raphael Alves

Before the pandemic, Amazonas state already had a lack of health services in rural areas, a lack of water and a minimally qualified sanitation system. The great distances between municipalities became an even bigger obstacle when the coronavirus swept through.

During the pandemic, separated families were unable to live their grief. Native peoples and their cultures were under constant threat. People were dying at their homes without any chances of fighting the disease. Victims of the disease huddled in cold rooms in hospitals and people were collectively buried in trenches.

The pandemic exasperated all these preexisting issues.

Boho Sofia, 67, an Indigenous woman of the Kanamari people, is a COVID-19 patient receiving care at the infirmary of the Municipal Field Hospital Gilberto Novaes, in northern Manaus, on June 2, 2020. The health unit, which had more than 140 beds, was deactivated even though cases were still rising in Manaus.

Boho Sofia, 67, an Indigenous woman of the Kanamari people, is a COVID-19 patient receiving care at the infirmary of the Municipal Field Hospital Gilberto Novaes, in northern Manaus, on June 2, 2020. The health unit, which had more than 140 beds, was deactivated even though cases were still rising in Manaus. / Raphael Alves

It is a region that has always been forgotten, largely on the sidelines of the issues surrounding the country. A state whose only land connection is an unfinished highway, but which may fuel the greatest danger to the Amazon — deforestation.

Here is what Alves captured.

A health team from the municipality of Iranduba, Amazonas, Brazil, navigates the waters of the Rio Negro, taking doses of the COVID-19 vaccine to riverside communities in the region, on April 15, 2021. Iranduba was one of the municipalities that suffered the most from the pandemic in Amazonas.

A health team from the municipality of Iranduba, Amazonas, Brazil, navigates the waters of the Rio Negro, taking doses of the COVID-19 vaccine to riverside communities in the region, on April 15, 2021. Iranduba was one of the municipalities that suffered the most from the pandemic in Amazonas. / Raphael Alves

A truck driver waits for men and machines from the National Department of Transport Infrastructure to work on a bridge over the Tocantins creek, located on the portion of the highway known as the <em>trecho do meio</em> (

A truck driver waits for men and machines from the National Department of Transport Infrastructure to work on a bridge over the Tocantins creek, located on the portion of the highway known as the trecho do meio ("middle section"), in the rural region of the municipality of Beruri, Amazonas, Brazil, on Oct. 19, 2021. / Raphael Alves

Relatives of coronavirus patients wait for hours since early in the morning to refill their oxygen cylinders at Carboxi, a company that sells oxygen, in Manaus, on Jan. 19, 2021. Manaus, the largest city in the Brazilian Amazon, suffered from a lack of medical oxygen during the second COVID-19 wave in early 2021 in Amazonas.

Relatives of coronavirus patients wait for hours since early in the morning to refill their oxygen cylinders at Carboxi, a company that sells oxygen, in Manaus, on Jan. 19, 2021. Manaus, the largest city in the Brazilian Amazon, suffered from a lack of medical oxygen during the second COVID-19 wave in early 2021 in Amazonas. / Raphael Alves

Alessandra Said, a 45-year-old doctor, assists her own mother, Maria da Consolação Said, 77, who has COVID-19 and also cancer, at her home in Manaus, on May 2, 2020. After finding out her mother was sick with COVID-19, the doctor asked for authorization to personally check her mother's health.

Alessandra Said, a 45-year-old doctor, assists her own mother, Maria da Consolação Said, 77, who has COVID-19 and also cancer, at her home in Manaus, on May 2, 2020. After finding out her mother was sick with COVID-19, the doctor asked for authorization to personally check her mother's health. / Raphael Alves

A coffin for someone who died from COVID-19 sits, with lunch still on the table next to it, inside the only room of a house in the poor neighborhood of Colonia Oliveira Machado, in southern Manaus, on May 7, 2020. Workers with a municipal social welfare program, SOS Funeral, later took away the coffin.

A coffin for someone who died from COVID-19 sits, with lunch still on the table next to it, inside the only room of a house in the poor neighborhood of Colonia Oliveira Machado, in southern Manaus, on May 7, 2020. Workers with a municipal social welfare program, SOS Funeral, later took away the coffin. / Raphael Alves

Nursing technician Vanda Ortega, 33, from the Witoto people, and the university nursing student Francineldo (right), 45, from the Kokama people, walk in the Parque das Tribos (Park of Tribes), the only Indigenous neighborhood in Manaus, looking for people with symptoms and explaining safety measures against COVID-19, on Feb. 11, 2021.

Nursing technician Vanda Ortega, 33, from the Witoto people, and the university nursing student Francineldo (right), 45, from the Kokama people, walk in the Parque das Tribos (Park of Tribes), the only Indigenous neighborhood in Manaus, looking for people with symptoms and explaining safety measures against COVID-19, on Feb. 11, 2021. / Raphael Alves

A nursing technician administers doses of COVID-19 vaccine to residents of São Sebastião da Serra Baixa, a rural community located in Iranduba, Amazonas, Brazil, on April 15, 2021. In the second wave of the disease, the city had a curfew to avoid an increase in cases.

A nursing technician administers doses of COVID-19 vaccine to residents of São Sebastião da Serra Baixa, a rural community located in Iranduba, Amazonas, Brazil, on April 15, 2021. In the second wave of the disease, the city had a curfew to avoid an increase in cases. / Raphael Alves

A city punished by COVID-19, Manaus, capital of Brazil's Amazonas state, hosts a trial run for public events during the pandemic, on Sept. 25, 2021. More than 2,000 people attended the musical show, but very few wore face masks.

A city punished by COVID-19, Manaus, capital of Brazil's Amazonas state, hosts a trial run for public events during the pandemic, on Sept. 25, 2021. More than 2,000 people attended the musical show, but very few wore face masks. / Raphael Alves

A student has her lunch served at the Instituto de Educação public school in Manaus, on Aug. 13, 2020. Manaus was still experiencing the first wave of the disease when about 110,000 students returned to school.

A student has her lunch served at the Instituto de Educação public school in Manaus, on Aug. 13, 2020. Manaus was still experiencing the first wave of the disease when about 110,000 students returned to school. / Raphael Alves

A woman wears a face mask, recommended by the World Health Organization to prevent the spread of the coronavirus, at an amusement park ride in Manaus, on Dec. 9, 2020. Health experts say the reopening of public activities at the end of 2020 helped lead to a new peak in COVID-19 infection in the largest city in the Brazilian Amazon in early 2021.

A woman wears a face mask, recommended by the World Health Organization to prevent the spread of the coronavirus, at an amusement park ride in Manaus, on Dec. 9, 2020. Health experts say the reopening of public activities at the end of 2020 helped lead to a new peak in COVID-19 infection in the largest city in the Brazilian Amazon in early 2021. / Raphael Alves

People attend a special session of court in the Palácio da Justiça cultural center in Manaus, on Aug. 24, 2021. Despite the event, most activities of the judiciary in Brazil's largest state only returned to 100% in person in November 2021.

People attend a special session of court in the Palácio da Justiça cultural center in Manaus, on Aug. 24, 2021. Despite the event, most activities of the judiciary in Brazil's largest state only returned to 100% in person in November 2021. / Raphael Alves

Cattle graze on deforested land on highway BR-319, in the rural area of Humaitá, Amazonas, Brazil, on Oct. 20, 2021. Located on the highway between the states of Amazonas and Rondonia, Humaitá is known for its environmental conflicts, with illegal land grabbers, farmers, ranchers, loggers and miners.

Cattle graze on deforested land on highway BR-319, in the rural area of Humaitá, Amazonas, Brazil, on Oct. 20, 2021. Located on the highway between the states of Amazonas and Rondonia, Humaitá is known for its environmental conflicts, with illegal land grabbers, farmers, ranchers, loggers and miners. / Raphael Alves

A health worker, carrying a cooler containing COVID-19 vaccine doses, traverses a green area in the rural community of São Sebastião da Serra Baixa, in Iranduba, Amazonas, Brazil, on April 15, 2021, in search of people who are not yet vaccinated.

A health worker, carrying a cooler containing COVID-19 vaccine doses, traverses a green area in the rural community of São Sebastião da Serra Baixa, in Iranduba, Amazonas, Brazil, on April 15, 2021, in search of people who are not yet vaccinated. / Raphael Alves

Nurse Taylline Bastos, 25, coordinator of the National Immunization Program in the municipality of Anama, about 100 miles from Manaus, administers a dose of the AstraZeneca vaccine, on May 27, 2021. People in the Vila do Cuinha community went to their vaccination appointment by boat, as they were dealing with major river flooding in Anama.

Nurse Taylline Bastos, 25, coordinator of the National Immunization Program in the municipality of Anama, about 100 miles from Manaus, administers a dose of the AstraZeneca vaccine, on May 27, 2021. People in the Vila do Cuinha community went to their vaccination appointment by boat, as they were dealing with major river flooding in Anama. / Raphael Alves

A worker with the municipal health department's death certificates office visits a residence to take a coronavirus test of the body of a man who died at home, in Manaus, on Jan. 15, 2021. Manaus collapsed during the pandemic: The number of dead in homes grew, and families lined up for a certificate that allowed them to bury their relatives.

A worker with the municipal health department's death certificates office visits a residence to take a coronavirus test of the body of a man who died at home, in Manaus, on Jan. 15, 2021. Manaus collapsed during the pandemic: The number of dead in homes grew, and families lined up for a certificate that allowed them to bury their relatives. / Raphael Alves

Dr. Alessandra Said, 45, puts on protective clothing at the Mobile Emergency Care Service in southern Manaus, before starting the last 12 hours of a shift that would last 36 hours in total, on May 2, 2020.

Dr. Alessandra Said, 45, puts on protective clothing at the Mobile Emergency Care Service in southern Manaus, before starting the last 12 hours of a shift that would last 36 hours in total, on May 2, 2020. / Raphael Alves

The shadow of a person attending a funeral for someone who died from COVID-19 is cast on a collective grave, while an undertaker works to close the grave under harsh sun in the Nossa Senhora Aparecida cemetery, in western Manaus, on June 5, 2020.

The shadow of a person attending a funeral for someone who died from COVID-19 is cast on a collective grave, while an undertaker works to close the grave under harsh sun in the Nossa Senhora Aparecida cemetery, in western Manaus, on June 5, 2020. / Raphael Alves

Priests get ready for the celebration of the Immaculate Conception, on Dec. 8, 2020, in Manaus. The celebration was marked by prayers for a better year, hopes for the continuation of health measures to prevent COVID-19 and memories of people who died during the pandemic.

Priests get ready for the celebration of the Immaculate Conception, on Dec. 8, 2020, in Manaus. The celebration was marked by prayers for a better year, hopes for the continuation of health measures to prevent COVID-19 and memories of people who died during the pandemic. / Raphael Alves

Gravediggers on a motorcycle pass a crowd entering the Nossa Senhora Aparecida Cemetery, as they carry crosses for the Day of Dead in Manaus, on Nov. 2, 2021. The cemetery was designated for mass grave burials during the first coronavirus outbreak the year before. Cemeteries closed when the first cases were reported in the city.

Gravediggers on a motorcycle pass a crowd entering the Nossa Senhora Aparecida Cemetery, as they carry crosses for the Day of Dead in Manaus, on Nov. 2, 2021. The cemetery was designated for mass grave burials during the first coronavirus outbreak the year before. Cemeteries closed when the first cases were reported in the city. / Raphael Alves

Raphael Alves is a photojournalist based in Manaus, state of Amazonas, Brazil. His project Insulae was photographed with the help of the 2021 Getty Images Editorial Grant. Follow him on Instagram @photoraphaelalves.

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Tags: Amazonas  COVID 19  Manaus  Coronavirus in Brazil  coronavirus pandemic  COVID-19  pandemic  amazon rainforest  Brazil  Series: The Coronavirus Crisis