Based on approximately 75% attack rate and low levels of daily cases and deaths, it appeared the worst was over in Manaus, Brazil, last fall (ASA Monitor 2021;85:1,6-7). Restrictions were relaxed. In December, the appearance of the Gamma (“P1”) variant resulted in cases and deaths surging to rates not previously experienced, eventually forcing another lockdown. Adapted from ASA Monitor 2021;85:1,6-7.