RIO DE JANEIRO (AP) — There has been a renewed surge of COVID-19 in Brazil with the spread of the omicron variant and, as elsewhere in the world, it is largely a pandemic of the unvaccinated.

Brazil confirmed an average 162,000 cases in the week through Jan. 26, up from a 20-month low of some 3,000 in late December, according to Our World in Data, an online research site. Deaths have climbed to an average 370 per day, five times higher than early this month, but down sharply from last year.

“We see that the people who are being hospitalized are those who either weren’t vaccinated or didn’t finish the three doses, who have comorbidities,” Dr. Rafaela Ribeiro told The Associated Press inside the intensive-care unit of her hospital in Marica, in Rio de Janeiro’s metropolitan region. “This time the medical team is more prepared. In the beginning, we didn’t really know how to deal with it. It was chaos.”

While cities like Rio moved quickly to vaccinate their populations — 98% of adults have had two shots or the single Jannsen shot — other areas of the country are lagging.

States in the northern region, home to the vast Amazon rainforest, are among those with the nation’s lowest vaccination rates, according to the confederation of state health secretariats. In Amazonas state, the number of new infections last week surged to the most since the pandemic’s start in 2020, and more than double the level registered last year when its health system collapsed. While hospitalizations for severe respiratory distress and deaths have ticked upwards in recent weeks, both remain far below levels seen one year ago.

Following a delay in rollout of its vaccination campaign, Brazil has since caught up with many countries and surpassed others. According to Our World in Data, 70% of Brazilians have received both shots, versus 63% in the U.S. Only 40 million people – in a country of 214 million – have received booster shots, according to government data.

Over the weekend, Health Minister Marcelo Queiroga was in Amazonas’ capital, Manaus, to promote the vaccination effort. And on Wednesday night, back in capital Brasilia, he said Brazil’s hospitals are stronger than last year, when the COVID-19 death toll surpassed 4,000 per day, and again stressed the need for vaccines.

“It’s fundamental that we increase coverage of the second dose. There are still states where that coverage isn’t so broad as in bigger (more populous) states,” Queiroga told reporters, adding that he encourages children and adolescents to receive their shots.

But Brazil’s government has delivered mixed messages about vaccines. President Jair Bolsonaro is an outspoken skeptic who refuses to be vaccinated himself, opposed immunization of children and has warned of potential side effects. Tens of millions of doses have been administered to children around the world and serious side effects have been rare, plus risks are lower than that of serious disease from COVID-19.

The health ministry included children aged 5 to 11 in its vaccination plan on Jan. 6. Yet a technical note from the ministry on Jan. 20 contained a table claiming vaccines hadn’t been demonstrated to be either safe or effective in treating COVID-19 — and that anti-malarial hydroxycholorquine had. Broad testing has long since shown it isn’t effective against COVID-19.

The ministry retracted the technical note following outcry from health experts, and issued a new one without the table.

Although this wave of COVID-19 isn’t causing the same level of severe illness or death, concern about the jump in cases has led local leaders to cancel or postpone upcoming Carnival festivities, including the world-famous parade in Rio de Janeiro that was pushed to April.

The increase of hospitalizations also led the health ministry this week to maintain funding for additional COVID-19 intensive care beds for another month, the ministry said in a statement.

Of those hospitalized in Rio de Janeiro state, 88% haven’t completed their vaccination program, according to the press office of the state’s health secretariat.

Hospitals’ infirmaries are facing greatest demand at the moment, and no longer their intensive-care units as occurred last year, according to Alberto Chebabo, the vice-president of the Brazilian society of infectious disease specialists.

“The majority of the severe cases are among the elderly, especially the elderly who haven’t completed a vaccination program,” Chebabo said in a video call. “The chance of hospitalization for someone elderly with incomplete vaccination is 17 times greater than for elderly people with two doses or three doses.” ___

AP videojournalists Mario Lobão, Lucas Dumphreys and Diarlei Rodrigues contributed from Marica.