Pope Francis hits 3-week mark of hospitalization after giving world a sign of his frailty

ROME (AP) — Pope Francis hit the three-week mark Friday in his hospitalization for double pneumonia, in stable condition, receiving therapy but not necessarily improving, after giving the world a tangible indication of just how frail and sick he is.

The 88-year-old Francis spent 20 minutes in the Gemelli hospital chapel, praying and doing some work in between rest and respiratory and physical therapy, the Vatican said. He was using high flows of supplemental oxygen to help him breathe during the day and a noninvasive mechanical ventilation mask at night.

Doctors not involved in his care said after three weeks of acute care in the hospital for double pneumonia, they would have hoped to have seen improvement and warned that he was increasingly at risk of secondary infections the longer he remains hospitalized. Additionally, Francis has had episodes of acute respiratory failure earlier this week and underwent bronchoscopies to suction mucus from his lungs.

"He’s had respiratory failure and they were not able to liberate him from the hospital in the first three weeks. And therefore I think you’d say this does look concerning, perhaps more concerning than it did right at the beginning,” said Dr. Andrew Chadwick, a respiratory and intensive care specialist at Oxford University Hospitals in England.

Dr. Jeffrey Millstein, a clinical assistant professor of internal medicine at the University of Pennsylvania, said it wasn't shocking that Francis hadn't improved in three weeks, and that it was encouraging he was able to breathe part of the day with just a nasal tube of high-flow oxygen. But he said that his condition certainly was “a precarious, touch and go kind of situation” and that recovery, while still possible, would be a long process.

Going forward, “I just would be looking for no new setbacks," he said. "I think as long as he is dealing with the current issues and he’s just making incremental progress, that would be great.”

Francis offered a first public sign of just how weak he is on Thursday by recording an audio message that was broadcast to the faithful in St. Peter’s Square who had gathered for the nightly recitation of the rosary prayer.

In it, Francis thanked the people for their prayers. But his voice was barely discernible through his labored breaths and he spoke in his native Spanish, not Italian.

“I thank you from the bottom of my heart for your prayers for my health from the square, I accompany you from here,” he said to the hushed square. “May God bless you and the Virgin protect you. Thank you.”

The messaged served many purposes. It was the first public sign of life from the pope since he entered Rome's Gemelli hospital on Feb. 14, and put to rest right-wing conspiracy theories and rumors calling into question his true medical status.

The Vatican said that Francis himself wanted to record it, to thank all those people who had been praying for him. In his Sunday message last weekend, Francis said he had felt the affection of so many people, and felt “as if I am ‘carried’ and supported by all God’s people.”

But the audio also underscored just how weak Francis is. For anyone used to hearing his voice, the message was an emotional punch to the gut that hammered home just how hard it is for him to even breathe.

The pope has chronic lung disease and had part of one lung removed as a young man.

The Vatican has given twice-daily updates on Francis’ condition, but has distributed no photos or video of him since the morning of Feb. 14, when he held a handful of audiences at the Vatican before being admitted to Gemelli hospital for what was then just a bad case of bronchitis.

The infection progressed into a complex respiratory tract infection and double pneumonia that has sidelined Francis for the longest period of his 12-year papacy and raised questions about the future of his papacy.

Maria Cheng reported from London.

Associated Press religion coverage receives support through the AP’s collaboration with The Conversation US, with funding from Lilly Endowment Inc. The AP is solely responsible for this content.

People pray for Pope Francis in front of the Agostino Gemelli Polyclinic, in Rome, Friday, March 7, 2025, where the Pontiff is hospitalised since Friday, Feb. 14. (AP Photo/Andrew Medichini)

A nun prays for Pope Francis in front of the Agostino Gemelli Polyclinic, in Rome, Friday, March 7, 2025, where the Pontiff is hospitalized since Friday, Feb. 14. (AP Photo/Andrew Medichini)

Candles for Pope Francis are seen in front of the Agostino Gemelli Polyclinic, in Rome, Friday, March 7, 2025, where the Pontiff is hospitalized since Friday, Feb. 14. (AP Photo/Andrew Medichini)

Candles for Pope Francis are seen in front of the Agostino Gemelli Polyclinic, in Rome, Friday, March 7, 2025, where the Pontiff is hospitalized since Friday, Feb. 14. (AP Photo/Andrew Medichini)

Candles for Pope Francis are seen in front of the Agostino Gemelli Polyclinic, in Rome, Friday, March 7, 2025, where the Pontiff is hospitalized since Friday, Feb. 14. (AP Photo/Andrew Medichini)

People pray for Pope Francis in front of the Agostino Gemelli Polyclinic, in Rome, Friday, March 7, 2025, where the Pontiff is hospitalized since Friday, Feb. 14. (AP Photo/Andrew Medichini)

Tourists sit near Sant'Angelo castle, background, as the sun sets in Rome, Italy, Friday, March 7, 2025. (AP Photo/Francisco Seco)

People pray for Pope Francis in front of the Agostino Gemelli Polyclinic, in Rome, Friday, March 7, 2025, where the Pontiff is hospitalized since Friday, Feb. 14. (AP Photo/Andrew Medichini)

Volunteers carry wooden crosses near St. Peter's Square in Rome, Italy, Friday, March 7, 2025. (AP Photo/Francisco Seco)

Locals and tourists walk along a main street near St. Peter's Basilica, background, as the sun sets in Rome, Italy, Friday, March 7, 2025. (AP Photo/Francisco Seco)

Catholic worshippers pray the Rosary for Pope Francis in St. Peter's Square at The Vatican, Thursday, March 6, 2025. (AP Photo/Francisco Seco)

A woman touches the statue of Pope John Paul II placed outside the Agostino Gemelli hospital in Rome, Thursday, March 6, 2025. (AP Photo/Francisco Seco)

Catholic worshippers attend a nightly rosary prayer service for Pope Francis in St. Peter's Square at the Vatican, Thursday, March 6, 2025. (AP Photo/Francisco Seco)

Catholic nuns attend a nightly rosary prayer service for Pope Francis in St. Peter's Square at the Vatican, Thursday, March 6, 2025. (AP Photo/Francisco Seco)

Catholic nuns listen to a recorded message from Pope Francis during a prayer of the Rosary for Pope Francis in St. Peter's Square at The Vatican, Thursday, March 6, 2025. (AP Photo/Francisco Seco)

A Catholic nun shows the back cover of her mobile phone with a photograph of Pope Francis as she attends a nightly rosary prayer service for Pope Francis in St. Peter's Square at the Vatican, Thursday, March 6, 2025. (AP Photo/Francisco Seco)

Catholic worshippers pray during a prayer of the Rosary for Pope Francis in St. Peter's Square at The Vatican, Thursday, March 6, 2025. (AP Photo/Francisco Seco)

CAXIUANA NATIONAL FOREST, Brazil (AP) — Deep in silence, as if under a spell, children watch intently as Bacuri, a young Amazonian manatee, glides around a small plastic pool. When he surfaces for air, some of them exchange wide smiles. The soft rustle of rainforest leaves punctuated by bird song adds to the magic of the moment.

The children from riverside communities traveled for hours by boat just to meet Bacuri at the field station of the Emilio Goeldi Museum, Brazil’s oldest research institute in the Amazon. Despite their endangered status, manatees are still hunted and their meat illegally sold, and they are increasingly threatened by climate change. Environmentalists hope that by engaging local communities, Bacuri and others like him will be spared.

The Amazonian manatee is the region’s largest mammal but is rarely seen, much less up close. The reasons for this are twofold: The manatee has acute hearing and will vanish into the murky water at the slightest sound; and its population has dwindled after being overhunted for hundreds of years, mostly for its tough hides that were exported to Europe and Central America.

To help the manatee population recover, several institutions are rescuing orphaned manatee calves, rehabilitating them and reintroducing them to the wild.

Bacuri weighed just 22 pounds (10 kilograms) — a fraction of the more than 900 pounds (400 kilograms) of an adult manatee — when he was rescued and taken to the museum's research center in the federally protected Caxiuana National Forest. He was named after the local community that found him. Two years and several thousand milk bottles later, Bacuri has grown to about 130 pounds (60 kilos).

Three institutions are responsible for his care. The Goeldi Museum provides facilities and educates nearby communities. The federal Chico Mendes Institute for Biodiversity Conservation assigns two staffers for 15-day shifts to feed Bacuri three bottles of milk a day as well as chopped beets and carrots, and clean the pool every 48 hours. The nonprofit Instituto Bicho d'Agua— meaning institute of water animals in Portuguese — oversees veterinary care, dietary planning and caregiver training.

During their visit, the children learn that female manatees are pregnant for about a year then nurse their young for two more, feeding them from nipples behind their front flippers — the manatee equivalent of armpits. This long reproductive cycle is one reason the manatee population has not recovered from the commercial hunting that persisted until the mid-20th century.

They also learn the species is endangered and that they are the ones who must protect it.

“You are the main guardians,” biologist Tatyanna Mariúcha, head of the scientific base, tells the children, who spend the rest of the day drawing and making Play-Doh models of Bacuri.

With its auditorium, dormitories, observation towers, cafeteria and laboratories, the research station — two hours by speedboat from Portel, the nearest city — stands in stark contrast to nearby communities comprising clusters of wooden houses on stilts where families rely on cassava farming, fishing and harvesting açaí berries. School field trips and community outreach aim to narrow the gap.

“Caxiuana is their home,” Mariúcha told The Associated Press. “We can’t just come here and do things without their consent.”

Local knowledge will play a key role when Bacuri is finally released. He is the only manatee calf under care at Caxiuana. Once he has fully transitioned to a plant-based diet, he’ll spend time in a river enclosure before his release. That site will be selected based on where residents say wild manatees feed and pass through.

If all goes as planned, Bacuri will be the first released in the Caxiuana area. Two other calves rescued in poor health died in captivity, a sadly common outcome.

While subsistence hunting isn’t a major threat to the species, some fishermen still sell manatee meat illegally in nearby towns. Brazil banned hunting of all wild animals in 1967, with two exceptions: Indigenous peoples are allowed to hunt, and others can kill a wild animal to satisfy the hunger of the hunter or his family.

The threat of hunters has become harder to manage due to climate change, said Miriam Marmontel, a senior researcher at the Mamirauá Institute for Sustainable Development, hundreds of miles (kilometers) upstream along the Amazon River.

Dozens of dolphins died near Mamiraua in 2023, likely due to soaring water temperatures during a historic drought. Manatees avoided mass mortality then because they typically inhabit deep pools during the dry season, but recent droughts have dramatically reduced the water level, making manatees more vulnerable to poachers.

“As climate change accelerates, manatees may begin to suffer from heat stress too,” Marmontel said. “They also have a thermal limit, and eventually it may be crossed.”

That’s why reintroduction efforts are so important.

Around 60 rescued manatees are being cared for across the state of Para, where Caxiuana is located. Bicho d’Agua is caring for four in partnership with the Federal University of Para and Brazil's environmental agency. One of the four, named Coral, was found near Óbidos and airlifted 620 miles (1,000 kilometers) to the institute's facility in Castanhal. She arrived dehydrated and with severe skin burns, likely from sun exposure.

“The population has declined so much that every hunted animal impacts the species,” Renata Emin, president of Bicho d’Agua, told AP. “That’s why any effort matters, not just because one individual may return to the wild and help rebuild the population but because of the community and government engagement it inspires.”

The Associated Press’ climate and environmental coverage receives financial support from multiple private foundations. AP is solely responsible for all content. Find AP’s standards for working with philanthropies, a list of supporters and funded coverage areas at AP.org.

Maria, a rescued manatee, swims in a pool at the Bicho d'Agua project facilities in Castanhal, Brazil, Sunday, March 23, 2025. (AP Photo/Jorge Saenz)

Coral, a rescued manatee, is fed while in a pool at the Bicho d'Agua project facilities in Castanhal, Brazil on Sunday, March 23, 2025. (AP Photo/Jorge Saenz)

Coral, a rescued manatee, swims in a pool at the Bicho d'Agua project facilities in Castanhal, Brazil, Sunday, March 23, 2025. (AP Photo/Jorge Saenz)

Coral, a rescued manatee, sleeps belly up in a pool at Bicho d'Agua project facilities in Castanhal, Brazil, Sunday, March 23, 2025. (AP Photo/Jorge Saenz)

Coral, a rescued manatee, receives healing cream from an assistant at a pool at Bicho d'Agua project facilities in Castanhal, Brazil, Sunday, March 23, 2025. (AP Photo/Jorge Saenz)

Workers clean a pool near Bacuri, a rescued manatee, at the Emilio Goeldi Museum's scientific station in Para state, Brazil, Thursday, March 20, 2025. (AP Photo/Jorge Saenz)

Children make manatee models out of Play-Doh during a trip to Emilio Goeldi Museum's scientific station in Para state, Brazil, Friday, March 21, 2025. (AP Photo/Jorge Saenz)

Bacuri, a rescued manatee, swims as children observe in the Emilio Goeldi Museum's scientific base at Caxiuana National Forest in Para state, Brazil, Friday, March 21, 2025. (AP Photo/Jorge Saenz)

A girl embraces biologist Tatyanna Mariúcha, head of the Emilio Goeldi Museum's scientific base, as children arrive at the station in the Caxiuana National Forest in Para state, Brazil, Friday, March 21, 2025. (AP Photo/Jorge Saenz)

The Curua River crosses the Caxiuana National Forest with Emilio Goeldi Museum's scientific station at bottom in Para state, Brazil, Saturday, March 22, 2025. (AP Photo/Jorge Saenz)

Children arrive at the Emilio Goeldi Museum's scientific station in the Caxiuana National Forest in Para state, Brazil, Friday, March 21, 2025. (AP Photo/Jorge Saenz)

Bacuri, a rescued manatee, breathes while swimming in a pool at the Emilio Goeldi Museum's scientific station in the Caxiuana National Forest in Para state, Brazil, Thursday, March 20, 2025. (AP Photo/Jorge Saenz)