The fpm www pool has pm.max_children = 5 which is easily reached by a single page load.
This can be seen in the logs (docker logs matomo_app_1): [01-Dec-2020 19:59:29] WARNING: [pool www] server reached pm.max_children setting (5), consider raising it
The config is located in /usr/local/etc/php-fpm.d/www.conf.
The setting is pm.max_children = 5 on line 114.
I arbitrarily set it to 20 and it works fine for now.