Juana Portugal (INI/Fiocruz)
Analyzing the characteristics of patients hospitalized due to Covid-19 in Brazil and examining the impact of the disease in the use of resources and in hospital mortality were the goals of the study that assessed the first 250 thousand hospitalizations due to Covid-19 in Brazil, between February 16 and August 15, 2020. “The work has two great contributions to give: documenting the effect of the epidemic on the Brazilian population and on the country’s health system, and showing the importance of having a fair, inclusive and equitable health system, especially for the most vulnerable populations”, explains Fernando Bozza, chief of the INI’s Laboratory of Clinical Research on Intensive Medicine. The results were published today, January 15, on The Lancet Respiratory Medicine.
The study made a retrospective analysis of hospitalizations of patients over 20 years old with Covid-19 confirmed by RT-PCR and recorded in the Influenza Surveillance Information System (Sivep-Gripe), the country’s national surveillance system. Researchers compared the regional rate of hospitalizations, stratified by age, admission into intensive care units (ICUs) and use of respiratory support.
During the period under study, Siveg-Gripe was notified of 254,288 patients who were hospitalized with Covid-19 confirmed by RT-PCR. The average age of the patients was 60 years; 119,657 patients (47%) were younger than 60 and 143,521 (56%) were male. The rate of hospitalizations was higher in the North and North-East regions, where there are fewer hospital beds and ICU beds available per capita, when compared with the South and South-East regions. In the North-East, 16% of patients required invasive mechanical ventilation and were ventilated outside of the ICU, when compared with 8% in the South region. Hospital mortality in patients below 60 years of age was 31% in the North-East and 15% in the South. “The regional differences of intra-hospital mortality observed in this study were consistent with regional inequalities regarding access to good-quality healthcare before the pandemic, indicating that the Covid-19 affects in a disproportionate manner not only those people who are more vulnerable, but also health systems that are less robust”, the researcher stated.
Bozza also emphasized that hospital mortality figures are very high, especially when compared with other countries with older populations. “Most countries with low- and medium-income have little or no information integrated to the national surveillance system, which normally makes it possible to identify the characteristics or outcomes of hospitalizations due to Covid-19 and the impact of the pandemic on the national health services. In Brazil, we can analyze these data because we have the Unified Health System, which integrates the health system and health surveillance”, he said.
The research group that developed the study also relies on the participation of professionals of the University of São Paulo (USP), Catholic University of Rio de Janeiro (PUC-RJ), D’Or Institute of Research and Teaching (Idor), and the Barcelona Institute for Global Health (ISGlobal). The research was funded by the National Council for Scientific and Technological Development (CNPq), the Coordination for the Improvement of Higher Education Personnel (Capes), the Carlos Chagas Filho Foundation for Research in the State of Rio de Janeiro (Faperj) and Instituto de Salud Carlos III.