Study shows increase in deaths out of hospitals in Rio de Janeiro

Deaths in the city of Rio de Janeiro have increased by 64% in ths months of April and May 2020, when compared to the average in this same period in the last 3 years. In addition, a detailed analysis of the records shows a disturbing figure: deaths out of hospitals (both in health units, clinics, and other basic healthcare venues and at home) have practically doubled. This may be an indicator that, early in the epidemic, the city’s hospital network was not able to take in all patients - not only Covid-19 patients, but patients with other severe conditions as well. The conclusions are part of the Technical Note of the MonitoraCovid-19 Unassisted Deaths in Rio de Janeiro. Analysis of Excess mortality and impact of Covid-19, produced by researchers of the Institute of Scientific and Technological Communication and Information in Health (Icict/Fiocruz). The data analyzed come from the Mortality Information System (SIM). 

The analysis of the death records has provided another disturbing fact: there has been a marked increase in the number of death records at health units and at home due to tumors, nutritional and metabolical endocrinological diseases (diabetes, for instance), of the nervous system, and of the digestive, circulatory, and genito-urinary tract (genitals and urinary organs), among others not directly related to Covid-19. Together, these figures suggest that the collapse of the health system in its entirety, and not only hospitals, may have taken place as early as April and May in the city of Rio de Janeiro. “Some of these deaths might have been prevented with more effective basic healthcare, which involves health agents in the territory, testing suspect cases in health centers, and triage of serious cases in the emergency units”, comments Christovam Barcellos, vice-director of Icict/Fiocruz, geographer and public health researcher. 

According to the study, in April and May 2020 the city of Rio de Janeiro had about 7,450 deaths above the historical average (2017-2019) in the same period of the year, a 64% increase. Of this total of excess deaths, about 75% were recorded as caused by Covid-19.  Other deaths may have occurred due to lack of assistance to patients with chronic diseases, who found the public health network already overloaded due to Covid-19 cases.

Deaths out of hospitals showed a marked increase: 110% in health units and 95% at home. Crossing causes of death and the places where they took place, some numbers rocketed. For instance, deaths by infectious and parasitic diseases (which include Covid-19) grew 785% in health units (not including hospitals) and 598% at home. The overall number of people who died at home due to nutritional and metabolical endocrinological diseases (including diabetes) more than doubled in April and May this year: they grew by 109%. The same increase (109%) was observed in deaths idue to respiratory diseases as recorded in health units out of hospitals in the period under analysis.

The researchers were also surprised by the high number of deaths without diagnosis. In April and May 2020, one thousand extra deaths with ill-defined cause (no definitive diagnosis) were recorded, when compared to the previous years. According to Icict epidemiologist Diego Xavier, who was also in the study, “This highlights failures in epidemiological surveillance procedures and in proper healthcare to chronic patients and to suspected Covid-19 cases”. 

The Technical Note issued by Icict/Fiocruz also states: “We have observed a migration of deaths, which previously took place in hospitals, but in April and May 2020 became more frequent at home. This is the case of cancer cases, metabolic diseases (predominantly diabetes), nervous system diseases (with a prevalence of Alzheimer’s), and cardiovascular and genito-urinary tract diaseases (with countless cases of renal failure), making up a scenario of severe lack of assistance in those two months, and which may remain as the epidemic continues. Most of these diseases are of a chronic nature, and death can be considered preventable through prevention actions and basic healthcare”.

According to Christovam Barcellos, in order to discover the causes of these atypical figures it would be necessary to carry out a more detailed epidemiological investigation. “We are clearly facing figures that indicate a lack of public health assistance in the beginning of the epidemic in the city of Rio de Janeiro, perhaps even a collapse of the hospital system. I believe that many of the people who died at home or at emergency health units may have had difficulty being treated in hospitals. It should be noted that it has been widely emphasized that the in the past three years the city’s public health network has suffered loss of personnel and of venues. If this is true, this may have contributed to the compromise of hospital service at the peak of the Covid-19 epidemic”, says Barcellos.