The distribution of COVID-19 in Brazil, health systems have overwhelmed all regions of the country, especially in areas where they were already fragile, according to a collaborative effort involving the Barcelona Institute for Global Health (ISGlobal), an institution supported by the “la Caixa Foundation, the University of Sao Paulo, the Catholic University of Rio de Janeiro, the D’Or Institute for Research and Education and the Oswaldo Cruz Foundation. The findings, published in The Lancet respiratory medicine, reveals that a large percentage of COVID-19 patients hospitalized in Brazil require intensive care and respiratory support, and many have not survived.
The COVID-19 pandemic has made healthcare systems around the world extremely strong by increasing the demand for healthcare workers and the need for beds in intensive care units and respiratory support such as ventilators. However, the mortality rate among confirmed cases varies greatly between countries and this is largely due to differences in the capacity and readiness of their health systems.
“To date, there is very limited data on the mortality rate of patients admitted to hospital with COVID-19, or on how health systems can cope with the pandemic in low- and middle-income countries,” explains Otavio Ranzani, IS Global researcher and first author of the study. Brazil, for example, is a country with a higher middle income with a unified health system for its 210 million inhabitants. However, the country’s unique health system has been undermined by recent economic and political crises, and there is great heterogeneity in different regions of the country.
Ranzani and his colleagues used data from a nationwide surveillance system to evaluate the characteristics of the first 250,000 patients admitted to the hospital with COVID-19 in Brazil, whether they needed intensive care or respiratory support, and how many of them died . They also analyzed the impact of COVID-19 on health care resources and hospital deaths in the five major regions of the country.
The analysis shows that almost half (47%) of the 254,288 patients admitted to the hospital with COVID-19 were younger than 60. The death rate in the hospital was high (38%) and increased to 60% among those admitted to the intensive care unit and up to 80% for those who were mechanically ventilated. Although COVID-19 overwhelmed the health care system in all five regions, hospital admissions and mortality rates were significantly higher in the North and Northeast regions at the onset of the pandemic (for example, 31% of patients under the age of 60 die in hospitals in the Northeast versus 15% in the South).
“These regional differences in mortality reflect the differences in access to better health care that already existed before the pandemic,” explains Fernando Bozza, study coordinator and researcher at the National Institute of Infectious Disease. “This means that COVID-19 affects not only the most vulnerable patients excessively, but also the most fragile health systems,” he adds. ‘Brazil’s healthcare system is one of the largest around the world offering free care to all and has a good tradition in the control of infectious diseases. However, COVID-19 has overwhelmed the capacity of the system, ”says Ranzani.
The authors conclude that the high mortality rate observed in hospitals underscores the need to improve the structure and organization of the health system, especially in low- and middle-income countries. This implies an increase in the resources available – from equipment and consumables to ICU beds and trained medical staff.
Reference: “Characterization of the first 250,000 hospital admissions for COVID-19 in Brazil: a retrospective analysis of nationwide data” by Ranzani OT, Bastos LSL, Gelli JGM et al., January 15, 2021, Lancet respiratory medicine.
DOI: 10.1016 / S2213-2600 (20) 30560-9