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The spread of COVID-19 in Brazil overwhelmed health systems in all regions of the country, especially in areas where they were already fragile. This resulted from a joint effort by 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 results published in The Lancet Respiratory Medicine show that a large percentage of COVID-19 patients hospitalized in Brazil required intensive care and respiratory support, and many did not survive.

The COVID-19 pandemic has put a tremendous strain on healthcare systems around the world as the demand for healthcare professionals and the need for intensive care beds and respiratory support such as ventilators have increased. However, the death rate among confirmed cases varied widely across countries, in large part due to differences in the capacity and preparedness of their health systems.

“So far, there is very limited data on the mortality of patients hospitalized with COVID-19 or how health systems have dealt with the pandemic in low- and middle-income countries,” said Otavio Ranzani, ISGlobal researcher and first author of the study. Brazil, for example, is a country with a higher middle income and a unified health system for 210 million people. However, the country’s unique health system has been undermined by the recent economic and political crises and there is great heterogeneity between the different regions of the country.

Ranzani and colleagues used data from a nationwide surveillance system to assess the characteristics of the first 250,000 patients hospitalized with COVID-19 in Brazil, whether they needed critical care or respiratory support, and how many of them died. They also analyzed the impact of COVID-19 on health care resources and hospital mortality in the five major regions of the country.

The analysis shows that almost half (47%) of the 254,288 patients hospitalized with COVID-19 were under 60 years of age. The in-hospital mortality rate was high (38%), increasing to 60% for those admitted to the intensive care unit and 80% for those receiving mechanical ventilation. Although COVID-19 overwhelmed health systems in all five regions, hospital admissions and mortality rates were significantly higher at the start of the pandemic in the North and Northeast regions (for example, 31% of patients under 60 died in hospitals in the Northeast versus 15% in the South ).

“These regional differences in mortality reflect differences in access to better health care that existed before the pandemic,” explains Fernando Bozza, study coordinator and researcher at the National Institute for Infectious Diseases. “This means that COVID-19 disproportionately affects not only the most vulnerable patients but also the most vulnerable health systems,” he adds. “The Brazilian health system is one of the largest in the world providing free care for all and has a solid tradition of monitoring infectious diseases. However, COVID-19 has overwhelmed the system’s capacity,” says Ranzani.

The authors conclude that the high mortality observed in hospitals underscores the need to improve the structure and organization of the health system, especially in low and middle income countries. This means increasing the resources available – from equipment and supplies to intensive care beds to trained health workers.

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More information:
Ranzani OT, Bastos LSL, Gelli JGM et al. Characterizing the First 250,000 Hospital Admissions for COVID-19 in Brazil: A Retrospective Analysis of Nationwide Data. Lancet Resp Med. Jan 2021, DOI: 10.1016 / S2213-2600 (20) 30560-9 Provided by the Barcelona Institute for Global Health

Quote: The COVID-19 pandemic in Brazil has overwhelmed their health systems (2021 January 15) and was discovered on January 15, 2021 by health.html

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