Brazilian guidelines for the treatment of outpatients with suspected or confirmed COVID-19. A joint guideline of the Brazilian Association of Emergency Medicine (ABRAMEDE), Brazilian Medical Association (AMB), Brazilian Society of Angiology and Vascular Surgery (SBACV), Brazilian Society of Geriatrics and Gerontology (SBGG), Brazilian Society of Infectious Diseases (SBI), Brazilian Society of Family and Community Medicine (SBFMC), and Brazilian Thoracic Society (SBPT)

Falavigna, Maicon; Belli, Karlyse Claudino; Barbosa, Alexandre Naime; Zavascki, Alexandre Prehn; Nastri, Ana Catharina de Seixas Santos; Santana, Christiane Machado; Stein, Cinara; Gräf, Débora Dalmas; Cadegiani, Flavio; Guimarães, Hélio Penna; Monteiro, José Tadeu Colares; Ferreira, Juliana Carvalho; Azevedo, Luciano César Pontes; Magri, Marcelo Mihailenko Chaves; Sobreira, Marcone Lima; Dias, Maria Beatriz Gandra de Souza; Oliveira, Maura Salaroli de; Corradi, Mírian de Freitas Dal Ben; Rosa, Régis Goulart; Heinzelmann, Ricardo Souza; Silva, Rosemeri Maurici da; Belfort, Rubens; Cimerman, Sérgio; Colpani, Verônica; Veiga, Viviane Cordeiro; Carvalho, Carlos Roberto Ribeiro

doi:10.1016/j.bjid.2022.102347

Cited by 5 publications

(4 citation statements)

References 17 publications

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“…In Brazil, two guidelines were published for pharmacological treatment in outpatients and hospitalised patients. The Brazilian guidelines for the treatment of outpatients with suspected or con rmed COVID-19 provide ten recommendations, most of which advice against the use of the candidate technologies, contraindicating the clinical treatment of COVID-19 with anticoagulants, azithromycin, budesonide, colchicine, corticosteroids, hydroxychloroquine/chloroquine alone or combined with azithromycin, ivermectin, nitazoxanide, or convalescent plasma [50]. Using monoclonal antibodies in outpatients was impossible because of their uncertain bene ts and high costs, with availability and implementation limitations [50].…”

Section: Discussionmentioning

confidence: 99%

“…The Brazilian guidelines for the treatment of outpatients with suspected or con rmed COVID-19 provide ten recommendations, most of which advice against the use of the candidate technologies, contraindicating the clinical treatment of COVID-19 with anticoagulants, azithromycin, budesonide, colchicine, corticosteroids, hydroxychloroquine/chloroquine alone or combined with azithromycin, ivermectin, nitazoxanide, or convalescent plasma [50]. Using monoclonal antibodies in outpatients was impossible because of their uncertain bene ts and high costs, with availability and implementation limitations [50]. The Brazilian guidelines for the pharmacological treatment of hospitalised patients with COVID-19 provide 16 recommendations that include treatment with corticosteroids in patients receiving supplemental oxygen and the use of prophylactic doses of anticoagulants for venous thromboembolism.…”

Section: Discussionmentioning

confidence: 99%

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Pan-American Guidelines for the Treatment of SARS-CoV-2/COVID-19: A Joint Evidence-Based Guideline of the Brazilian Society of Infectious Diseases (SBI) and the Pan-American Association of Infectious Diseases (API)

Barbosa

Chebabo

Starling

et al. 2023

Preprint

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Background Since the beginning of the COVID-19 pandemic, therapeutic options for treating COVID-19 have been investigated at different stages of clinical manifestations. Considering the particular impact of COVID-19 in the Americas, this document aims to present recommendations for the pharmacological treatment of COVID-19 specific to this population. Method Fifteen experts, members of the Brazilian Society of Infectious Diseases (SBI) and the Pan-American Association of Infectious Diseases (API) make up the panel responsible for developing this guideline. Questions were formulated regarding prophylaxis and treatment of COVID-19 in outpatient and inpatient settings. The outcomes considered in decision-making were mortality, hospitalisation, need for mechanical ventilation, symptomatic COVID-19 episodes, and adverse events. In addition, a systematic review of randomised controlled trials was conducted. The quality of evidence assessment and guideline development process followed the GRADE system. Results Nine technologies were evaluated, and ten recommendations were made, including the use of tixagevimab + cilgavimab in the prophylaxis of COVID-19, tixagevimab + cilgavimab, molnupiravir, nirmatrelvir + ritonavir, and remdesivir in the treatment of outpatients, and remdesivir, baricitinib, and tocilizumab in the treatment of hospitalised patients with severe COVID-19. The use of hydroxychloroquine or chloroquine and ivermectin was discouraged. Conclusion This guideline provides recommendations for treating patients in the Americas following the principles of evidence-based medicine. The recommendations present a set of drugs that have proven effective in the prophylaxis and treatment of COVID-19, emphasising the strong recommendation for the use of nirmatrelvir/ritonavir in outpatients as the lack of benefit from the use of hydroxychloroquine and ivermectin.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Pan-American Guidelines for the Treatment of SARS-CoV-2/COVID-19: A Joint Evidence-Based Guideline of the Brazilian Society of Infectious Diseases (SBI) and the Pan-American Association of Infectious Diseases (API)

Barbosa

Chebabo

Starling

et al. 2023

Preprint

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“…Further, epidemic management was not in place at the national level, delegating social restrictions of physical contacts and other prevention measures to state and municipal governments [ 12 , 13 ]. The activities implemented by the Federal Government focused on minimizing COVID-19 severity, setting a strategy of disseminating fake news, and using medicines that were proven ineffective against COVID-19 [ 14 , 15 ]. Errant and contradictory messages from political agents of the Brazilian government formed a narrative that diverged and competed with guidelines and good practices based on evidence in health [ 16 , 17 ].…”

Section: Introductionmentioning

confidence: 99%

COVID-19 mortality in Brazil, 2020-21: consequences of the pandemic inadequate management

et al. 2022

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Background The COVID-19 pandemic brought countless challenges to public health and highlighted the Brazilian health system vulnerabilities in facing the emergency. In this article, we analyze data on COVID-19-related deaths in 2020-21 to show the epidemic consequences in Brazil. Methods The Mortality Information System and the Live Birth Information System were the primary information sources. We used population estimates in 2020-21 to calculate COVID-19 specific mortality rates by age, sex, and educational level. Considering the total number of COVID-19 deaths in 2020-21, the COVID-19 proportional mortality (%) was estimated for each age group and sex. A graph of the daily number of deaths from January 2020 to December 2021 by sex was elaborated to show the temporal evolution of COVID-19 deaths in Brazil. In addition, four indicators related to COVID-19 mortality were estimated: infant mortality rate (IMR); maternal mortality ratio (MMR); number and rate of orphans due to mother’s COVID-19 death; the average number of years lost. Results The overall COVID-19 mortality rate was 14.8 (/10,000). The mortality rates increase with age and show a decreasing gradient with higher schooling. The rate among illiterate people was 38.8/10,000, three times higher than a college education. Male mortality was 31% higher than female mortality. COVID-19 deaths represented 19.1% of all deaths, with the highest proportions in the age group of 40-59 years. The average number of years lost due to COVID-19 was 19 years. The MMR due to COVID-19 was 35.7 per 100,000 live births (LB), representing 37.4% of the overall MMR. Regarding the number of orphans due to COVID-19, we estimated that 40,830 children under 18 lost their mothers during the epidemic, with an orphans’ rate of 7.5/10,000 children aged 0-17 years. The IMR was 11.7 per 1000 LB, with 0.2 caused by COVID-19. The peak of COVID-19 deaths occurred in March 2021, reaching almost 4000 COVID-19 deaths per day, higher than the average number of deaths per day from all causes in 2019. Conclusions The delay in adopting public health measures necessary to control the epidemic has exacerbated the spread of the disease, resulting in several avoidable deaths.

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“…Further, the pandemic management was not in place at the national level, delegating social restriction of physical contacts and other prevention measures to state and municipal governments [11,12]. The activities implemented by the Federal Government were focused on minimizing COVID-19 severity, setting a strategy of disseminating fake news, with the guidance of using medicines that were proven ineffective against COVID-19 [13,14].…”

Section: Introductionmentioning

confidence: 99%

COVID-19 Mortality in Brazil, 2020-21: Consequences of the pandemic inadequate management

Szwarcwald

Boccolini

Almeida

et al. 2022

Preprint

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Background The COVID-19 pandemic brought countless challenges to public health and highlighted the Brazilian health system vulnerabilities to face the emergency situation. In this article, we analyze data on COVID-19-related deaths in Brazil in 2020-21 to show the tragic consequences of the pandemic on the Brazilian population. Methods The Mortality Information System and the Live Birth Information System were the main information sources. We used the population estimates in 2020-21 to calculate COVID-19 specific mortality rates by age and sex and educational level. Considering the total number of deaths in 2020-21, the COVID-19 proportional mortality (%) was estimated for each age group and sex. A graph of the daily deaths from January 2020 to December 2021 by sex was elaborated to show the temporal evolution of COVID-19 deaths in Brazil. In addition, four indicators related to COVID-19 mortality were estimated: infant mortality rate; maternal mortality ratio (MMR); number of orphans due to mother's death; average number of years lost. Results The overall COVID-19 mortality rate was 14.8 (/10,000). The mortality rates increase with age and show a decreasing gradient with higher schooling. Among illiterate people, the rate was 38.8/10,000, three times higher than those with college education. Male mortality was 31% higher than female mortality. COVID-19 deaths represented 19.1% of all deaths, with the highest proportions in the median age groups. The average number of years lost due to COVID-19 was 19 years. The MMR due to COVID-19 was 35.7 per 100,000 LB, representing 37.4% of the overall MMR. Regarding the number of orphans due to COVID-19, we estimated that 40,830 children under 18 years old lost their mothers during the pandemic, with an orphans' rate of 7.5/10,000 children aged 0–17 years. The pandemic peak occurred in March 2021, reaching almost 4,000 deaths per day, higher than the average number of deaths per day from all causes in 2019. Conclusions The COVID-19 lethality rate in Brazil was 2.2%, twice the global lethality rate. The delay in adopting public health measures necessary to control the epidemic has exacerbated the spread of the disease, resulting in several avoidable deaths.

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Cited by 5 publications

References 17 publications

Pan-American Guidelines for the Treatment of SARS-CoV-2/COVID-19: A Joint Evidence-Based Guideline of the Brazilian Society of Infectious Diseases (SBI) and the Pan-American Association of Infectious Diseases (API)

Pan-American Guidelines for the Treatment of SARS-CoV-2/COVID-19: A Joint Evidence-Based Guideline of the Brazilian Society of Infectious Diseases (SBI) and the Pan-American Association of Infectious Diseases (API)

COVID-19 mortality in Brazil, 2020-21: consequences of the pandemic inadequate management

COVID-19 Mortality in Brazil, 2020-21: Consequences of the pandemic inadequate management

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