COVID-19 Mortality in Public Hospitals in a Brazilian State: An Analysis of the Three Waves of the Pandemic

Abstract

Objective: To analyze COVID-19 deaths in public hospitals in a Brazilian state, stratified by the three waves of the pandemic, and to test their association with socio-clinical variables. Methods: Observational analytical study, where 5436 deaths by COVID-19 occurred in hospitals of the public network of Espírito Santo, between 1 April 2020, and 31 August 2021, stratified by the three waves of the pandemic, were analyzed. For the bivariate analyses, the Pearson’s chi-square, Fisher’s Exact or Friedman’s tests were performed depending on the Gaussian or non-Gaussian distribution of the data. For the relationship between time from diagnosis to death in each wave, quantile regression was used, and multinomial regression for multiple analyses. Results: The mean time between diagnosis and death was 18.5 days in the first wave, 20.5 days in the second wave, and 21.4 days in the third wave. In the first wave, deaths in public hospitals were associated with the following variables: immunodeficiency, obesity, neoplasia, and origin. In the second wave, deaths were associated with education, O2 saturation < 95%, chronic neurological disease, and origin. In the third wave, deaths were associated with race/color, education, difficulty breathing, nasal or conjunctival congestion, irritability or confusion, adynamia or weakness, chronic cardiovascular disease, neoplasms, and diabetes mellitus. Origin was associated with the outcome in the three waves of the pandemic, in the same way that education was in the second and third waves (p < 0.05). Conclusion: The time interval between diagnosis and death can be impacted by several factors, such as: plasticity of the health system, improved clinical management of patients, and the start of vaccination at the end of January 2021, which covered the age group with the higher incidence of deaths. The deaths occurring in public hospitals were associated with socio-clinical characteristics.

Completeness and quality of information about death from COVID-19 in a Brazilian state: A descriptive population-based register study

“…[ 39 ] It is noteworthy that there are still few publications that aim to evaluate the data of death notification by COVID-19 in the country, which makes it difficult to compare information with other notifying states. [ 40 , 41 ]…”

“…It is important to be concerned about the asymptomatic public since they may have viral load similar to that of symptomatic patients. The “comorbidities” variable is of interest for the health sector to pay attention to the probability of the patient developing more severe forms of the disease, [ 40 ] because if he or she has any specific morbidity, he or she can be classified in risk groups.…”

Clinical Characterization of the Three Waves of COVID-19 Occurring in Southern Italy: Results of a Multicenter Cohort Study

“…Different were the results of Bociąga-Jasik et al [ 19 ] showing in Poland an in-hospital death rate of 10.4% ( n = 91/875), 19.8% ( n = 503/2545), and 20.3% ( n = 359/1771) for waves 1, 2, and 3, respectively ( p < 0.001), probably because in Poland during the first wave all patients with SARS-CoV-2 infection were supervised by the epidemiological services and their hospitalization was mandatory; so many patients hospitalized during the first pandemic wave were admitted in a good general condition. Then, a Brazilian cohort showed that the mean time between diagnosis and death was 18.5 days in the first wave, 20.5 days in the second wave, and 21.4 days in the third [ 20 ]. Another study performed in Lombardy, Italy [ 21 ] showed that mortality was significantly higher during the 1st wave than in the following periods (24.2% v.s.…”

Acute COVID-19 Management in Heart Failure Patients: A Specific Setting Requiring Detailed Inpatient and Outpatient Hospital Care

“…In the same country, hospitalization during the second wave and third wave was associated with a reduced risk of COVID-19 death in comparison with the first wave; the prevalence of patients with heart disease at admission was 48.5%, 58.1%, and 58.4%, respectively, for each wave; nevertheless, there was no difference in survival probability in patients aged >75 years [ 24 ]. In a Brazilian population, chronic cardiovascular disease was more prevalent in the first and second waves of COVID-19 deaths; nevertheless, deaths were more frequently associated with chronic cardiovascular disease in the third wave, maybe related to sicker patients with advanced cardiovascular disease [ 25 ]. Similar results were found in three Canadian provinces, where the total burden of cardiovascular disease was higher during the first and second waves, with a significant reduction in total mortality and the need for invasive mechanical ventilation, vasopressors, and renal replacement therapy in patients with HF during the third wave [ 26 ].…”