How many more? Under‐reporting of the COVID‐19 deaths in Brazil in 2020

Kupek, Emil

doi:10.1111/tmi.13628

Cited by 45 publications

(35 citation statements)

References 35 publications

(44 reference statements)

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“…Data from our study suggest the occurrence of underreporting of COVID-19 deaths, as described in other articles 6,7,20,21 . In several Brazilian states, there was an increase in mortality rate from ill-defined causes.…”

Section: Discussionsupporting

confidence: 82%

Excess Deaths From All Causes and by Covid-19 in Brazil in 2020

Santos

Souza

Carvalho

et al. 2021

Preprint

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Objective: To estimate the 2020 all-cause and COVID-19 excess mortality according to sex, age, race/color, and state, and to compare mortality rates by selected causes with that of the five previous years in Brazil. Methods: Data from the Mortality Information System were used. Expected deaths for 2020 were estimated from 2015 to 2019 data using a negative binomial log-linear model. Results: Excess deaths in Brazil in 2020 amounted to 13.7%, and the ratio of excess deaths to COVID-19 deaths was 0.90. Reductions in deaths from cardiovascular diseases (CVD), respiratory diseases, and external causes, and an increase in ill-defined causes were all noted. Excess deaths were also found to be heterogeneous, being higher in the Northern, Center-Western, and Northeastern states. In some states, the number of COVID-19 deaths was lower than that of excess deaths, whereas the opposite occurred in others. Moreover, excess deaths were higher in men, in those aged 20 to 59, and in black, yellow, or indigenous individuals. Meanwhile, excess mortality was lower in women, individuals aged 80 years or older, and in whites. Additionally, deaths among those aged 0 to 19 were 7.2% lower than expected, with reduction in mortality from respiratory diseases and external causes. There was also a drop in mortality due to external causes in men and in those aged 20 to 39 years. Furthermore, reductions in deaths from CVD and neoplasms were noted in some states and groups. Conclusion: There is evidence of underreporting of COVID-19 deaths and of the possible impact of restrictive measures in the reduction of deaths from external causes and respiratory diseases. The impacts of COVID-19 on mortality were heterogeneous among the states and groups, revealing that regional, demographic, socioeconomic, and racial differences expose individuals in distinct ways to the risk of death from both COVID-19 and other causes. Keywords: COVID-19, mortality, cause of death

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Section: Discussionsupporting

confidence: 82%

Excess Deaths From All Causes and by Covid-19 in Brazil in 2020

Santos

Souza

Carvalho

et al. 2021

Preprint

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“…Data until May 2020 indicated a positive association between higher per-capita income and molecular COVID-19 diagnosis, while the severe acute respiratory infection cases with unknown etiology were associated with lower per-capita income, suggesting a possible diagnosis bias related to economic status (de Souza et al, 2020). Inadequate diagnosis availability may lead to underreporting (Kupek, 2021). Our data estimated underreporting rates up to 20 times.…”

Section: Discussionmentioning

confidence: 70%

Seroprevalence, Prevalence, and Genomic Surveillance: Monitoring the Initial Phases of the SARS-CoV-2 Pandemic in Betim, Brazil

et al. 2022

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The COVID-19 pandemic has created an unprecedented need for epidemiological monitoring using diverse strategies. We conducted a project combining prevalence, seroprevalence, and genomic surveillance approaches to describe the initial pandemic stages in Betim City, Brazil. We collected 3239 subjects in a population-based age-, sex- and neighborhood-stratified, household, prospective; cross-sectional study divided into three surveys 21 days apart sampling the same geographical area. In the first survey, overall prevalence (participants positive in serological or molecular tests) reached 0.46% (90% CI 0.12–0.80%), followed by 2.69% (90% CI 1.88–3.49%) in the second survey and 6.67% (90% CI 5.42–7.92%) in the third. The underreporting reached 11, 19.6, and 20.4 times in each survey. We observed increased odds to test positive in females compared to males (OR 1.88 95% CI 1.25–2.82), while the single best predictor for positivity was ageusia/anosmia (OR 8.12, 95% CI 4.72–13.98). Thirty-five SARS-CoV-2 genomes were sequenced, of which 18 were classified as lineage B.1.1.28, while 17 were B.1.1.33. Multiple independent viral introductions were observed. Integration of multiple epidemiological strategies was able to adequately describe COVID-19 dispersion in the city. Presented results have helped local government authorities to guide pandemic management.

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“…For example, early in the pandemic, before tests were widely available, many deaths due to COVID-19 among older individuals in high-income countries, particularly in long-term care facilities, are unlikely to have been attributed to COVID-19, 2 with evidence of extensive underreporting in many locations. [3][4][5][6] Second, country systems for registering deaths vary in their quality and comprehensiveness, as well as in the definitions used for increase in observed mortality from excessive heat during the pandemic. Third, we used an ensemble of six models to predict the expected mortality rate in the absence of COVID-19.…”

Section: Introductionmentioning

confidence: 99%