First and Second COVID-19 Waves in Brazil: A Cross-Sectional Study of Patients’ Characteristics Related to In-Hospital Mortality

Abstract

Background: The second wave of the COVID-19 pandemic was more aggressive in Brazil compared to other countries around the globe. Considering the Brazilian peculiarities, we analyze the in-hospital mortality concerning socio-epidemiological characteristics of patients and the health system of all states during the first and second waves of COVID-19. Methods: We performed a cross-sectional study of hospitalized patients with positive RT-PCR for SARS-CoV-2 in Brazil. Data was obtained from the Influenza Epidemiological Surveillance Information System (SIVEP-Gripe) and comprised the period from February 25, 2020, to April 30, 2021, separated in two waves on November 5, 2020. We performed a descriptive study of patients analyzing socio-demographic characteristics, symptoms, comorbidities, and risk factors stratified by age. In addition, we analyzed in-hospital and intensive care unit (ICU) mortality in both waves and how it varies in each Brazilian state.Findings: Between February 25, 2020 and April 30, 2021, 678 235 patients were admitted with a positive RT-PCR for SARS-CoV-2, with 325 903 and 352 332 patients for the first and second wave, respectively. The mean age of patients was 59$.65 (IQR 48.0 - 72.0). In total, 379 817 (56.00%) patients had a risk factor or comorbidity. The most common symptoms at hospital admission were dyspnea, cough, and oxygen saturation Interpretation: We observed a more significant burden on the Brazilian hospital system throughout the second wave. Furthermore, a greater number of hospital beds was not able to reduce mortality, and the north and northeast of Brazil, which present lower Human Development Indexes, concentrated the worst in-hospital mortality rates. The highest mortality rates are also shown among vulnerable social groups. Finally, we believe that the results can help to understand the behavior of the COVID-19 pandemic in Brazil, helping to define public policies, allocate resources, and improve strategies for vaccination of priority groups.Funding Information: The authors would like to thank the Coordinating Agency for Advanced Training of Graduate Personnel (CAPES) (C.F. 001) and the National Council for Scientific and Technological Development (CNPq) (No. 309537/2020-7).Declaration of Interests: We declare no competing interests.Ethics Approval Statement: Following ethically agreed principles on open data, this analysis did not require ethical approval in Brazil.