Abstract
The COVID-19 pandemic may indirectly impact hospitalizations for other natural causes. Belo Horizonte is a city with 2.5 million inhabitants in Brazil, one of the most hardly-hit countries by the pandemic, where local authorities monitored hospitalizations daily to guide regulatory measures. In an ecological, time-series study, we investigated how the pandemic impacted the number and severity of public hospitalizations by other natural causes in the city, during 2020. We assessed the number and proportion of intensive care unit (ICU) admissions and in-hospital deaths for all-natural causes, COVID-19, non-COVID-19 natural causes, and four disease groups: infectious, respiratory, cardiovascular, and neoplasms. Observed data from epidemiological week (EW) 9 (first diagnosis of COVID-19) to EW 48, 2020, was compared to the mean for the same EW of 2015-2019 and differences were tested by Wilcoxon rank-sum test. The five-week moving averages of the studied variables in 2020 were compared to that of 2015-2019 to describe the influence of regulatory measures on the indicators. During the studied period, there was 54,722 hospitalizations by non-COVID-19 natural causes, representing a 28% decline compared to the previous five years (p<0.001). There was a concurrent significant increase in the proportion of ICU admissions and deaths. The greater reductions were simultaneous to the first social distancing decree or occurred in the peak of COVID-19 hospitalizations, suggesting different drivers. Hospitalizations by specific causes decreased significantly, with greater increase in ICU admissions and deaths for infectious, cardiovascular, and respiratory diseases than for neoplasms. While the first reduction may have resulted from avoidance of contact with healthcare facilities, the second reduction may represent competing causes for hospital beds with COVID-19 after reopening of activities. Health policies must include protocols to address hospitalizations by other causes during this or future pandemics, and a plan to face the rebound effect for elective deferred procedures.
Highlights
The coronavirus disease 2019 (COVID-19) pandemic had direct and indirect impacts on health systems, with previous reports of hospitalizations declines in many countries, such as the US, Italy, and Denmark [1,2,3]
We examined by epidemiological weeks (EW) the following variables: number of hospitalizations, number and percent of hospitalizations resulting in intensive care unit (ICU) admissions, or deaths, for all natural causes, COVID-19, and non-COVID-19
The indirect impact of the COVID-19 pandemic in hospitalizations in Belo Horizonte during 2020 follows the same trend already described in other countries and Brazilian cities [1,2,3, 5, 6] there was a reduction in hospital admissions by non-COVID-19 natural causes, when compared to the 5 previous years, which did not return to baseline levels until the end of 2020
Summary
The coronavirus disease 2019 (COVID-19) pandemic had direct and indirect impacts on health systems, with previous reports of hospitalizations declines in many countries, such as the US, Italy, and Denmark [1,2,3]. Brazil has been one of the most hardly-hit countries by the pandemic with more than 500,000 deaths reported by the end of June, 2021 [4], as well as reductions in hospitalizations by other non-COVID-19 natural causes [5, 6]. Little is known about the changes in the profile of hospitalizations by natural non-COVID causes, including use of intensive care units (ICU) and in-hospital mortality, during the pandemic in low- and middle-income countries (LMIC) and an increase in the number of deaths at home attended by the Mobile Emergency Medical Service in Belo Horizonte has been observed [7]. A decline in hospital admission by urgent conditions, such as acute coronary syndromes and stroke have been reported [10], what may have led to excess mortality by these causes [11]
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