Hospital admission and mortality rates for non-COVID-19 respiratory diseases in Brazil's public health system during the covid-19 pandemic: a nationwide observational study / Internações hospitalares e taxas de mortalidade por doenças respiratórias não COVID-19 no sistema público de saúde do Brasil durante a pandemia de COVID-19: um estudo observacional nacional

ABSTRACT Objective: To assess the influence of the COVID-19 pandemic on hospital admissions (HA), intra-hospital deaths (HD), and intra-hospital lethality rates (HL) related to respiratory diseases (RD) other than COVID-19 in Brazil. Methods: This observational time-series study was conducted through comparative analyses of the HA, HD, and HL related to non-COVID-19 RD registered between March and December 2020 by the Brazilian Unified Public Health System on the DataSUS Tabnet platform, using as reference the values recorded in the same period of 2019 and those projected by linear regression methods for 2020, considering the period from 2015 to 2019. The adopted statistical significance level was 5% (p < 0.05). Results: Compared to 2019, in 2020, there was a 42% decrease in HA and a 7.4% decrease in total HD related to non-COVID-19 RD, followed by a 60% increase in HL associated with this group of diseases. The HA and HL registered in 2020 differed significantly from the projected trend for that year by linear regression (p < 0.05). Of note, a significant reduction in hospitalizations due to asthma (-46%), chronic obstructive pulmonary disease (-45%), bronchiectasis (-54%), pneumonia (-46%), and acute bronchitis (-73%) was observed. Conclusions: During the first 8 months of the pandemic, there was a decline in HA and an increase in HL related to non-COVID-19 RD in Brazil, which can hypothetically reflect logistical challenges and delays in the management of this group of diseases.

RESUMO Objetivo: Avaliar a influência da pandemia de COVID-19 nas taxas de internações hospitalares (IH), óbitos intra-hospitalares (OH) e letalidade intra-hospitalar (LH) relacionadas a outras doenças respiratórias (DR) que não a COVID-19 no Brasil. Métodos: Este estudo observacional de série temporal foi realizado por meio da análise comparativa das IH, OH e LH relacionadas a DR não COVID-19 registradas entre março e dezembro de 2020 pelo Sistema Único de Saúde na plataforma DataSUS Tabnet, tendo como referência o valores registrados no mesmo período de 2019 e aqueles projetados pelos métodos de regressão linear para 2020, considerando o período de 2015 a 2019. O nível de significância estatística adotado foi de 5% (p < 0,05). Resultados: Comparado a 2019, em 2020, houve uma redução de 42% nas IH e de 7,4% nos OH totais relacionados a DR não COVID-19, seguido de um aumento de 60% nas taxas de LH associadas a esse grupo de doenças. As IH e as taxas de LH registradas em 2020 diferiram significantemente da tendência projetada para aquele ano por regressão linear (p < 0,05). Vale ressaltar que foi observada uma redução significativa das internações por asma (-46%), doença pulmonar obstrutiva crônica (-45%), bronquiectasia (-54%), pneumonia (-46%) e bronquite aguda (-73%). Conclusão: Durante os primeiros 8 meses da pandemia, houve um declínio nas IH e um aumento das taxas de LH relacionadas a DR não COVID-19 no Brasil, o que pode, hipoteticamente, refletir desafios logísticos e atrasos no manejo desse grupo de doenças.

The impact of government- and institution-implemented COVID-19 control measures on tertiary- and regional- level intensive care units in Pietermaritzburg, KwaZulu-Natal Province, South Africa

Background. The COVID-19 pandemic has had a significant impact on healthcare systems globally as most countries were not equipped to deal with the outbreak. To avoid complete collapse of intensive care units (ICUs) and health systems as a whole, containment measures had to be instituted. In South Africa (SA), the biggest intervention was the government-regulated national lockdown instituted in March 2020. Objective. To evaluate the effects of the implemented lockdown and institutional guidelines on the admission rate and profile of non-COVID-19 patients in a regional and tertiary level ICU in Pietermaritzburg, KwaZulu-Natal Province, SA. Methods. A retrospective analysis of all non-COVID-19 admissions to Harry Gwala and Greys hospitals was performed over an 8-month period (1 December 2019 - 31 July 2020), which included 4 months prior to lockdown implementation and 4 months post lockdown. Results. There were a total of 678 non-COVID-19 admissions over the 8-month period. The majority of the admissions were at Greys Hospital (52.4%; n=355) and the rest at Harry Gwala Hospital (47.6%; n=323). A change in spectrum of patients admitted was noted, with a significant decrease in trauma and burns admissions post lockdown implementation (from 34.2 - 24.6%; p=0.006). Conversely, there was a notable increase in non-COVID-19 medical admissions after lockdown regulations were implemented (20.1 - 31.3%; p<0.001). We hypothesized that this was due to the gap left by trauma patients in an already overburdened system. Conclusions. Despite the implementation of a national lockdown and multiple institutional directives, there was no significant decrease in the total number of non-COVID-19 admissions to ICUs. There was, however, a notable change in spectrum of patients admitted, which may reflect a bias towards trauma admissions in the pre COVID-19 era

Fracaso multiorgánico secundario a infección por coronavirus no COVID-19 / Multiple-organ failure as a result of non-COVID-19 coronavirus infection

Las infecciones por coronavirus son habituales en los pacientes pediátricos. Por lo general, producen un cuadro clínico leve de infección del tracto respiratorio superior que no suele afectar a los pulmones, salvo en prematuros y niños con enfermedades crónicas de base. Excepcionalmente, afectan a otros órganos (corazón, cerebro, tracto gastrointestinal) e incrementan su gravedad.En relación con la coincidencia temporal con el inicio de la actual pandemia por el nuevo beta coronavirus (SARS-CoV-2), responsable de su enfermedad asociada (COVID-19), se presenta el caso clínico de un paciente de 5 años con fracaso multiorgánico y secuelas neurológicas por afectación bulbar y trombosis vascular ocasionados por un alfa coronavirus (CoV-NL63) debido a su gravedad y excepcionalidad

Coronavirus infections (CoV) are common in pediatric patients. In general, they produce a mild clinical presentation consisting of an upper respiratory tract infection that does not usually infect the lungs, with the exception of preterm infants and children with chronic diseases. These infections exceptionally affect other organs (heart, brain, gastrointestinal tract), thus increasing their severity.In relation to the temporal coincidence with the beginning of the current situation of pandemic by the new beta coronavirus SARS-CoV-2 responsible for its associated disease (COVID-19), this study presents a clinical case of a 5-year-old patient showing multiple-organ failure and neurological sequelae due to bulbar injury and vascular thrombosis caused by an alpha coronavirus (CoV-NL63) due to its severity and exceptionality

Impact de la pandémie à COVID-19 sur la morbi-mortalité hospitalière au CHU Hussein Dey ­ Alger: étude comparative sur deux périodes (Avril-Septembre 2019 et Avril-Septembre 2020) / Impact of COVID-19 pandemic on hospital morbidity and mortality at the University Hospital of Hussein Dey - Algiers: a comparative study over two perdiods (april - september 2019 and april - september 2020)

Introduction : Depuis le début de la pandémie du COVID-19, les pays ont été confrontés au défi de prendre en charge les malades de la pandémie et en même temps de préserver la continuité des soins pour les autres patients, l'objectif de notre étude est d'évaluer l'impact de la pandémie COVID-19 sur le profil de la morbi-mortalité hospitalière. Méthodes : étude rétrospective comparative sur deux périodes avril-septembre 2019 « période de comparaison ¼ et avril-septembre 2020 « période de la pandémie ¼ au CHU Hussein Dey -Alger, portant sur l'analyse de l'évolution de l'activé hospitalière en matière d'admissions et de mortalité hospitalière. Résultats : au total 12 742 admissions durant la période de référence et seulement 10 110 admissions durant la période de la pandémie (dont 553 admissions dans les unités COVID-19), soit une baisse de 25% des admissions non-COVID-19 (p<10-5), la mortalité hospitalière qui était de 4.04% est passée à 4.88% (p<0.04), le RR de décès était de 1.6 et 13.9 dans les unités COVID-19 et les soins intensifs respectivement. Conclusion : tous les systèmes de santé ont montré leurs limites à ce type de menace de portée internationale, il est nécessaire de prévoir des schémas organisationnels adaptés au contexte pour une riposte efficace par la mise en place d'un système d'alerte et d'intervention souple capable de s'adapter à des variations de situation.