Clinical Profile, Comorbidities, and Outcome of the Unvaccinated and Hospitalized for COVID-19 in Northern Brazil: Retrospective Cohort (preprint)

Over the course of the pandemic, COVID-19 affected health, the economy and quality of life in Brazil. The worst years for the country were the first and second. There were delays in vaccine purchases for political reasons at the time. The northern region of the country had a higher mortality rate compared to other regions, associated with local vulnerabilities and fragility of surveillance due to geographic and population characteristics. This study aims to investigate the clinical profile, comorbidities, and outcome of unvaccinated people hospitalized for COVID-19 in the state of Para in 2022. Retrospective cohort epidemiological study, with data from the national epidemiological surveillance of acute and severe respiratory syndromes. Cases reported in 2022 with vaccinated yes or no field and completed doses were included. Only closed cases cure or death were included. We performed a chi-square test on categorical variables and a Mann-Whitney test on numerical variables. We compared vaccinated VS non-vaccinated; we performed the Odds Ratio in the significant variables. We used the SPSS 20.0 software. The study worked with 2,634 cases of COVID-19 hospitalized in the study period, confirmed by RT-PCR (851/32.30%) and (1,784/67.70%) rapid antigen test. The lethality was (778/29.53%), and those vaccinated with two doses were (1,473/55.90%) and those unvaccinated with no dose (1,162/44.10%). Death represents p- <0.001 (HR 1.306 - CI 1.124/1.517) higher risk of the event occurring in the unvaccinated cases, followed by male sex p-0.004 (HR 1.188 - CI 1.058/1.334).. The first cohort in Brazil and in the north of the country to evaluate the clinical profile, comorbidities, and outcome of COVID-19 in hospitalized patients in this Amazon region, which is a region characterized by local vulnerability factors unique to the other regions of Brazil, showed that the unvaccinated were males, younger, with fewer comor-bidities, and that they were associated the deaths.

Epidemiological pattern of births from the largest surveillance database of live births in Brazil "SINASC" before and during the COVID-19 pandemic in the Brazilian Amazon (preprint)

The surveillance of live births in Brazil has been carried out since 1990 by the Information System on Live Births (SINASC), which was implemented by the Ministry of Health aiming at standardized registration on a national level. The state of Para is part of the Brazilian Amazon, northern Brazil, which has several unique characteristics. Thus, the purpose of this study was to identify the epidemiological pattern of live births before and during the pandemic of COVID-19 in the state of Para, 2016 to 2020. This is an ecological epidemiological time-series study, using epidemiological surveillance data from DATASUS, referring to the Live Births Information System (SINASC). These are data that have been treated by surveillance and are in aggregate format. The study population is the live births residing in the state of Para, in the period from 2016 to 2020. The data collection instrument was the Declaration of Live Births (DLB). There were 689,454 live births, and the highest rates of births were and continued to remain in the Marajo II, Baixo Amazonas, Xingu, and Tapajos regions. The Metropolitan I and Araguaia regions were and continue to be the lowest rates in the state. Age of the mother 15 to 19 years old 22.29%, 20 to 24 years old 30.05% and 25 to 29 years old 22.58%, most of the single pregnancy type 98.32%, prenatal consultations, performed 7 or more 48.10%, followed by 4 to 6 consultations 33.98%, most presented 7 or more years of the study 48.10%, followed by 3 to 6 years 33.98%. Represented 51.21% male and 48.77% female. The occurrence of congenital anomalies represented 0.52% of live births. Another congenital malformation and deformity were the most prevalent at 25.53%, followed by Congenital deformities of the feet 14.90%, Other congenital malformations of the nervous system 14.84%, and Other congenital malformations 10.77%, Cleft lip, and cleft palate 8.88%, Other congenital malformations digestive tract 8.10%. The demographic transition has already occurred for several decades, including the reduction of fertility and birth rate, so our study showed that the reduction in the number of live births was already a reality in the country, but we emphasize that this reduction was enhanced by the pandemic. We observed greater adherence to prenatal care and a lower prevalence of low birth weight compared to other studies, but the limitation was the absence of studies in the same place of the research. Regarding data incompleteness, we emphasize the ignored fields that reflect the fragility in the surveillance of live births, which was reinforced by the literature.

Predictors of Death for Hospitalized Patents with COVID-19 in the First Year of the Pandemic in Northern Brazil - A Retrospective Study (preprint)

Objective Identified predictors of death for hospitalized patients with COVID-19 in the First Year of the Pandemic in Northern Brazil.Methods A longitudinal retrospective cohort study was carried out, using data from the Brazilian Ministry of Health's COVID-19 severe case and hospitalization notification forms, considering the period from January 1, 2020 to December 31, 2020. The extracted variables were related to the epidemiological profile and outcome of the disease. Data were analyzed using SPSS software, with chi-square test by contingency table, binary logistic regression, and survival analysis.Results Those vaccinated against influenza were associated with survivors in univariate and multivariate analysis, as well as survival analysis. The predictors of lethality were invasive ventilation (OR 6.627; CI 5.780–7.597), other pneumopathy (OR 1.901; CI 1.439–2.510), dyspnea (OR 1.899; CI 1.737–2.076), immunodeficiency (OR 1.905; CI 1.493–2.431), hospitalized in ICU (OR 1.764; CI 1.588–1.959), chronic kidney disease (OR 1.753; CI 1.396–2.203), diabetes mellitus (OR 1.210; CI 1.108–1.321), and male sex (OR 1.198; CI 1.111–1.293).Conclusion Those vaccinated against influenza were associated with survival; namely, they showed a lower risk of death in the regression and showed longer survival in the survival analysis, when compared to those who were not vaccinated. The lethality was higher than the other studies, while the predictors were similar. Evidencing that COVID-19 had more impact on deaths, which may be associated with the vulnerability factors of the region.

Epidemiological analysis of hospitalized cases of COVID-19 in in-digenous people in an Amazonian region: cross-sectional study with data from the surveillance of acute and severe respiratory syn-dromes in Brazil (preprint)

Indigenous people are considered more vulnerable to new infectious agents. In view of the novel coronavirus causing COVID-19, health authorities are concerned about the possible impact of the pandemic on reaching vulnerable populations, such as the in-digenous people of the Brazilian Amazon. Thus, we aimed to carry out an epidemiological analysis of serious cases and deaths from COVID-19 in indigenous population in the state of Para, Brazil. The data was obtained from the public Ministry of Health platform. Data analysis was performed using the Statistical Package for the Social Sciences 20, Chi-square of adherence, the independence test and G test. For spatial distribution was used ArcGIS. We observed 123 COVID-19 cases: 46 deaths (37.40%), male gender (76-61.79%), age above 60 years (61- 49.6%), the most frequent risk factor was chronic cardiovascular disease (18- 14.63%). The predictors of death were: invasive ventilation has (10.73) more chances for the outcome death, those not vaccinated against influenza have (3.41) and age (1.4). COVID-19 occurrence was higher in municipalities that have villages with health care or commerce, or with migrants from the Warao ethnic group. Notifications should take into consideration the specific issues of in-digenous people so that effective control measures can be defined.

Analysis of 472,688 severe cases of COVID-19 in Brazil showed lower mortality in those vaccinated against influenza (preprint)

Objective To analyze the severe cases of COVID-19 in Brazil in 2020 and compare those vaccinated and unvaccinated against influenza in invasive ventilation, admission in Intensive Care Unit (ICU) and deaths. Method Cross-sectional study with public data from the OpenDataSUS platform, regarding confirmed severe cases for COVID-19 in Brazil in the year 2020. Data were analyzed by SPSS, from the chi-square test of independence and binary logistic regression. Results The population was 472,688 cases and 177,640 deaths, with a lethality of 37.58% in severe cases. The test of independence was highly significant in vaccinated survivors (<0.0001), and regression showed an almost twofold odds ratio for invasive ventilation, ICU admission, and death in unvaccinated cases. Conclusion We recommend mass influenza vaccination as an adjuvant in combating the COVID-19 pandemic in Brazil.