Mortality in a swiftly repurposed hospital in northeast Brazil during the first and second COVID-19 waves: A retrospective cohort study.

Background: The first months of the coronavirus disease 2019 (COVID-19) pandemic demanded rapid re-organization of available local resources. This study evaluated the performance of a private hospital in the Brazilian state of Ceará that was swiftly repurposed into a public tertiary COVID-19 centre during the first wave of the COVID-19 pandemic, and how it improved in the second wave. Methods: This retrospective cohort study included 2492 patients with COVID-19 at Hospital Estadual Leonardo da Vinci (HELV) during the first and second waves. Demographic, clinical and laboratory data were collected using a dedicated web platform (ResCOVID). A Poisson regression model was used to estimate factors associated with in-hospital mortality. Results: Differences in demographics and clinical features were found between the two waves. There was reduced in-hospital mortality during the second wave (36.2%) in comparison with the first wave (48.8%). Invasive mechanical ventilation showed the strongest association with increased risk of death in both waves {first wave: relative risk (RR) 4.28 [95% confidence interval (CI) 2.86-6.41], P<0.001; second wave: RR 12.94 (95% CI 3.4-49.12), P<0.001}. Conclusions: HELV was a pillar in the strategic public health plan to respond to COVID-19 in Ceará, helping to assist a group of moderate-to-severe cases and reduce the pressure on emergency and primary care facilities. Although mortality in intubated individuals remained high, there was an overall decrease in the in-hospital mortality rate in the second wave.

Mortality in a swiftly repurposed hospital in northeast Brazil during first and second COVID-19 waves: a retrospective cohort study

Background The first months of COVID-19 pandemic demanded rapid reorganization of available local resources. We evaluated the performance obtained by swiftly repurposing a private hospital in the Brazilian state of Ceará into a public tertiary COVID-19 center under the 1st wave and how it evolved to improved levels in the 2nd wave. Methods Retrospective cohort of 2492 COVID-19 patients at Hospital Estadual Leonardo da Vinci (HELV) during the 1st and 2nd waves. Demographic, clinical and laboratorial data were collected using a dedicated web platform (ResCOVID). A Poisson regression model was used to estimate factors associated with in-hospital mortality. Results We found differences in demographics and clinical features between the two waves. There was a reduced in-hospital mortality during the 2nd wave (36.2%) in comparison with the 1st wave (48.8%). Invasive mechanical ventilation showed the strongest association with increased risk of death in both waves (1st wave: RR 4.28 [2.86-6.41], p<0.001;2nd wave: RR 12.94 [3.4-49.12], p<0.001). Conclusions HELV was a pillar in the strategic public health plan to respond to COVID-19 in Ceará, helping to assist a group of moderate to severe patients and to decompress the demand from emergency and primary care. Although mortality in intubated individuals remained high, we found an overall decreased in-hospital mortality in the 2nd wave.