ABSTRACT
In the current context of crisis caused by the COVID-19 pandemic, we observe a rearrangement of federative relations in Brazil, in force since the Federal Constitution of 1988. With the vacuum left by the lack of action by the federal government, new action arrangements have been designed by the other entities of the federation, by the states and municipalities. In this context, this paper aims to map the intergovernmental relations developed during the COVID-19 pandemic in Brazil based on the actions of the states. For this, we analyzed the regulations elaborated by the 26 Brazilian states and the Federal District and published in the Official Gazettes of these states between February and December 2020 were analyzed.
ABSTRACT
Background The COVID-19 pandemic significantly impacted the Brazilian healthcare system, resulting in deferral of elective cardiac procedures and avoidance of medical care due to social distancing. We aimed to evaluate the impact of COVID-19 on hospital admissions and death rates associated with coronary events in a Brazilian large-scale private health system. Methods From March 18 - Sep 30, 2020 we evaluated the administrative database of UNIMED-BH, a cooperative Brazilian private insurance, with over 1.25 million clients from a large urban center. We collected data from admissions in all owned and accredited hospitals related to urgent and elective coronary events (acute coronary syndromes, coronary interventions, clinical management of coronary artery disease and invasive diagnostic procedures). Admissions in 2020 were compared to the 2-year historical series (2018, 2019), and rates/100,000 were calculated considering the mean covered population. Outcomes were assessed until October 15th, 15 days after the last enrollment. Results In the 196-day period, the number of coronary admissions in 2018, 2019 and 2020 were, respectively, 2,789, 3,519 and 2,348, and patients had a median age of 67 [58-76] years, being 59% men. The mean length of hospital stay was 6.7±9.3 days, and 27% had >1 admission in 3 years. The adjusted rates of admissions were 221, 278 and 184/100,000 clients, resulting in a significant 26% (95% CI 22 - 30) reduction in 2020 compared to the historical series (p<0.001). The reduction was more pronounced from March to May (36%) - when social isolation started - compared to the peak of the pandemic (June to September, 19%). In-hospital mortality was also significantly higher in 2020 (5.4%, 95% CI 4.5 - 6.4) compared to 2018/2019 (3.6%, 95% CI 3.2 - 4.1), p<0.001, despite the similar age (67 [57-76) vs. 67 [58-76], p=0.15) and length of hospital stay (6.9±8.9 vs. 6.7±9.5 days, p=0.43). Conclusion There was a significant decrease in admissions due to coronary events during the COVID-19 pandemic in Brazil, in parallel with increased in-hospital mortality. Deferral of elective procedures and avoidance of medical care possibly resulted in delayed presentation and unfavorable outcomes.
ABSTRACT
INTRODUCTION: We aimed to evaluate the impact of the new coronavirus disease 2019 on coronary hospitalizations in the Brazilian private health system. METHODS: Data on coronary admissions in 2020 and a 2-year historical series were collected from the UNIMED-BH insurance system. RESULTS: Admission rates in 2020 reduced by 26% (95%CI, 22-30) in comparison with 2018/2019, markedly from March to May (37%) compared to the peak of the pandemic (June-September, 19%). Mortality was higher in 2020 (5.4%, 95%CI 4.5-6.4) than in 2018/2019 (3.6%, 95%CI 3.2-4.1). CONCLUSIONS: There was a significant decrease in coronary admissions, with higher mortality during the COVID-19 pandemic.