Longer length of stay, days between discharge/first readmission, and pulmonary involvement ≥50% increase prevalence of admissions in ICU in unplanned readmissions after COVID-19 hospitalizations.

Hospital readmissions due to COVID-19 are one of the main concerns for the health system due to risks to the patient's life and increased use of health resources. Studies focusing on this issue are important to understand the risk factors and create strategies to avoid readmissions. We evaluated the readmission of patients with confirmed COVID-19 in a private hospital in southern Brazil, between March 2020 and 2021. Also, the characteristics and clinical outcomes of patients admitted to the intensive care unit (ICU) and nonadmitted were compared. Poisson regression models with prevalence ratio (PR) with 95% confidence intervals (95% CIs) were applied to confirm the association between variables and ICU admission. Of the 2084 hospitalized patients with COVID-19, 1806 were discharged alive. Among them, 106 were readmitted for unplanned reasons during one year. Early hospital readmission (≤30 days) occurred in 52.8% of the cases. The main reasons were respiratory, gastroenterological, kidney, and cardiac disease. The median age was 73.0 years old and women correspond to 52.8%. The presence of at least one comorbidity was detected in 87.7% of patients. Hypertension, diabetes, cardiac, and lung disease were more frequent. The ICU admitted patients (n = 43; 40.5%) mostly had 4-5 comorbidities, pulmonary involvement ≥50%, length of stay (LOS), and days between discharge and first readmission. Longer LOS (PR: 3.46; 95% CI: 1.24-5.67), days between discharge/first readmission (PR: 2.21; 95% CI: 1.15-5.88), and pulmonary involvement (≥50%; PR: 1.59; 95% CI: 1.11-3.54) were independently associated with ICU admission. Longer LOS, longer days between discharge/first readmission, and pulmonary involvement (≥50%) were associated with ICU admission in readmitted patients. Readmissions evaluation is pivotal and may help in ensuring safe care transition and postdischarge follow-up.

Temporal spread and evolution of SARS-CoV-2 in the second pandemic wave in Brazil.

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic spread rapidly and this scenario is concerning in South America, mainly in Brazil that presented more than 21 million coronavirus disease 2019 cases and 590 000 deaths. The recent emergence of novel lineages carrying several mutations in the spike protein has raised additional public health concerns worldwide. The present study describes the temporal spreading and evolution of SARS-CoV2 in the beginning of the second pandemic wave in Brazil, highlighting the fast dissemination of the two major concerning variants (P.1 and P.2). A total of 2507 SARS-CoV-2 whole-genome sequences (WGSs) with available information from the country (Brazil) and sampling date (July 2020-February 2021), were obtained and the frequencies of the lineages were evaluated in the period of the growing second pandemic wave. The results demonstrated the increasing prevalence of P.1 and P.2 lineages in the period evaluated. P.2 lineage was first detected in the middle of 2020, but a high increase occurred only in the last trimester of this same year and the spreading to all Brazilian regions. P.1 lineage emerged even later, first in the North region in December 2020 and really fast dissemination to all other Brazilian regions in January and February 2021. All SARS-CoV-2 WGSs of P.1 and P.2 were further separately evaluated with a Bayesian approach. The rates of nucleotide and amino acid substitutions were statistically higher in P.1 than P.2 (p < 0.01). The phylodynamic analysis demonstrated that P.2 gradually spread in all the country from September 2020 to January 2021, while P.1 disseminated even faster from December 2020 to February 2021. Skyline plots of both lineages demonstrated a slight rise in the spreading for P.2 and exponential growth for P.1. In conclusion, these data demonstrated that the P.1 (recently renamed as Gamma) and P.2 lineages have predominated in the second pandemic wave due to the very high spreading across all geographic regions in Brazil at the end of 2020 and beginning of 2021.