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Spatial and temporal fluctuations in COVID-19 fatality rates in Brazilian hospitals.
Brizzi, Andrea; Whittaker, Charles; Servo, Luciana M S; Hawryluk, Iwona; Prete, Carlos A; de Souza, William M; Aguiar, Renato S; Araujo, Leonardo J T; Bastos, Leonardo S; Blenkinsop, Alexandra; Buss, Lewis F; Candido, Darlan; Castro, Marcia C; Costa, Silvia F; Croda, Julio; de Souza Santos, Andreza Aruska; Dye, Christopher; Flaxman, Seth; Fonseca, Paula L C; Geddes, Victor E V; Gutierrez, Bernardo; Lemey, Philippe; Levin, Anna S; Mellan, Thomas; Bonfim, Diego M; Miscouridou, Xenia; Mishra, Swapnil; Monod, Mélodie; Moreira, Filipe R R; Nelson, Bruce; Pereira, Rafael H M; Ranzani, Otavio; Schnekenberg, Ricardo P; Semenova, Elizaveta; Sonabend, Raphael; Souza, Renan P; Xi, Xiaoyue; Sabino, Ester C; Faria, Nuno R; Bhatt, Samir; Ratmann, Oliver.
  • Brizzi A; Department of Mathematics, Imperial College London, London, UK.
  • Whittaker C; MRC Centre for Global Infectious Disease Analysis, Jameel Institute, School of Public Health, Imperial College London, London, UK.
  • Servo LMS; Institute for Applied Economic Research, IPEA, Brasília, Brazil.
  • Hawryluk I; MRC Centre for Global Infectious Disease Analysis, Jameel Institute, School of Public Health, Imperial College London, London, UK.
  • Prete CA; Departamento de Engenharia de Sistemas Eletrônicos, Escola Politécnica, Universidade de São Paulo, São Paulo, Brazil.
  • de Souza WM; World Reference Center for Emerging Viruses and Arboviruses and Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston TX, USA.
  • Aguiar RS; Departamento de Genética, Ecologia e Evolução, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
  • Araujo LJT; Instituto D'Or de Pesquisa e Ensino (IDOR), Rio de Janeiro, Brazil.
  • Bastos LS; Laboratory of Quantitative Pathology, Center of Pathology, Adolfo Lutz Institute, São Paulo, Brazil.
  • Blenkinsop A; Programa de Computação Científica, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.
  • Buss LF; Department of Mathematics, Imperial College London, London, UK.
  • Candido D; MRC Centre for Global Infectious Disease Analysis, Jameel Institute, School of Public Health, Imperial College London, London, UK.
  • Castro MC; Departamento de Moléstias Infecciosas e Parasitárias e Instituto de Medicina Tropical da Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
  • Costa SF; Department of Zoology, University of Oxford, Oxford, UK.
  • Croda J; Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston MA, USA.
  • de Souza Santos AA; Departamento de Moléstias Infecciosas e Parasitárias e Instituto de Medicina Tropical da Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
  • Dye C; Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven CT, USA.
  • Flaxman S; Latin American Centre, University of Oxford, Oxford, UK.
  • Fonseca PLC; Department of Zoology, University of Oxford, Oxford, UK.
  • Geddes VEV; Department of Computer Science, University of Oxford, Oxford, UK.
  • Gutierrez B; Departamento de Genética, Ecologia e Evolução, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
  • Lemey P; Departamento de Genética, Ecologia e Evolução, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
  • Levin AS; Department of Zoology, University of Oxford, Oxford, UK.
  • Mellan T; Department of Microbiology, Immunology and Transplantation, Rega Institute, KU Leuven - University of Leuven, Leuven, Belgium.
  • Bonfim DM; Departamento de Moléstias Infecciosas e Parasitárias e Instituto de Medicina Tropical da Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
  • Miscouridou X; MRC Centre for Global Infectious Disease Analysis, Jameel Institute, School of Public Health, Imperial College London, London, UK.
  • Mishra S; Departamento de Genética, Ecologia e Evolução, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
  • Monod M; Department of Mathematics, Imperial College London, London, UK.
  • Moreira FRR; MRC Centre for Global Infectious Disease Analysis, Jameel Institute, School of Public Health, Imperial College London, London, UK.
  • Nelson B; Section of Epidemiology, School of Public Health, University of Copenhagen, Copenhagen, Denmark.
  • Pereira RHM; Department of Mathematics, Imperial College London, London, UK.
  • Ranzani O; Departamento de Genética, Instituto de Biologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
  • Schnekenberg RP; Environmental Dynamics, INPA, National Institute for Amazon Research, Manaus, Brazil.
  • Semenova E; Institute for Applied Economic Research, IPEA, Brasília, Brazil.
  • Sonabend R; Barcelona Institute for Global Health, ISGlobal, Barcelona, Spain.
  • Souza RP; Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.
  • Xi X; Department of Mathematics, Imperial College London, London, UK.
  • Sabino EC; MRC Centre for Global Infectious Disease Analysis, Jameel Institute, School of Public Health, Imperial College London, London, UK.
  • Faria NR; Departamento de Genética, Ecologia e Evolução, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
  • Bhatt S; Department of Mathematics, Imperial College London, London, UK.
  • Ratmann O; Departamento de Moléstias Infecciosas e Parasitárias e Instituto de Medicina Tropical da Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil. sabinoec@usp.br.
Nat Med ; 28(7): 1476-1485, 2022 07.
Article in English | MEDLINE | ID: covidwho-1830084
ABSTRACT
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Gamma variant of concern has spread rapidly across Brazil since late 2020, causing substantial infection and death waves. Here we used individual-level patient records after hospitalization with suspected or confirmed coronavirus disease 2019 (COVID-19) between 20 January 2020 and 26 July 2021 to document temporary, sweeping shocks in hospital fatality rates that followed the spread of Gamma across 14 state capitals, during which typically more than half of hospitalized patients aged 70 years and older died. We show that such extensive shocks in COVID-19 in-hospital fatality rates also existed before the detection of Gamma. Using a Bayesian fatality rate model, we found that the geographic and temporal fluctuations in Brazil's COVID-19 in-hospital fatality rates were primarily associated with geographic inequities and shortages in healthcare capacity. We estimate that approximately half of the COVID-19 deaths in hospitals in the 14 cities could have been avoided without pre-pandemic geographic inequities and without pandemic healthcare pressure. Our results suggest that investments in healthcare resources, healthcare optimization and pandemic preparedness are critical to minimize population-wide mortality and morbidity caused by highly transmissible and deadly pathogens such as SARS-CoV-2, especially in low- and middle-income countries.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: COVID-19 Type of study: Prognostic study Topics: Variants Limits: Aged / Humans Country/Region as subject: South America / Brazil Language: English Journal: Nat Med Journal subject: Molecular Biology / Medicine Year: 2022 Document Type: Article Affiliation country: S41591-022-01807-1

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Full text: Available Collection: International databases Database: MEDLINE Main subject: COVID-19 Type of study: Prognostic study Topics: Variants Limits: Aged / Humans Country/Region as subject: South America / Brazil Language: English Journal: Nat Med Journal subject: Molecular Biology / Medicine Year: 2022 Document Type: Article Affiliation country: S41591-022-01807-1