Risk Assessment and Rationalization of Health Resource Allocation: Lessons From the Brazilian COVID-19 Cohort in 2020 (preprint)

ABSTRACT

Background: Due to the slow vaccination and limited resources in Brazil, a risk assessment in hospital screening becomes imperative to improve efficiency and ensure universal access to the health system. This study aimed to evaluate the association between pre-screening clinical characteristics (age, symptoms, and comorbidities) and healthcare resource demand (ventilatory support or intensive care units) and COVID-19-related deaths.Methods: We included patients from the SIVEP-Gripe database with a confirmatory diagnosis of COVID-19, aged 21-80 years, admitted and discharged from February 20th to December 31st, 2020. We used binomial models adjusted for confounders with second-order interactions between the effects of interest.Findings: Of 430,723 symptomatic patients diagnosed with COVID-19 admitted to hospitals, and registered in the SIVEP-Gripe, 258,564 (70·6%) required some ventilatory support, 127,663 (29·6%) required intensive care, and 112,569 (26·1%) had COVID-19-related deaths. Diabetes (27-65%), obesity (53-129%), and smoking (68-130%) increased the chance of ventilatory support in almost all age strata and symptom groups. Obesity (45-124%) was a major risk factor for ICU admission, while immunosuppression (54-235%) and renal disease (89-189%) increased the risk of COVID-19-related deaths. Unexpectedly, Patients who had mild symptoms were often more associated with an unfavorable clinical course than other symptoms considered more severe.Interpretation: Our results revealed the complex distribution of risks considering the interaction between age, group of symptoms, and comorbidities for increased demand for healthcare resources and deaths. Early identification of high-risk patients may improve the efficiency of the health system.Funding Information Inova Fiocruz/Fundação Oswaldo Cruz.Declaration of Interests We declare no competing interests.