Two in five Covid patients in Brazilian hospitals die, study finds

Two in five coronavirus patients die after being hospitalised in Brazil, a study has shown, underlining how the virus has overwhelmed the healthcare system in all of the country’s regions.

Brazil’s in-hospital mortality rate was 38 per cent, rising to 60 per cent among those admitted to the intensive care unit (ICU) and to 80 per cent for those who were mechanically ventilated, the research published in The Lancet Respiratory Medicine journal found.

The analysis examined data from a nationwide surveillance system to evaluate the mortality rates among the first 250,000 patients admitted to hospital with Covid-19 in Brazil. It also found that almost half (47 percent) of the 254,288 patients admitted to hospital were under 60 years old.

The mortality rate has differed greatly between countries, largely due to differences in the capacity and preparedness of their healthcare systems. The analysis comes as the Amazon city of Manaus is hit by oxygen shortages, triggering mass transfers of patients to hospitals outside the state. 

"To date, there is very limited data on the mortality of patients hospitalised with Covid-19 or on how the health systems have coped with the pandemic in low- and middle-income countries," said Otavio Ranzani, ISGlobal researcher and lead author of the study.

Brazil is an upper middle-income country with a national healthcare system for its 210 million residents. However, the country’s response has been mired by both political and economic crises, with president Jair Bolsonaro consistently downplaying the severity of the disease that has killed more than 200,000 Brazilians.

Additionally, there is is a great deal of variation in healthcare provision across different regions of the country. More than 7.8 million Brazilians live at least four hours away from a town where high-complexity healthcare needed to treat Covid-19 is available, including an ICU, suitable equipment and specialised staff, the Institute of Scientific and Technological Communication and Information in Health found last year.

Although the virus overwhelmed the healthcare system in all of the country’s five regions, hospital admissions and mortality were significantly higher in the north and northeast at the beginning of the pandemic. 31 per cent of patients aged under 60 died in hospitals in the northeast compared to 15 per cent in the country’s south.

"These regional differences in mortality reflect differences in access to better health care that already existed before the pandemic", said Fernando Bozza, study coordinator and researcher at the National Institute of Infectious Disease. 

"This means that Covid-19 not only disproportionately affects the most vulnerable patients but also the most fragile health systems," he added. 

The research comes amid a worsening crisis in Brazil’s Amazonas state as hospitals in the city of Manaus run out of oxygen tanks. The crisis, which is linked to the highly transmissible variant believed to have been circulating in Amazonas since July, has seen a mass transfer of Covid-19 patients out of Manaus. More than 6,000 people have died from Covid across the state.

Brazil has registered 8,324,294 cases since the pandemic began, and the official death toll stands at 207,095, according to ministry data. It is the world's third worst outbreak outside the United States and India.