Friday, April 30, 2021

Brazil FIOCRUZ Bulletin: Cases Slowly Dropping But Case Fatality Rate Has Risen


While Brazil finally appears to be on a downward trend in COVID cases and deaths during their disastrous 2nd wave (see charts below), theor pandemic crisis remains at a critical level across much of the country. 

The latest Boletim Extraordinario, released by FIOCRUZ (Fundação Oswaldo Cruz) summarizes the impacts of the pandemic, and the recent slowdown in cases - but also notes a recent increase in the CFR (Case Fatality Rate) of the pandemic - likely due in large part to the overwhelming of their healthcare system.

First the summary from FIOCRUZ followed by (translated) excerpts from the report.

Bulletin points out that pandemic remains at critical levels
Regina Castro (CCS / Fiocruz)

The Covid-19 Fiocruz Observatory's Extraordinary Bulletin , released on Wednesday (4/28), points to a drop in the number of cases, deaths and occupancy rates of Covid-19 ICU beds for adults. The values, however, still remain at critical levels. Another worrying fact is the lethality rate. 
At the end of 2020, this indicator was in the range of 2%, increased to 3% in SE 11 (14 to 20 March) and, in the last SE, rose to 4.4%. The analysis of the Bulletin refers to Epidemiological Week 15, between 18 and 24 April.

The number of cases decreased at a rate of -1.5% per day, while that of deaths by Covid-19 was reduced at a rate of -1.8% per day, “showing a slight downward trend, but not yet containment, the epidemic ”. In relation to the bed occupancy rate, the reduction in the states of Rondônia (from 94% to 85%) and Acre (from 94% to 83%) is noteworthy - even though both remain in the critical alert zone - the exit of Alagoas from the critical alert zone to the intermediate alert zone (from 83% to 76%) and the departure of Paraíba from the alert zone (from 63% to 53%).

In the view of the Observatory researchers, the current situation may represent a deceleration of the pandemic, with the formation of a new level, as occurred in mid-2020, but with much higher numbers of serious cases and deaths, which reveal the intense circulation of the virus in the country. "This set of indicators, which has been monitored by the Covid-19 Fiocruz Observatory, shows that the pandemic may remain at critical levels over the next few weeks."

Faced with this scenario, the researchers warn that flexibilization without a strict control of physical and social distance measures can resume the pace of accelerated transmission, with the “production” of new cases, several of them serious, and an increase in hospitalizations and rates of bed occupation.

"The integration between Primary Health Care and Health Surveillance must be intensified in order to optimize the processes of screening for severe cases, their referral to more complex health services, as well as the identification and counseling of contacts for protection and quarantine measures. In addition, the reorganization and expansion of the testing strategy is essential to avoid new cases, as well as to reduce the pressure on hospital services ”, they guide.

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The following (translated) excerpt comes from the full report:

In the last Epidemiological Week (April 18-24), still high death rates were recorded by Covid-19, close to the 3,000 daily deaths. However, there is a downward trend in the number of cases as of April. In the country, a an average of 65,000 daily cases and 2,900 deaths per day in the last SE.

The number of cases decreased at a rate of -1.5% per day, while the number of deaths by Covid-19 was reduced at a rate of -1.8% over day, showing a slight downward trend, but not yet containment, of the epidemic. The analysis points to the maintenance of rates of lethality, which was in the range of 2% at the end of 2020: in SE 11 (14 to 20 March), the rate increased to 3% in SE 11 (14 to March 20) and in the last SE rose to 4.4%.

According to the Observatory researchers, this increase can be consequence of the lack of capacity to diagnose serious cases correctly and in a timely manner, added to the overload of hospitals, which has making it difficult for patients to access the necessary care and also compromised the quality of care offered.

In this context, they argue that the integration between Primary Care to Health and Health Surveillance should be intensified to optimize serious case screening processes, referral to emergency services complex health conditions, as well as the identification and counseling of contacts for protection and quarantine measures. “The reorganization and Expansion of the testing strategy is essential to avoid new cases, as well as reducing pressure on hospital services. ”, they defend.

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A reminder that in countries with an inadequate existing healthcare system - or one which has been degraded by a surge in patients due to the pandemic - the fatality rate of COVID may be double or even triple what we've experienced thus far in the United States and other developed countries. 

So far, through NPIs (non-pharmaceutical interventions) like social distancing, mask wearing, etc. most nations have managed to avoid a total collapse of their healthcare systems.  But in places like Brazil, and more recently India, we've seen the buckling of their healthcare delivery system, and the resultant rise in COVID deaths. 

Whether its another wave of COVID, or the next pandemic (to be announced at a later date), the need to protect our healthcare delivery system is paramount if we are to avoid an even greater tragedy in the future.