#15,923
Two weeks ago, in FIOCRUZ Bulletin: Brazil's Fastest Increase In COVID Cases/Deaths In Younger Adults, we looked at the changing demographics of Brazil's pandemic, which indicated deaths in those under the age of 60 had increased at roughly double the global rate since the first week of January in Brazil.
We looked at an early report of this shift nearly a month ago (see Preprint: Sudden Rise In COVID-19 Case Fatality Among Young & Middle Aged Adults - Paraná, Brazil), raising concerns that the recent proliferation of the P.1 variant virus might be behind this trend.
A January technical report from FIOCRUZ (Fundação Oswaldo Cruz) found that the P.1 variant had rapidly overtaken all other variants in the region, jumping from 51% of all sequenced samples in December to 91% by the first half of January.
Covid-19: Bulletin points to pandemic rejuvenation progression
4/23/2021
Regina Castro (CCS / Fiocruz)
Published this Friday (4/23), the Fiocruz Covid-19 Observatory Bulletin for the weeks 14 and 15, period from April 4 to 17, presents a general panel of the Covid-19 scenario in the country and its implications. The study, based on comparisons between epidemiological weeks 14 and 15, finds the pandemic rejuvenation process. The numbers of cases and deaths of Covid-19 by age group show that the differential increase by age was maintained.
The analysis points out that the age group of the youngest, from 20 to 29 years old, was the one that registered the greatest increase in the number of deaths by Covid: 1,081.82%. In the ages of 40 to 49 years (1,173.75%) there was the greatest increase in the number of cases.
The Bulletin also includes analyzes and data on the rejuvenation of the pandemic in Brazil, beds for Covid-19, Serious Respiratory Syndromes, activity and incidence levels, demographic profile, vaccination, income, work and social impacts, among others. Based on these indicators, it points out ways to face the pandemic.
The global increase, for all ages, between SE 1 and SE 14, was 642.80%. Some age groups maintained growth higher than the global one: 20 to 29 years (745.67%), 30 to 39 years (1,103.49%), 40 to 49 years (1,173.75%), 50 to 59 years (1,082.69 %) and 60 to 69 years old (747.65%).For deaths, the global increase was 429.47%. The same age groups had a different increase: 20 to 29 years (1,081.82%), 30 to 39 years (818.60%), 40 to 49 years (933.33%), 50 to 59 years (845.21% ) and 60 to 69 years old (571.52%).
As for hospitalization in Intensive Care Units (ICU), still comparing SE 1 and SE 14, the occupation of these beds was quite different over the weeks. In SE one, the proportion of patients under 70 years of age hospitalized in ICU beds was 52.74%. In SE 14, this proportion was 72.11%. These figures, according to the investigation, suggest that the occupancy of ICU beds by a less long-lived population has increased.
ICU beds for Covid-19
The occupancy rates of ICU Covid-19 beds for adults in the SUS in several states remain, in general, at very high levels. Data obtained on April 19, compared to the last 12, indicate the departure of Amapá from the critical alert zone to the intermediate alert zone, in which Amazonas, Maranhão and Paraíba were already located. Except for Roraima, outside the alert zone, the other states and the Federal District remained in a critical alert zone.
Of note were the reductions in Amazonas (73% to 69%), Roraima (44% to 38%), Pará (82% to 80%), Amapá (84% to 68%), Rio Grande do Norte (98% to 93%), Paraíba (70% to 63%), Alagoas (88% to 83%), Bahia (84% to 82%), Minas Gerais (91% to 89 %), Espírito Santo (95% to 91%), Rio de Janeiro (90% to 86%), São Paulo (86% to 83%), Rio Grande do Sul (88% to 83%) and Goiás (96% to 90%).
Fourteen states and the Federal District have occupancy rates above 90%: Rondônia (94%), Acre (94%), Tocantins (93%), Piauí (94%), Ceará (98%), Rio Grande do Norte (93%), Pernambuco (97%), Sergipe (97%), Espírito Santo (91%), Paraná (94%), Santa Catarina (97%), Mato Grosso do Sul (100%), Mato Grosso (96%), Goiás (90%) and the Federal District (98%). Seven have adult occupancy rates of ICU Covid-19 beds for adults between 80% and 89%: Pará (80%), Alagoas (83%), Bahia (82%), Minas Gerais (89%), Rio de Janeiro ( 86%), São Paulo (83%) and Rio Grande do Sul (83%). Finally, four states have rates between 63% and 78% - Amazonas (73%), Amapá (68%), Maranhão (78%) and Paraíba (63%) - and one (Roraima), a rate of 38%.
Cases and deaths by Covid-19
In Epidemiological Weeks 14 and 15 (April 4 to 17), almost all of the states showed stability in the indicators, with the exception of Roraima, where a new increase was observed in both the number of cases and deaths. In Amapá there was a small reduction in the number of cases.
The highest incidence rates of Covid-19 were observed in the states of Rondônia, Amapá, Tocantins, Ceará, Minas Gerais, Espírito Santo, Mato Grosso do Sul and Mato Grosso, and in the Federal District. High mortality rates were observed in the states of Rondônia, Espírito Santo, São Paulo, Paraná, Rio Grande do Sul, Mato Grosso do Sul, Goiás and the Federal District. This pattern keeps the South and Midwest regions as critical for the coming weeks, which can be aggravated by the saturation of the health system in these states.
Rio de Janeiro (8.3%), Paraná (6.2%), Distrito Federal (5.3%), Goiás (5.2%) and São Paulo (5.1%) had the highest lethality rates. According to the researchers, the high levels of lethality reveal serious flaws in the health care and surveillance system in these states, such as insufficient diagnostic tests, identification of vulnerable groups and referral of critically ill patients.
Severe Acute Respiratory Syndromes
The analysis finds that the incidences of Severe Acute Respiratory Syndromes (SRAG), another strategic indicator, are at levels of stability in many states or decreasing. However, still at very high levels. About 90% of SARS cases are due to Sars-CoV-2 infections.
Nineteen states and the Federal District have very high incidence rates, above 10 cases per 100 thousand inhabitants: Rondônia, Roraima, Pará, Maranhão, Piauí, Ceará, Rio Grande do Norte, Paraíba, Pernambuco, Alagoas, Sergipe, Minas Gerais, Rio de Janeiro, São Paulo, Paraná, Santa Catarina, Rio Grande do Sul, Mato Grosso do Sul and Goiás. In the other states, incidence rates are very high, exceeding one case per 100 thousand inhabitants.
The states with high and stable SRAG levels are mainly from the South and Northeast regions. In particular, Recife shows an upward trend, observing the moving average in the last three epidemiological weeks. The researchers warn that “high levels of stability are not desirable because hospital beds still remain under high occupation”.
While the rise of the P.1 variant is perhaps the easiest answer as to why the demographic change in Brazil's pandemic, and the greater burden on younger adults, it isn't necessarily the only answer.
Hospitals are near - or at - the point of collapse, there are other variants claiming `market share', and of course, the accuracy of real time data (in Brazil, and elsewhere) is always subject to the `fog of war', or political manipulation, or simply delays in reporting.
It may take years to parse the data, and form reasonable assumptions as to what is really going on in Brazil, and why. And as we've seen in the past, the true impact of the COVID pandemic around the world may never be fully appreciated.
For those countries that are currently experiencing a stabilization or even a reduction in cases and deaths, the goal is not to backslide into a `Brazilian' scenario. With new variants, like P.1 in Brazil and B.1.617 in India making inroads globally, however, there still may be significant challenges ahead.
