#15,978
Although Brazil's daily case counts are down about 20% from their highs of a month ago - COVID continues to exact a heavy toll, with a 7-day moving average still of over 65,000 cases. Of obvious concern, the downward trend in cases reported a couple of weeks ago, appears to have stalled.
While Brazil's dominant P.1 variant might be producing more severe illness and a higher death rate, some of this observed rise in CFR could also be due to the overwhelming of Brazil's healthcare system.Three weeks ago, in Brazil FIOCRUZ Bulletin: Cases Slowly Dropping But Case Fatality Rate Has Risen, we looked at a worrisome rise in the CFR documented by FIOCRUZ (Fundação Oswaldo Cruz).
The chart at the top of this blog post shows the difference between Epi Week 1 (2021) and Epi Week 18 (cases on the left, deaths on the right).
Simply put, in early January the median age of hospitalization from COVID in Brazil was 66 - 68 for ICU admission - and now both are below 60; (55 for hospitalization, 58 for ICU). While we've previously seen some anecdotal reports that P.1 might be affecting a younger cohort, this adds more weight.
Friday's report also notes a slight drop in the CFR, which they suggest may be linked to a lessening of the strain on their healthcare system, along with slowly increasing vaccination rates, and an uptick in new cases (deaths being a lagging indicator).
This pronounced shift in the burden of Brazil's pandemic to a younger demographic is easily seen in the graphic below (cases on the left, deaths on the right).
I've posted a (translated) summary from the FIOCRUZ website, but you may also want to access the full 14 Page PDF (in Portuguese).
I'll have a brief postscript after the break.
Median age of hospitalizations for Covid-19 is below 60 years for the first time
5/21/2021
Regina Castro (CCS / Fiocruz)
The Covid-19 Fiocruz Observatory Bulletin , released this Friday (5/21), shows an increase in notifications for Severe Acute Respiratory Syndrome (SRAG). SARS cases are responsible for serious incidences of respiratory diseases, which require hospitalization or lead to death. They are currently largely due to infections by Sars-CoV-2. Another worrying fact is that, for the first time in Brazil, the median age of hospitalizations in ICUs across the country was below 60 years.
The analysis compared Epidemiological Week 1 (3 to 9 of January) and 18 (2 to 8 of May) of 2021 and found that the median age of hospitalizations (age that limits the concentration of 50% of cases) was 66 years in SE 1 to 55 years in SE 18. The median age of ICU admissions was 68 years in SE 1 to 58 years in SE 18.
The researchers warn that the year 2021 comes, every week, showing rejuvenation of the pandemic. “Unlike the last few weeks, more than half of the cases of hospitalization and ICU admission occurred among non-elderly people. Regarding deaths, although the median is still over 60 years old, during this year there was a fall in a level of 10 years. The median age values of deaths were, respectively, 73 and 63 years.
The bulletin is a publication of the Covid-19 Observatory: Information for action , from Fiocruz.
SRAG
As for the increase in cases of SARS, many states (in particular those in the South) that had a reduction in the disease in the weeks prior to SE 18 show a tendency to reverse or even an increase in the number of cases. According to the analysis, even in the states that show reduction or stability, the numbers of cases still remained very high, demonstrating the strong pressure on the health system. "It is essential that there is a sustained reduction in the number of cases for the restoration of the health system, including reducing the bed occupancy rate", the researchers pointed out.
The difference in the incidence of cases in the states between the times of Epidemiological Weeks 8 and 9 and SE 18 and 19 shows that few states are at a significantly lower level (criterion: greater reduction of 5 cases per 100 thousand inhabitants): Mato Grosso, Goiás , Federal District, Paraná, Santa Catarina, Rio Grande do Sul, Rondônia, Roraima and Amapá, with Mato Grosso, Paraná and the capitals of the states of the South region showing signs of increase.
The other states are at levels close to those observed in mid-March or even above, as is the case of Mato Grosso do Sul, Maranhão, Pernambuco, Rio de Janeiro and Espírito Santo. "The increase or stability at very high levels and with high occupancy rates are highly undesirable scenarios", highlight the researchers.
ICU beds for Covid-19
The occupancy rates of ICU Covid-19 beds for adults in the Unified Health System (SUS) on May 17, 2021 signal a break in the expectation that had been drawn for the improvement of the indicator in the country in recent weeks. The analysis reinforces that it is necessary to pay attention to this moment of the pandemic. “If a sustainable fall is not maintained, the pandemic may resume its expansion”, highlight the Observatory's researchers.
The occupancy rates of ICU Covid-19 beds for adults in the SUS, which had been maintaining a slow but relatively consistent downward trend in much of the country, between May 10 and 17, 2021, showed small increases in many states and capitals, interrupting the impression of improving the general picture.
Mortality rates
During the last two epidemiological weeks, there has been a slight reduction in mortality rates in Brazil. However, incidence rates, which reflect the new cases of Covid-19, remain on a high plateau. According to the study, this new epidemiological pattern may be the result of a combination of factors such as the vaccination of populations at higher risk, a small reduction in the occupation of hospital beds, as well as the already signaled rejuvenation process of the pandemic.
"Combined, these new factors may be contributing to the decrease in the lethality of the disease, without however reducing the transmission of the disease, which remains intense, as demonstrated by the high rate of positivity of the diagnostic tests carried out in the last weeks".
This new socio-epidemiological scenario is seen as worrying when considering the still slow rate of vaccination in the country and the possibility of introducing new variants of the Sars-CoV-2 virus in Brazil. In addition, as emphasized in the analysis, the early relaxation of isolation measures can cause a resumption of transmission, with the generation of serious cases and deaths in the coming weeks, “putting pressure on health services still overburdened and with limitations for replenishing stocks medicines and supplies ”.
The Bulletin concludes with a balance of lessons learned in coping with Covid-19, taking as a reference the document released by the Independent Panel of the World Health Organization (WHO) and the new pandemic scenarios in the country.
On the Fiocruz Portal
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While this dramatic shift in the cases to a younger demographic is worrisome, we don't really have enough data to speculate on exactly what is driving it.
The P.1 (or some other) variant might be targeting a younger cohort, but these trends might just as plausibly be influenced by increasing`herd' immunity, greater social distancing, or vaccine uptake among the elderly.
In any event, this is a trend we'll be watching in the weeks ahead.
