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• W3190402337 abstract "Background: The second wave of the COVID-19 pandemic was more aggressive in Brazil compared to other countries around the globe. Considering the Brazilian peculiarities, we analyze the in-hospital mortality concerning socio-epidemiological characteristics of patients and the health system of all states during the first and second waves of COVID-19. Methods: We performed a cross-sectional study of hospitalized patients with positive RT-PCR for SARS-CoV-2 in Brazil. Data was obtained from the Influenza Epidemiological Surveillance Information System (SIVEP-Gripe) and comprised the period from February 25, 2020, to April 30, 2021, separated in two waves on November 5, 2020. We performed a descriptive study of patients analyzing socio-demographic characteristics, symptoms, comorbidities, and risk factors stratified by age. In addition, we analyzed in-hospital and intensive care unit (ICU) mortality in both waves and how it varies in each Brazilian state.Findings: Between February 25, 2020 and April 30, 2021, 678 235 patients were admitted with a positive RT-PCR for SARS-CoV-2, with 325 903 and 352 332 patients for the first and second wave, respectively. The mean age of patients was 59$.65 (IQR 48.0 - 72.0). In total, 379 817 (56.00%) patients had a risk factor or comorbidity. The most common symptoms at hospital admission were dyspnea, cough, and oxygen saturation <95%. In-hospital mortality increased from 34.81% in the first to 39.30% in the second wave. In the second wave, there were more ICU admissions, use of non-invasive and invasive ventilation, and increased mortality for younger age groups. The southern and southeastern regions of Brazil had the highest hospitalization rates per 100 000 inhabitants. However, the in-hospital mortality rate was higher in the northern and northeastern states of the country. Racial differences were observed in clinical outcomes, with white being the most prevalent hospitalized population, but with blacks/browns having higher mortality rates. Younger age groups had more significant differences in mortality as compared to groups with and without comorbidities in both waves.Interpretation: We observed a more significant burden on the Brazilian hospital system throughout the second wave. Furthermore, a greater number of hospital beds was not able to reduce mortality, and the north and northeast of Brazil, which present lower Human Development Indexes, concentrated the worst in-hospital mortality rates. The highest mortality rates are also shown among vulnerable social groups. Finally, we believe that the results can help to understand the behavior of the COVID-19 pandemic in Brazil, helping to define public policies, allocate resources, and improve strategies for vaccination of priority groups.Funding Information: The authors would like to thank the Coordinating Agency for Advanced Training of Graduate Personnel (CAPES) (C.F. 001) and the National Council for Scientific and Technological Development (CNPq) (No. 309537/2020-7).Declaration of Interests: We declare no competing interests.Ethics Approval Statement: Following ethically agreed principles on open data, this analysis did not require ethical approval in Brazil." @default.
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• W3190402337 date "2021-01-01" @default.
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• W3190402337 title "First and Second COVID-19 Waves in Brazil: A Cross-Sectional Study of Patients’ Characteristics Related to In-Hospital Mortality" @default.
• W3190402337 doi "https://doi.org/10.2139/ssrn.3894389" @default.
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