Download This Paper
Preprints with The Lancet is part of SSRN´s First Look, a place where journals identify content of interest prior to publication. Authors have opted in at submission to The Lancet family of journals to post their preprints on Preprints with The Lancet. The usual SSRN checks and a Lancet-specific check for appropriateness and transparency have been applied. Preprints available here are not Lancet publications or necessarily under review with a Lancet journal. These preprints are early stage research papers that have not been peer-reviewed. The findings should not be used for clinical or public health decision making and should not be presented to a lay audience without highlighting that they are preliminary and have not been peer-reviewed. For more information on this collaboration, see the comments published in The Lancet about the trial period, and our decision to make this a permanent offering, or visit The Lancet´s FAQ page, and for any feedback please contact preprints@lancet.com.
The Monomyth, the Journey and the Road Back:
One-Year of a COVID-19 Hospital in São Paulo, Brazil
27 Pages Posted: 25 Jun 2021
More...Abstract
Background: Using a dramaturgy concept as a feature, this study has the main objectives to describe the epidemiological profiles of hospitalized COVID-19 patients in a Brazilian public hospital, to verify changes over time, and to correlate them to possible background variables.
Methods: A total of 4,122 patients from March 28, 2020 to March, 31, 2021 were analyzed with regards to the geographical patient origin, clinical status on admission, imaging results, clinical evolution, and outcomes. An overall analysis was performed comparing groups and establishing risks and correlations. The time analysis was categorized into quarters and compared the first to the second Brazilian pandemic wave.
Results: In total, mortality increased with age, on male patients, with obesity, and with Chronic Obstructive Pulmonary Disease (p<.001). Severe pulmonary involvement, especially over 75% on chest computed tomography was associated with higher rates of mechanical ventilation (60.2%) and death (59%). A peak in mortality within the first hospitalized days associated with worse death rate on patients from longer distances (p<.001) and a positive correlation between severity score on admission and distance from the origin in Q2, 2020 (p<.001) reveals a potential healthcare system adaptation to the unexpected demand. Comparing both pandemic waves, younger and without co-existing diseases patients had increased hospitalizations and worse outcomes in Q1, 2021.
Conclusions: A tendency to worse outcomes in younger and with no comorbidities – and even in those with reduced severity scores on admission – may not be related to selection bias from vaccination and mortality over the year. Thus, analyzing all patients without testing for variants could lead to misconceptions on assumptions over COVID-19. Authors alert to the need to test for variants and to fingerprint current disease profiles for future actions worldwide.
Funding Information: Authors did not receive any funding related to this article.
Declaration of Interests: The authors declare they have no conflicts of interest.
Ethics Approval Statement: This research was approved on Research and Ethics Committee under “Plataforma Brasil” (CAAE 356 45429121.0.000.0086).
Suggested Citation: Suggested Citation
One-Year of a COVID-19 Hospital in São Paulo, Brazil. Available at SSRN: https://ssrn.com/abstract=3873820 or http://dx.doi.org/10.2139/ssrn.3873820