COVID-19 Pandemic in Brazil: Clinical manifestation and effect of comorbidities on outcomes of hospitalized SARI cases

Hospitalized SARI (Severe Acute Respiratory Infection) cases reported to the Brazilian Ministry of Health through the SIVEP Gripe system are subject to our analysis. Out of 617,020 cases included in the analysis, 364,904 (59.1%) had COVID-19 as the etiologic agent, while the rest had another (called non-COVID). Clinical manifestations and comorbidities are reported for each group. Among COVID and non-COVID cases 50.4% and 46.4% used non-Invasive Ventilatory Support (nIVS), 21.2% and 16.8% used Invasive Ventilatory Support (IVS) and 36.6% and 29.8% were admitted to ICU. 40% and 25.2% in each group evolved to death. Mean length of hospitalization and ICU stay were higher in COVID patients (10.8 vs 8.6 and 10.2 vs 7.3 days).

The comparison in time of SARI cases from 2020 with those reported in 2019 showed an increase in reporting of non-COVID cases. The proportion of COVID-19 cases for whom PCR test was detectable was up to 90%, while in non-COVID cases it was less than 20%. Logistic Regression analysis showed that patients having less education had lower odds of PCR test being detectable.

Full logistic regression models were used to estimate the effect of comorbidities, severity of SARI, etiologic agent, age, sex and race on outcomes simultaneously. Heart disease, lung disease, diabetes, and obesity had significantly higher odds of being admitted to ICU, having used nIVS and IVS. These same comorbidities, immunosuppression, renal, and liver diseases had also higher odds of dying. Asthma on the other hand showed to be a protective factor and was associated with significantly lower odds of being admitted to ICU and dying of SARI. Females had significantly better outcomes. COVID patients had higher odds of being admitted to the ICU, receiving nIVS and IVS, and dying.