Hospitalizations for SARS Double in Brazil, Exerting Pressure on National Health System

RIO DE JANEIRO, BRAZIL – The number of people hospitalized for Severe Acute Respiratory Syndrome (SARS), a complication caused both by influenza viruses already known in Brazil and the novel coronavirus, has doubled this year. The number of hospitalizations in the country has reached 16,879, compared to 7,761 during the same period last year.

But only four percent of these cases (757 patients) tested positive for the Covid-19, according to the Ministry of Health, which did not report how many others tested positive for other types of flu or how many were tested in total.

Given the shortage of tests in the country, even among the severe cases – only those are now being tested due to the need to ration materials – the data are an indication that the number of infections with coronavirus may be even higher than the 4,579 cases and 159 confirmed deaths by last Monday.

Moreover, they point to the “perfect storm” that is forming in the country’s health network, according to warnings made by the Ministry itself: the current system is already overloaded not only by the aggressive Covid-19, but also by other viruses, such as H1N1, which terrorized the world for its high mortality rate in 2009.

As there is immunization for the other diseases, the portfolio advanced the vaccination campaign, which began for the elderly last week and runs until May for risk groups.

Hospitalizations for SARS increased exponentially this March, about two weeks after the first case of Covid-19 was confirmed in Brazil on March 25th (14 days is the incubation limit for the virus).

This increase in demand in health care facilities – an important factor in the equation about the overload in the hospital network and the risk of a collapse of the health system – raises two scenarios: either there is an unbridled increase of Influenza and other flu viruses in the country, or a massive part of this demand comes from the coronavirus: in this case, the testing shortage conceals the real impacts of Covid-19 on the health system.

“The strongest assumption is that the increase is due to the coronavirus,” says researcher Daniel Vilella, who regularly monitors the flu in Brazil through Fiocruz, using the same system as the data submitted by the Ministry of Health.

He explains that the Influenza curve, for instance, has a seasonal pattern and usually worsens in winter. In some years, this curve begins to grow a little earlier. “This year, the curve was higher since the start of the year. But over the past three weeks, this increase has been much greater and is consistent with the sustained transmission of coronavirus in Brazil,” adds Vilella.

Another clue on the impact of the coronavirus in this hospitalization report pointed out by the researcher concerns the age group of patients with severe acute respiratory syndrome.

“Typically, SARS has been more frequent in the 0 to 4 year-old range. But in recent weeks, it has been more frequent for individuals in the 60+ age group,” he explains. People over 60 are statistically more likely to develop a more severe case of Covid-19, according to experts.

The cases of severe acute respiratory syndrome are accounted for and the patients’ samples are collected and sent to specific laboratories to determine the cause. Initially, tests are conducted for influenza A, B and other viruses. If these are negative, the protocol is to conduct the specific test for the coronavirus.

The Ministry of Health has so far failed to report the percentage of patients hospitalized for severe acute respiratory syndrome that was actually tested for Covid-19. The country faces difficulties both with the global shortage of tests and the delay in their processing. There are reports of delays of up to ten days for the result, which also influences the final data.

“The protocol is to test, but that’s not comprehensive. It may end without conclusions,” says Daniel Vilella, in reference to the mention in the system of cases whose causes are left unidentified. “The increase is a warning for us to expand our testing capacity,” he says.

The Ministry of Health is trying to work on this, amid a worldwide limitation of testing. It has said in press conferences that the country can currently process 6,700 daily coronavirus tests, but that it would need to achieve 30,000 to 50,000 tests per day. Health officials claim they will probably not reach that target, since although there are resources, but there are not enough test suppliers.

However, the government says it will increase capacity with more laboratory tests and a rapid (less conclusive) test support, but they may be used in screening.

Infectologist Rosana Paiva believes that the exponential increase in hospitalizations for severe acute respiratory syndrome is an important reflection of the presence of the coronavirus in Brazil, but considers that other factors may influence this account, related to the protocols at the health facilities.

Since Covid-19 is a new disease and quickly develops into severe cases, both the population and health professionals would be doubling the care for suspected cases – which also include flu cases, since the initial symptoms are similar.

Paiva says there is a greater search for patients with some respiratory disorder and doctors have been more discerning in admitting them.

“Most suspected cases are untested. Even if it is a lung infection caused by other agents, doctors cannot rule out a diagnosis (of the coronavirus). There are many people admitted and we don’t have tests. So the doctors lack assurance and end up hospitalizing more, because Covid-19 evolves very fast,” he explains.

Testing has no influence on the care of people with Covid-19. In the absence of proven drugs to treat the disease, the doctors’ job is basically to assist the patient with difficulties in more severe cases (with ventilators and intubation) until he or she regains breathing ability.

Coronavirus admissions specifically in ICUs may last three times longer than admissions for other flus. The concern is that the health system, already experiencing high demand, will collapse. This means that even with the resources, it will not be able to attend a great demand of patients.

Thus the significance of social isolation, since it can flatten the curve of the disease by spreading out the number of infections over a longer period of time, as stressed by Minister Luiz Henrique Mandetta on Monday. He says the Ministry of Health is working to expand the SUS (National Health Service) capacity to meet the new demand.

“The virus is attacking the world health systems. It is more dramatic than major wars,” he said.