Mortality in a swiftly repurposed hospital in northeast Brazil during the first and second COVID-19 waves: A retrospective cohort study

Ana Paula M Porto; José Xavier Neto; Francisco Jadson Franco Moreira; Antonio Brazil Viana Júnior; Camila Campos C das Dores; André R Castro Júnior; Flávio C Deulefeu; Virgínia A S Reis; Rafaela N Severino; Fernanda G Severino; Francisco Aislan da Silva Freitas; Nauber Bernardo Gois; Artur P Santos; Mayron F Oliveira; Carlos Roberto M R Sobrinho; Marcelo A Holanda; ResCOVID Task Force

doi:10.1016/j.ijregi.2023.03.009

Mortality in a swiftly repurposed hospital in northeast Brazil during the first and second COVID-19 waves: A retrospective cohort study

IJID Reg. 2023 Jun:7:182-190. doi: 10.1016/j.ijregi.2023.03.009. Epub 2023 Mar 21.

Authors

Ana Paula M Porto¹, José Xavier Neto^{1

2}, Francisco Jadson Franco Moreira¹, Antonio Brazil Viana Júnior¹, Camila Campos C das Dores¹, André R Castro Júnior¹, Flávio C Deulefeu³, Virgínia A S Reis³, Rafaela N Severino³, Fernanda G Severino³, Francisco Aislan da Silva Freitas¹, Nauber Bernardo Gois^{1

2}, Artur P Santos¹, Mayron F Oliveira¹, Carlos Roberto M R Sobrinho², Marcelo A Holanda¹; ResCOVID Task Force

Affiliations

¹ Escola de Saúde Pública do Estado do Ceará Paulo Marcelo Martins Rodrigues, Fortaleza, Ceará, Brazil.
² Secretaria de Saúde do Ceará, Fortaleza, Ceará, Brazil.
³ Instituto de Saúde e Gestão Hospitalar, Fortaleza, Ceará, Brazil.

Abstract

Background: The first months of the coronavirus disease 2019 (COVID-19) pandemic demanded rapid re-organization of available local resources. This study evaluated the performance of a private hospital in the Brazilian state of Ceará that was swiftly repurposed into a public tertiary COVID-19 centre during the first wave of the COVID-19 pandemic, and how it improved in the second wave.

Methods: This retrospective cohort study included 2492 patients with COVID-19 at Hospital Estadual Leonardo da Vinci (HELV) during the first and second waves. Demographic, clinical and laboratory data were collected using a dedicated web platform (ResCOVID). A Poisson regression model was used to estimate factors associated with in-hospital mortality.

Results: Differences in demographics and clinical features were found between the two waves. There was reduced in-hospital mortality during the second wave (36.2%) in comparison with the first wave (48.8%). Invasive mechanical ventilation showed the strongest association with increased risk of death in both waves {first wave: relative risk (RR) 4.28 [95% confidence interval (CI) 2.86-6.41], P<0.001; second wave: RR 12.94 (95% CI 3.4-49.12), P<0.001}.

Conclusions: HELV was a pillar in the strategic public health plan to respond to COVID-19 in Ceará, helping to assist a group of moderate-to-severe cases and reduce the pressure on emergency and primary care facilities. Although mortality in intubated individuals remained high, there was an overall decrease in the in-hospital mortality rate in the second wave.

Keywords: Brazil; COVID-19; Mortality; Public health.