Covid already represents 94% of consultations for flu syndromes in private emergency rooms

Covid-19 already represents 93.7% of flu syndromes treated in the emergency rooms of state-of-the-art private hospitals, shows unprecedented research by Anahp (National Association of Private Hospitals) with 21 institutions across the country.

Nine out of ten hospitals consulted report an increase in the number of Covid-19 cases in the last two weeks. Of the calls made in emergency rooms, 4.5% have resulted in hospitalization. Of those hospitalized, just over a quarter (28%) need intensive care.

The increase in cases is reflected in the occupancy rate of hospitals. In April, according to the survey, it was at 77.5%. At the end of May, it reached 84%. Anahp brings together 135 institutions, including Albert Einstein, Sírio-Libanês and Oswaldo Cruz, all in São Paulo.

“The moment is one of attention. There is a clear increase in hospitalizations, and hospitals are having to expand the allocation of beds for Covid. concern”, says Antônio Britto, executive director of Anahp.

The growth in cases has led hospitals to expand the number of isolation beds, to relocate procedures for patients with positive tests for the coronavirus and even to “step on the brakes” of elective surgeries.

Hospital Israelita Albert Einstein, for example, rebooked 114 beds for Covid, which were already vacant with a drop in cases in previous months. “We learned to be flexible and agile in the reconfiguration of hospitalization units. It transforms into Covid, then into non-Covid as needed”, says Miguel Cendoroglo Neto, the institution’s superintendent director.

In the first wave, the hospital had 186 patients admitted with Covid. “It seemed impossible to deal with those 186. In the second wave, we hit 305.” This Tuesday (7), Einstein had 72 inpatients, 54 of these in apartments and 18 in ICUs and semi-intensive units.

According to Cendoroglo, the balance of beds is still “positive”, but the hospital has decided to hold back some elective surgical procedures. “[Em meses anteriores] We even had ten patients hospitalized with Covid. As we are now over 70, it is to be expected that there will be a little difficulty in accommodation.”

At Hospital Sírio-Libanês, there was also a readjustment of beds that had already been deactivated for Covid. According to the hospital, on Tuesday (7), 43 people were hospitalized with the disease, six of them in the ICU. Two weeks ago, on May 24, 22 were hospitalized, four in the ICU.

In the São Camilo Hospital Network, there are 31 patients hospitalized with Covid-19, against eight on May 15.

At Hospital Alemão Oswaldo Cruz, the biggest impact so far has been in the emergency department. In four weeks, from the beginning of May until now, the number of people with respiratory symptoms has doubled, from 160 to 320. The positivity rate of tests for Covid has increased from 30% to 60% in this period.

This Wednesday (8), there were 41 patients hospitalized with Covid, of which 11 were in the ICU. On May 8, there were five hospitalized in total. The hospital has 32 apartment beds and 14 ICU beds dedicated to Covid, but can increase the number according to demand, according to José Marcelo Oliveira, director-president of Oswaldo Cruz. Current average occupancy rate is 90%

Immunosuppressed and older patients are the groups that have shown a greater degree of severity. “Among them, we know that the effectiveness of the vaccine is lower”, says infectologist Felipe Piastrelli, from the hospital infection control service.

Oswaldo Cruz has recorded postponements of some elective surgeries due to the confirmation of Covid in patients. As of early May, 0.5% of asymptomatic patients who were tested for Covid before scheduled surgeries had tested positive. Now, the rate has jumped to 1.5%.

For the manager of Oswaldo Cruz, the moment is of attention because the curve of cases has risen very fast in the last four weeks. “And we’re not seeing plateaus yet. We don’t know where we are on the curve. Nobody knows.”

The encouraging news is that, in general, the situation of hospitalized patients is less serious than in previous waves, according to Cendoroglo, from Einstein. “The average length of stay in the hospital has dropped a lot. It was just over ten days in March 2021, then it went to seven days at the peak of the omicron in January, and now it’s four days. It’s very close to non-Covid patients. “

This finding is prompting the hospital to review all admissions and assess whether they were really necessary.

Half of the patients admitted this Tuesday at Einstein were over 60 years old. Of the total, 85% declared themselves vaccinated against Covid with at least one dose, 13.9% said they were not immunized and 1.4% had no record in their medical records. The average age is 52 years, which reinforces the need for a fourth dose for people over 50 years of age.

Cendoroglo says that, in general, non-serious Covid patients are candidates for hospitalization when they are very prostrate and in need of hydration. “That’s why they are discharged soon, they need oxygen therapy much less.” Inflammation and throat infections have been classic symptoms.

According to Vanessa Teich, health economics superintendent at Einstein, other data reinforce this decrease in severity. In March 2021, of the 750 hospitalized at Einstein, 52% went to ICU or semi-intensive care and almost 20% needed mechanical ventilation. The mortality rate was 7.5%.

In January this year, of the 720 admissions, 28% went to the ICU or semi and 7% needed intubation. And the mortality rate was 5%. In April and May, of the 228 hospitalized, 28% went to the ICU, 2% needed hospitalization. The mortality rate is at 0.4%.

For infectious disease specialist Icaro Boszczowski, from Oswaldo Cruz, the lower frequency of serious cases has to do with the natural evolution of the pandemic, as people are vaccinated and, at the same time, exposed to the natural disease.

“The trend is that the next waves will be less intense, not from the point of view of the number of infected, but the level of severity. Until Covid becomes an endemic disease, which will have seasonal periods and hospitalizations of the most vulnerable, but that don’t stress the health systems so much.”