High of 139% in hospitalizations of pregnant women raises alert for record maternal deaths by Covid

Hospitalizations of pregnant and postpartum women due to Srag (Severe Acute Respiratory Syndrome) rose again from the end of December in the country, returning to the levels of July, after five months of stability.

In the last epidemiological week of December, there was a 139% increase in hospitalizations (from 147 to 351) compared to the same period in November, before the blackout of the Ministry of Health’s database.

If only confirmed cases of Srag by Covid-19 are considered, the increase is 62% (from 32 to 52). The suspicion is that, in addition to the advancement of the ômicron, the H3N2 flu epidemic is also responsible for part of this high, but, due to lack of testing, it is not possible to know the percentage.

Although hospitalizations for Srag have grown in similar proportions in the general population, the increase captured by the OOBr (Brazilian Obstetrics Observatory) based on data from the Ministry of Health raises another alert.

It comes at a time when Brazil is registering a record number of maternal deaths, making it virtually impossible to reach a UN global target of reducing the maternal mortality rate to 30 cases per 100,000 live births by 2030.

Preliminary data show that from January to September 2021 the country recorded 2,450 maternal deaths, a number 23% higher than that recorded in 2020 and 42% in 2019. As a result, the mortality rate reached 123.4 per 100,000 births. alive, a rate compared to African countries and four times above the global target. It is estimated that 40% of these deaths are related to Covid-19.

Before the pandemic, Brazil already had a bad rate of 55 deaths per 100,000 births. With the health crisis, it got even worse. “It was a massacre of pregnant and postpartum women, without any action on the part of public policy, we didn’t even have a vaccination campaign for this public”, says epidemiologist Fátima Marinho, a senior researcher at Vital Strategies and an expert on the subject.

Although studies show that pregnancy and postpartum increase the risk of complications and death from Covid-19, making the lethality even higher in this group, in Brazil the high number of maternal deaths associated with the disease is mainly attributed to the lack of adequate assistance.

Since the beginning of the pandemic, one in five pregnant and postpartum women (22.6%) killed by Covid have not had access to the ICU and 33.3% have not been intubated, a last therapeutic resource for severe cases of Covid-19. In 2020, a study placed Brazil as the world leader in maternal deaths from Covid – among the general population, the country is the second with the most deaths in official data, behind the USA.

For the gynecologist and obstetrician at Hospital das Clínicas, Rafaela Alkimin da Costa, one of the researchers at the OOBr, the data clearly show that the curve of hospitalizations has grown again and that, more than ever, attention is needed to stop them and avoid more maternal deaths.

A recent study by the OOBr shows that pregnant and postpartum women hospitalized without any dose of the Covid vaccine have a risk of death from Srag 5.26 times greater than those with the full immunization cycle.

Among pregnant and postpartum women without any dose, the case fatality rate, considering only severe cases, is 14.6%. In the group with at least one dose, it drops to 9.3%. With the two doses, it reduces to 3.2%.

“Because it is a new vaccine, this group was excluded in the first months of the vaccination campaign against Covid. There was a delay in immunization and no policy aimed at these people”, says Rafaela Costa.

According to the obstetrician, due to the blackout of data at the Ministry of Health, there is still no updated information on the percentage of pregnant women currently vaccinated. Until last October, only 4.3% of pregnant and postpartum women hospitalized with Srag had taken both doses of the vaccine.

“The more complete the vaccination schedule, the more evident the protection. You have to take the second dose and the booster dose as well. You have to keep safe distance, use a mask, hand hygiene. The pandemic is not over”, she says.

Last year, the death by thrombosis of a pregnant woman in Rio de Janeiro after vaccination against Covid and the spread of fake news on the networks about immunization, scared many pregnant women and mothers in the postpartum period. Without public enlightenment campaigns, the reflexes last until today, according to experts.

At the beginning of May 2021, the number of deaths of pregnant women was around 65 weekly. As of August, when vaccination was already extended to pregnant women without comorbidities, the number of deaths dropped to less than ten per week. Between the end of November and December, three deaths were recorded, but there are still delayed data due to the blackout.

The impact of the flu epidemic on pregnant women is also unclear, according to Rafaela da Costa. The vast majority of hospitalizations for Srag in this group have an unknown etiologic agent (72%). “We know that influenza is a very aggressive virus in pregnant women”, observes the doctor.

Therefore, according to her, it is very important that pregnant women are also vaccinated against influenza because there is evidence that immunization provides protection for severe forms of Covid. “It may not be the same virus, the immune response may not be the same, but somehow the vaccine works on the immune system.”

All these actions to protect pregnant and postpartum women should be part of public policies to avoid more hospitalizations and deaths, according to Fátima Marinho.

“It is a population at risk, specific care protocols, referral and counter-referral systems should have been organized. Even the decision to vaccinate them took a long time. This postponement had an impact on the health of these women, but there is still much to be done because the pandemic is still there.”