Study raises the number of deaths from Covid in Brazil by 18% in 2020

Brazil may have had 37,000 more deaths from Covid-19 than was recorded in the first year of the pandemic due to failures in reporting, new research suggests. The estimate represents an increase of 18% compared to official figures.

According to the study, published this Thursday (5) in the journal Plos Global Public Health, the country lost 243,000 lives in 2020 by Covid, and not the 206,000 recorded. For Elisabeth França, professor of the postgraduate program in Public Health at UFMG (Federal University of Minas Gerais) and lead author, it is the first research published to estimate deaths at a national level based on the determination of real deaths with causes related to Covid.

Problems with reporting a death can occur because a death certificate often lists multiple causes. However, explains França, among these explanations there is a basic cause — the one that triggers all the other problems in the body that would have led the person to death.

The study filtered out deaths that did not have Covid-19 as the underlying cause, but other reasons that were related to the disease caused by Sars-CoV-2. Some examples are Srag (Severe Acute Respiratory Syndrome), unspecified pneumonia and respiratory failure.

Initially, the research analyzed 1,365 deaths that entered these parameters in the period between February and June 2020 in three Brazilian capitals: Belo Horizonte, Natal and Salvador.

From there, the researchers used methods to verify whether the deaths were caused by Covid. Two ways were to investigate the clinical picture and the examination for the disease.

In this case, patient information was compared with test results to identify whether the person had the infection. “Sometimes the doctor asks for the laboratory test, but the patient progresses to death before the result. So Covid is not included in the causes”, explains França.

Similarly, the researchers compared data from these patients with information from Sivep-Gripe, the Ministry of Health’s system that monitors Covid-19 cases.

If it was observed that the person was in this database or had a positive laboratory test, along with a clinical history common to Covid, the researchers considered the death to be caused by the disease. These cases were called definitive.

There were also situations of patients who did not have positive records for Covid, but had a similar clinical picture. In these circumstances, doctors analyzed the medical records in detail and exams, such as lung X-rays. Thus, they were able to indicate other patients who would have Covid as the underlying cause of death – this group was classified as probable.

Other deaths did not have lung images and also did not have a positive test, but the clinical picture and course of the disease were very similar to those of the infection. Therefore, some of these also had Covid-19 considered as the underlying cause according to the analysis carried out by the study experts – they were called possible cases.

With this methodology, the researchers found that, of the 1,365 deaths investigated in the municipalities, 319 would have been caused by Covid.

To make the national estimate, the scientists noted that deaths from Covid-related causes had been higher in 2020 compared to the average from 2017 to 2019, particularly in May, which was when there was a spike in Covid deaths.

According to França, this was an indication that this excess of deaths could be from unreported Covid cases. The metrics found in the study of the three capitals were then applied to the numbers of deaths attributed to these other causes.

“Considering that these municipalities could represent what was happening in the country as a whole, we evaluated these causes of death for each state in Brazil and the proportion that we found in the cities”, explains the professor.

global problem

The WHO (World Health Organization) announced this Wednesday that the pandemic has caused between 13.3 and 16.6 million deaths since January 2020 in December 2021, a number much higher than the 5.4 million officially registered by countries.

For France, changes in the health systems and the training of doctors for this type of record can minimize, in the future, the problem of underreporting.

“Many times doctors put many causes, but do not point out the underlying cause. So, there is no way to know what caused the events that lead the person to death”, he exemplifies.

She recalls that knowing precisely the reason for the deaths helps in the formulation of more effective public health policies. “The correct mortality data is important from the point of view of assessing the severity of the pandemic”, she concludes.