SÃO PAULO – Data compiled by Brazilian Intensive Care Medicine Association (Amib) point out that one in three coronavirus patients (36.6%) died after needing to be admitted to the ICU during the pandemic. Proportionally, mortality is higher in the public network, with a rate of 52.9%, according to the survey. In private hospitals, the death rate is 29.7%. In Brazil, the number of deaths from the disease every 24 hours is already approaching 4 thousand and health networks in several regions have already collapsed, with a lack of beds or medicines for intubation.
Information on mortality in intensive care beds is contained in the Brazilian UTIs platform, with the objective of guiding health managers, which gathers data from 652 hospitals – equivalent to about 25% of intensive care units in the country. There are 403 units from the private network and 249 from the public network, which correspond to 20,865 beds.
Member of the Advisory Board and former president of Amib, Ederlon Rezende is the coordinator of the platform. For him, the fact that the public network is receiving patients in a more acute situation helps to understand the difference between mortality rates. “When we talk about public and private ICUs, the first thing to note is the percentage of patients on mechanical ventilation, that is, the most serious cases,” he says.
“In public hospitals, this represents about 65% of the people served, while in private ICUs it is 40%. The data, alone, already explains why mortality is higher.” He ponders, however, that there is also a discrepancy when comparing lethality only in intubated patients. In the public network, the index is 72.4%, according to the Brazilian ICUs. In particular, it is 63.6%. For patients who do not need ventilation, the mortality rate is 17.1% (public) and 7.6% (private), respectively.
“If I consider that it is also different in this subgroup, then I must admit that there are other variables influencing it, although there is no way to prove what they are”, says Rezende. Among the possible factors, he cites better infrastructure of the private network and greater difficulty in finding a place in a public hospital.
“When there is a queue to get a place in the ICU, especially now with the system collapsed, the patient arrives with an aggravated condition”, he says. “This compromises the outcome, increasing the risk of dying.”
Also according to the platform, the hospitalization period for covid-19 is longer in the public ICU. In these units, 54.2% stay more than seven days. The rate is 48.6% in the private sector. In general, the average length of stay is 12.6 days.
The worse, the worse
The survey also shows that, with the escalation of new cases in recent weeks, the lethality rate has been rising in the ICUs. According to Rezende, overload in hospitals decreases the ability to serve patients with quality. A survey by Fiocruz this week showed 24 states and the Federal District with occupancy rates above 80% in intensive care units. To avoid aggravating the collapse and curbing transmission rates, governors and mayors have increased isolation measures and adopted them until the lockdown.
“In the first semesters, mortality in general was 32%. Now, between December and February, it was 38%”, says the expert. “It means an 18.7% increase in mortality, which is quite significant.”
For Rezende, “it is clear that it is no longer useful to open an ICU” and it is necessary to “reduce the number of cases and be more rigorous in the circulation of people”. “The new beds end up being important to offer dignity and the person does not die in the UPA or on the street”, he says. “However, it must be clear that the limit has already been reached. There are places that have tripled the number of ICUs and some do not have an adequate structure, especially with regard to the qualification of the teams. This compromises the result”, he highlights.
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