The Monomyth, the Journey and the Road Back: One-Year of a COVID-19 Hospital in São Paulo, Brazil

Abstract

Background: Using a dramaturgy concept as a feature, this study has the main objectives to describe the epidemiological profiles of hospitalized COVID-19 patients in a Brazilian public hospital, to verify changes over time, and to correlate them to possible background variables. \n \nMethods: A total of 4,122 patients from March 28, 2020 to March, 31, 2021 were analyzed with regards to the geographical patient origin, clinical status on admission, imaging results, clinical evolution, and outcomes. An overall analysis was performed comparing groups and establishing risks and correlations. The time analysis was categorized into quarters and compared the first to the second Brazilian pandemic wave. \n \nResults: In total, mortality increased with age, on male patients, with obesity, and with Chronic Obstructive Pulmonary Disease (p<.001). Severe pulmonary involvement, especially over 75% on chest computed tomography was associated with higher rates of mechanical ventilation (60.2%) and death (59%). A peak in mortality within the first hospitalized days associated with worse death rate on patients from longer distances (p<.001) and a positive correlation between severity score on admission and distance from the origin in Q2, 2020 (p<.001) reveals a potential healthcare system adaptation to the unexpected demand. Comparing both pandemic waves, younger and without co-existing diseases patients had increased hospitalizations and worse outcomes in Q1, 2021. \n \nConclusions: A tendency to worse outcomes in younger and with no comorbidities – and even in those with reduced severity scores on admission – may not be related to selection bias from vaccination and mortality over the year. Thus, analyzing all patients without testing for variants could lead to misconceptions on assumptions over COVID-19. Authors alert to the need to test for variants and to fingerprint current disease profiles for future actions worldwide. \n \nFunding Information: Authors did not receive any funding related to this article. \n \nDeclaration of Interests: The authors declare they have no conflicts of interest. \n \nEthics Approval Statement: This research was approved on Research and Ethics Committee under “Plataforma Brasil” (CAAE 356 45429121.0.000.0086).