A retrospective cohort study of 238,000 COVID-19 hospitalizations and deaths in Brazil.

The coronavirus disease (COVID-19) pandemic has overwhelmed health care systems in many countries and bed availability has become a concern. In this context, the present study aimed to analyze the hospitalization and intensive care unit (ICU) times in patients diagnosed with COVID-19. The study covered 55,563 ICU admissions and 238,075 hospitalizations in Brazilian Health System units from February 22, 2020, to June 7, 2021. All the patients had a positive COVID-19 diagnosis. The symptoms analyzed included: fever, dyspnea, low oxygen saturation (SpO2 < 95%), cough, respiratory distress, fatigue, sore throat, diarrhea, vomiting, loss of taste, loss of smell, and abdominal pain. We performed Cox regression in two models (ICU and hospitalization times). Hazard ratios (HRs) and survival curves were calculated by age group. The average stay was 14.4 days for hospitalized patients and 12.4 days for ICU patients. For hospitalized cases, the highest hazard mean values, with a positive correlation, were for symptoms of dyspnea (HR = 1.249; 95% confidence interval [CI], 1.225-1.273) and low oxygen saturation (HR = 1.157; 95% CI 1.137-1.178). In the ICU, the highest hazard mean values were for respiratory discomfort (HR = 1.194; 95% CI 1.161-1.227) and abdominal pain (HR = 1.100; 95% CI 1.047-1.156). Survival decreased by an average of 2.27% per day for hospitalization and 3.27% per day for ICU stay. Survival by age group curves indicated that younger patients were more resistant to prolonged hospital stay than older patients. Hospitalization was also lower in younger patients. The mortality rate was higher in males than females. Symptoms related to the respiratory tract were associated with longer hospital stay. This is the first study carried out with a sample of 238,000 COVID-19 positive participants, covering the main symptoms and evaluating the hospitalization and ICU times.

Determinants of access to the SARS-CoV-2 vaccine: a preliminary approach.

BACKGROUND: The determinants of access to immunizers are still poorly understood, leading to questions about which criteria were considered in this distribution. Given the above, the present study aimed to analyze the determinants of access to the SARS-CoV-2 vaccine by different countries. METHODS: The study covered 189 countries using data from different public databases, and collected until February 19, 2021. We used eight explanatory variables: gross domestic product (GDP), extreme poverty, human development index (HDI), life expectancy, median age, coronavirus disease 2019 (COVID-19) cases, COVID-19 tests, and COVID-19 deaths. The endogenous variables were total vaccine doses, vaccine doses per thousand, and days of vaccination. The structural equation modeling (SEM) technique was applied to establish the causal relationship between the country's COVID-19 impact, socioeconomic variables, and vaccine access. To support SEM, we used confirmatory factor analysis, t-test, and Pearson's correlation. RESULTS: We collected the sample on February 19, and to date, 80 countries (42.1%) had already received a batch of immunizers against COVID-19. The countries with first access to the vaccine (e.g., number of days elapsed since they took the first dose) were the United Kingdom (68), China (68), Russia (66), and Israel (62). The countries receiving the highest doses were the United States, China, India, and Israel. The countries with extreme poverty had lower access to vaccines and the richer countries gained priority access. Countries most affected by COVID (deaths and cases) also received immunizers earlier and in greater volumes. Unfortunately, similar to other vaccines, indicators, such as income, poverty, and human development, influence vaccines' access. Thus affecting the population of vulnerable and less protected countries. Therefore, global initiatives for the equitable distribution of COVID need to be discussed and encouraged. CONCLUSIONS: Determinants of vaccine distribution consider the impact of the disease in the country and are also affected by favorable socioeconomic indicators. The COVID-19 vaccines need to be accessible to all affected countries, regardless of their social hands.