Although covid-19 is notably less aggressive in children than in adults, in Brazil the infant mortality rate due to the disease is well above that registered in other parts of the world. In the United Kingdom, for example, studies with hospitalized children point to a mortality of 1% (all with comorbidities). In Brazil, the number reaches 7.6%. But why does this happen?
According to a study developed by researchers at the Federal University of Minas Gerais and recently published by the scientific journal The Lancet, social factors, such as race and region, can be decisive for the evolution of the disease’s conditions. Furthermore, inequality and gaps in access to quality health care can also be determinants for the negative outcome.
“Our study outlined the profile of Brazilian children hospitalized with COVID-19 in 2020. Data from more than 80,000 children admitted to Brazilian hospitals with suspected covid-19 were analyzed. Of these, 11,613 had laboratory evidence of SARS-CoV-2 infection and were included in the analysis. This is the largest pediatric clipping of covid-19 published so far in the world,” Professor Eduardo Oliveira, a researcher at the Department of Pediatrics, of the Graduate Program in Health Sciences, Faculty of Medicine, explains to CRESCER. UFMG.
According to the researchers, among the age group of up to 20 years old, those who are at greater risk of death are children under 2 years old and adolescents. The presence of comorbidities was also strongly associated with the risk of death in these patients. In addition, the analysis showed that social factors (such as being hospitalized in the Northeast and North regions, greater social vulnerability and less access to health care) and indigenous ethnicity were independently associated with the worst prognosis.
“The results of our study highlight that social and health care inequalities can contribute to increasing the negative impact of covid-19 on the most vulnerable and socioeconomically disadvantaged children and adolescents in Brazil. This fact has also been reported in national and international studies of adult patients.Social and biological factors seem to be intricately interlinked and can act synergistically to increase the impact of the disease on this most vulnerable population.Furthermore, the pandemic situation has exacerbated the chronic deficiency of SUS funding. In the case of children, the scarcity of the disease of pediatric ICUs was evidenced, as our study shows that a significant percentage of children who required invasive ventilation were not admitted to these units”, highlights the researcher.
While here in Brazil 7.6% of the total of 11,613 young people hospitalized with covid-19 died (886 people), in the United Kingdom this number was only 1% (only 6 children out of the total 632 hospitalized in the country, all with declared comorbidities). This makes the number of children who died in Brazil from the disease to be about 7 times higher than in the United Kingdom. Of the 886 young people who died as victims of covid-19 in Brazil, 261 (or 31%) were not even admitted to the ICU.
The impacts of the second wave
After presenting the numbers for the year 2020, a new study in progress now analyzes data collected between January and May of this year. During the period, Brazil was facing the second wave of covid-19, probably related to the gamma variant (identified in Manaus, in January). “One aspect that caught our attention was that the average number of cases and deaths per week doubled in this period, when compared to the data from the first wave”, said Professor Oliveira.
In this study, still in the preliminary phase, the mortality rate remained high, with a proportion similar to the first study (7.7%), but a more severe picture of the disease was observed in children and adolescents, with higher prevalence of hypoxemia (low oxygen concentration), hospitalization in ICUs and need for invasive ventilation, according to the researcher.
“With ongoing vaccination programs, our study underscores that the specific needs of the most susceptible pediatric patients should be considered a priority in the context of future directions for preventive measures and therapeutic strategies for these groups,” he said.
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