People aged 80 or over who were admitted to the public health system in the city of São Paulo with severe covid-19 had less chance of surviving than those who sought private care, according to official figures from the Ministry of Health.
The information is contained in the Severe Acute Respiratory Syndrome (SRAG) database, supplied with information sent by health units across the country since the beginning of the pandemic and updated until September this year.
According to government data, for every 100 people in this age group who were admitted to state and municipal health units in the capital, 58 died, on average. In private units this number was lower: 46.
The state government reported having found divergences between its internal databases and the Ministry of Health’s information. The Municipality of São Paulo said it considered the comparison inadequate (see below).
The Ministry of Health is the only one to release covid-19 infection data detailed by health unit in the country. Even so, the feeding of information into the system is the responsibility of those responsible for providing care at the end, that is, private health groups, states and municipalities.
Health professionals are instructed to fill out a paper form. Subsequently, the sheets are typed in a system directly connected to Brasília. According to the ministry’s protocol, the database only considers hospitalizations with observation of the symptoms that characterize the serious condition of the disease.
In addition to obtaining information directly from the federal government portal, the UOL asked two specialists to do the same work, to guarantee the authenticity of the numbers and the correctness of the treatment applied to them. An economist from the Central Bank and a transparency NGO from Mato Grosso were consulted.
The data show different proportions of deaths due to hospitalization in the capital of São Paulo for elderly patients treated in units administered by the city hall and the state.
According to the database, for every 100 patients aged 80 years or older with a positive diagnosis for covid-19 seen at municipal units, 54 died. In the state network, this number reached 62.
As expected, the highest death rates occurred in units that worked in more complex cases. In the case of the municipal network, the rates of municipal hospitals are worse than those of UPAs (Emergency Care Units). In the first case, there are 53 deaths for every 100 hospitalized; in the second, 49.
In the case of the state network, the worst data are in general hospitals in the periphery, such as Vila Alpina (eastern area, 66 deaths per 100), Mandaqui (north area) and Pedreira, in the southern area (56 deaths per 100, each).
“Our ICUs do not have the same structure”
Infectologist physician and specialist in public health at Fiocruz Amazônia, Marcus Vinícius Lacerda believes that the disparity is expected. According to him, historically the private network has better equipment, supplies and specialist professionals than the SUS (Unified Health System).
“Unfortunately, our ICU beds do not have the same structure [da rede privada]”, he said. He recalled that the lack of equipment for extracorporeal breathing, good respirators, professionals specialized in ICU and adequate systems for dialysis of patients is common in the public health system.
“This explains that other data we’ve seen, since last year, that the poor died more. In addition to the lack of access, late diagnosis, the poorest person goes to the public bed,” he said.
Preconditions harm SUS, says researcher
A public health researcher at Fiocruz and coordinator of the Infogripe project, which monitors the national covid-19 indexes, Marcelo Gomes recalls that unfavorable previous conditions of people in socioeconomic vulnerability situations help a little to explain the difference in numbers in the public and private networks .
“The higher incidence of diabetes and tuberculosis, poor eating, leisure and health habits increase the risk of death for covid-19. Even if cared for in a private network, it is possible that many of these cases had the same outcome. of a debate about the capacity of the SUS to offer adequate care”, he argues.
Activist in the area of public transparency, the lawyer and member of the Social Observatory of Mato Grosso Pedro Valim Fim said that information on mortality in hospitals should be disclosed more easily to citizens, as well as the number of deaths, occupation of beds and moving average of deaths for covid-19, not only nationally but regionally.
Currently, to have access to covid-19 data in hospitals, it is necessary to download from the Ministry of Health website files that total almost 2 gigabytes and that need to be worked on in specific software. There is no simplified visualization of the numbers, as with other general indicators of the fight against the pandemic in the country.
Valim Fim recalls that the director of the equivalent of the SUS in England, the NHS, forced health facilities to disclose success rates of cardiac surgeries and this improved the quality of care.
For him, the increase in transparency about mortality in hospitals favors a culture of “healthy competition between institutions and evaluating what the best practices are”. “What does this hospital that has better indicators do differently?”
Epidemiologist Ana Paula Muraro, a professor at the Institute of Collective Health at the Federal University of Mato Grosso, said that the conditions of SUS patients hinder the success of care. “It is necessary to consider the inequalities of access and patient profile that are likely to be the determining factors of prognosis, not just the care received during hospitalization specifically,” she said.
Government says different public prevents comparison
Through a note, the state government informed that it does not consider it correct to compare “services with different care profiles, which consequently received patients with different profiles”.
The government recalled that state hospitals are focused on “medium and high complexity”, which would explain the occurrence of different numbers in the primary, municipal network, which is responsible for absorbing “less complex” cases.
“In the pre-pandemic phase, hospitals under state management already accounted for more than 65% of the clinical and ICU beds among the services of the Covid-19’s contingency plan for coping in São Paulo, absorbing the most serious cases of the disease since the beginning of the pandemic,” the staff wrote.
The government also noted that the main referral services for critically ill patients are state, regional units responsible for treating patients from less structured hospitals and various municipalities.
“Unlike what conventionally happens with municipal or private services, which generally serve the population residing in the city where they are installed”, he added.
The government of São Paulo said it has different mortality rates for the hospitals in Mandaqui, Pedreira and Vila Alpina, in its database, but could not explain why the notifications to the Ministry of Health are different from the data it has.
In government records, death rates for internees aged 80 and over in Vila Alpina would be 39%; in Pedreira, 44% and, in Mandaqui, 28%.
Comparison is “simplified”, says city hall
The City of São Paulo classified the comparison of deaths and hospitalizations between spheres of management as “simplified” and inadequate. He said that he considers a “complex analysis” is necessary, considering the specific characteristics of each service, the levels of complexity of care, the number of available beds and the profile of patients, among other factors.
“This type of comparison does not portray reality and leads to misinterpretations of the situation of the pandemic in the city of São Paulo.”
O UOL asked the city hall for its own analysis of the data, in light of the complexity and factors cited by it. The municipal administration did not respond.
For the sanitary doctor Gonzalo Vecina, the comparison is not wrong. “It must be done in order to have conditions to improve the service provided by the SUS. The data are important for this type of reflection to take place.”