Covid: Brazil reaches 700,000 deaths with change in deaths – 03/28/2023 – Health

Three years after the first death from Covid in the country, Brazil reaches the sad mark of 700,000 deaths from the disease in a scenario marked by paradoxes.

According to the National Council of Health Secretaries (Conass), in the last week, the country reached an accumulated 700,239 deaths from the disease.

While the pandemic has recently slowed down due to advances in vaccination, the country still faces challenges such as low vaccination coverage against Covid in some age groups, such as children under five.

Interspersed with stories of lost lives, the milestone of 700,000 deaths is also accompanied by a change in the profile of mortality from the disease compared to other periods – with a higher proportion of deaths now in people over 80 and immunosuppressed, for example.

InfoGripe survey, Fiocruz system that tracks records of severe respiratory syndromes, including Covid, also points to up to three times higher mortality from Covid in unvaccinated people compared to those who received doses.

For experts, vaccination is the key to explaining the slowdown of the pandemic in recent months.

An example of this is in the previous milestones of the epidemic in the country.

From the first death from Covid in Brazil, in March 2020, to the record of 100,000 deaths from the disease, in August 2020, almost five months passed. The other records (from 200,000, 300,000 to 600,000 deaths) all occurred in 2021, with two of them at intervals of just over a month. This time, it took the country more than a year and five months to reach the 700,000 death mark.

The total consolidates Brazil as the second country in accumulated deaths from Covid, behind only the United States.

In practice, it is as if the population of an entire capital, like Aracaju, had disappeared from the map little by little in the last three years. The total of victims of the disease is also equivalent to the population, added, of 337 municipalities among those of smaller size.

“It’s what we call preventable deaths”, says Marcelo Gomes, coordinator of InfoGripe, for whom the number of deaths could have been lower if the country had adopted control policies earlier.

“We could, for example, have had a faster and more effective vaccination, with more adequate communication with the population, without unnecessary discussions and noise that raised doubts and led several people not to be vaccinated.”

Despite this delay and persistent challenges, vaccination began to make progress in the second half of 2021 and, since then, has already brought changes in the profile of mortality from the disease.

An example is data on the proportion of deaths from Covid among different age groups.

In the last quarter of 2020, before vaccination began, the 60-79 age group accounted for the highest proportion of deaths from the disease (50%), according to data from the Influenza Epidemiological Surveillance Information System (Sivep-Flu).

The population aged over 80 appeared in second place, with 29%, and those aged 45 to 59, in third, with 15%.

In the second quarter of 2021, with vaccination already underway, the proportion of victims both aged 60 to 79 years (43%) and over 80 years (13%) fell. Those aged 45 to 59, on the other hand, rose (30%).

Already in this first quarter of 2023, the highest proportion of deaths is registered in people over 80 years old (43%), followed by the 60 to 79 years old group (42%). The 49 to 59 year olds account for 9%.

“As vaccination progressed, we saw an overall reduction in risk [de morte] for all age groups, but for young adults this decrease was much greater than for the elderly”, says Gomes.

The reason is the lower vaccine response among the elderly – a phenomenon called immunosenescence, when there is a natural decline in the immune system due to aging.

Bulletin data from the Ministry of Health also show that, of the deaths recorded by Covid in 2022, 66.5% were of people who had comorbidities, most of them also elderly.

“What we clearly observe after a large portion of the world’s population was immunized is that Covid is concentrated in the most vulnerable groups. Who are they? Unvaccinated people and, in Brazil, especially children”, says infectologist Julio Croda, professor at UFMS (Federal University of Mato Grosso do Sul). “And another group are people who don’t respond well to the vaccine because that protection doesn’t last long, who are elderly and immunosuppressed.”

“Covid-19, now in 2023, is a completely different disease than when we first met it in 2020. At that time, I had patients under 40 years old who, even without comorbidities, evolved to death”, reports Alexandre Naime, vice president of the Brazilian Society of Infectology.

“With vaccination, today the serious conditions that progress to death are of people who have some impairment in the immune response, such as people of extreme age and immunosuppressed”, he completes.

Another group that recorded an increase in the proportion of deaths from Covid was that of children under five, a reflection of low vaccination coverage.

“It’s worrying”, points out the doctor and researcher Fátima Marinho, senior consultant at Vital Strategies, who also points out that there is underreporting.

Data from the Ministry of Health indicate that only 48% of children up to 11 years old received the first dose of vaccine against Covid. Furthermore, only 33% took the second.

For Marinho, it is necessary to strengthen strategies to recover the incentive for vaccination. “If this low coverage is not reversed, it will affect children a lot, because they are already more susceptible to respiratory diseases.”

As for the elderly, specialists say that a strategy would be, in addition to reinforcing protection with the bivalent vaccine, to increase the supply of antiviral treatment.

In November, the SUS decided to incorporate Paxlovid into the network, an association between the antivirals nirmatrelvir, ritonavir and approved by Anvisa for the treatment of mild and moderate cases in patients at higher risk of hospitalization. The health network also has other options, such as baracetinib, indicated for severe cases.

Prescription, especially for Paxlovid, however, is still low, says Naime. “Many times doctors don’t even know that the drugs are available. Then we end up admitting the patient with severe Covid.”

According to the Ministry of Health, around 50,000 Paxlovid treatments have been distributed to the states to be used in the indicated cases. An equivalent amount has yet to be distributed, he informs.

In a note, the folder also warns that, in order for the downward trend in deaths from Covid to continue, it is necessary for the population to vaccinate and complete the vaccination schedule with all recommended doses.

Since the end of February, the government has carried out a campaign with the bivalent vaccine, which also protects against the omicron variant and subvariants. The idea is to vaccinate more vulnerable groups, such as the elderly, immunocompromised people, pregnant women, among others.

The measure comes at a time when recent data from InfoGripe, accounted for until March 13, showed a trend towards an increase in cases, a scenario that, according to Gomes, should now be repeated at different times.

“We came with a downward trend, but we have already begun to observe a reversal trend.” According to him, Carnival may have contributed, but it should not be the only factor. “Our hypothesis is that this is a result of the natural cycle of the disease”, says the researcher, according to whom a possible seasonal pattern is still not well defined.

Recently, the WHO (World Health Organization) even brought together experts to discuss the possibility of reviewing the global health emergency status by Covid. The group, however, decided it was too soon for that.

For Croda, the data show that Covid may be on the way to becoming endemic, but the scenario still needs to be observed further. The disease has also shown a new profile.

“What has changed is that it is becoming lighter in general. The symptoms are milder, because the population has acquired some type of immunity, and this somehow impacts on the clinical presentation. Before, we had a lot of shortness of breath. Now we see more patients in ward beds, not necessarily in intensive care beds”, he says.

“Perhaps, in the future, if the virus becomes seasonal, and respects a period of greater occurrence, such as winter, we can apply the vaccine in the same period to the population.”

Uncertainties about the future of the disease reinforce the importance of vaccination and protection policies.

“Covid has not ceased to be an important problem just because [o número de mortes] it has decreased in relation to the catastrophe of previous years”, says Gomes. “These are still expressive values, and it is one of the main causes of death.”