COVID-19 – The Availability of ICU Beds in Brazil during the Onset of Pandemic

Abstract

Background: Brazil faces some challenges in the battle against the COVID-19 pandemic, including: the risks for cross-infection (community infection) increase in densely populated areas; low access to health services in areas where the number of beds in intensive care units (ICUs) is scarce and poorly distributed, mainly in states with low population density. Objective: To describe and intercorrelate epidemiology and geographic data from Brazil about the number of intensive care unit (ICU) beds at the onset of COVID-19 pandemic. Methods: The epidemiology and geographic data were correlated with the distribution of ICU beds (public and private health systems) and the number of beneficiaries of private health insurance using Pearson's Correlation Coefficient. The same data were correlated using partial correlation controlled by gross domestic product (GDP) and number of beneficiaries of private health insurance. Findings: Brazil has a large geographical area and diverse demographic and economic aspects. This diversity is also present in the states and the Federal District regarding the number of COVID-19 cases, deaths and case fatality rate. The effective management of severe COVID-19 patients requires ICU services, and the scenario was also dissimilar as for ICU beds and ICU beds/10,000 inhabitants for the public (SUS) and private health systems mainly at the onset of COVID-19 pandemic. The distribution of ICUs was uneven between public and private services, and most patients rely on SUS, which had the lowest number of ICU beds. In only a few states, the number of ICU beds at SUS was above 1 to 3 by 10,000 inhabitants, which is the number recommended by the World Health Organization (WHO). Conclusions: Brazil needed to improve the number of ICU beds units to deal with COVID-19 pandemic, mainly for the SUS showing a late involvement of government and health authorities to deal with the COVID-19 pandemic.

COVID-19 in medium-sized municipalities in the 14 health macro-regions of Minas Gerais, Brazil

“…Four municipalities have an unsatisfactory number and fewer ICU beds than the national average (15.6 per 100,000 inhabitants). Although the number of ICU beds in Brazil is within the WHO recommendation (10-30 ICU beds per 100,000 inhabitants) (28), its distribution among the regions is not homogenous and is mostly concentrated in state capitals, reducing the effectiveness of health care in the state inner municipalities (29). The three municipalities without ICU beds were the ones with the highest lethality.…”

The impact of healthcare-associated infections on COVID-19 mortality: a cohort study from a Brazilian public hospital

“…In Rio de Janeiro, the deficit of beds was already known in the public Brazilian healthcare system, which is responsible for serving most of the population. The ratio of ICU beds per 10 thousand inhabitants in Rio de Janeiro is 0.97; the WHO recommended one to three beds per 10 thousand inhabitants (in a context outside the pandemic) 13 . Furthermore, in addition to the availability of beds, the manner of healthcare delivery for critical care patients was also important 14 .…”

Main aspects and prophylatic measures of COVID-19 in Brazil

“…WHO recommends 1 to 3 ICU beds for every 10,000 inhabitants, but Brazil provides approximately 1 bed for every 10,000 inhabitants, distributed unevenly between Brazilian regions and between the public and private health systems 28 . In addition, since the beginning of the pandemic in Brazil, there have been three ministers of health, which has generated political conflicts and made it difficult to target effective measures in the area of health, increasing inequality between Brazilian states in combating COVID-19.…”