1. Brazil became the new center of the COVID-19 pandemic by surpassing the USA in new daily cases on 27 May, tending to stay in that relative position in a sustainable manner in the last few days (a new daily peak was registered 10 June 2020), as anticipated on 23 April 2020.

 

2. The country ranks just behind the US in number of total cases but still has only approximately 1/3 the number of cases of the latter, and will reach the second position in total deaths by surpassing the UK within 2 days or so. However, in terms of number of deaths per million inhabitants Brazil just surpassed Portugal, is at approximately half of the USA and the Netherlands, approximately 1/3 of Spain or the UK and just over 20% of Belgium. 

 

3. The situation in Brazil is dramatic because the country is already at full or near full occupancy of its resources in Intensive Care, as we have been estimating and as disseminated in the media for some Brazilian States (in Portuguese).

 

4. However, the mortality rate from COVID-19 is decreasing in Brazil since approximately 12 May (see Fatality rate per country), from a high of 6,98% to the current value of 5,1% a month later, on 11 June 2020. If the country is operating at full capacity to combat the pandemic, how can mortality rates be in the decrease? There is some concern with delay in official death reporting (in Portuguese) and possibly also of misreporting of Acute Respiratory Distress Syndrome, or ARDS (in Portuguese). But could a different therapeutic approach be also playing an important role?

 

5. Despite the fact that we often hear that mortality rates will go down when we increase the number of tests and extend them to a larger fraction of the population, we do not see that anywhere in the world with a significant number of cases. Once COVID-19 mortality rates go up in a given country they stay that way. The only other country that has been able to see a decrease in its mortality rate from COVID-19 is Spain, as we noted earlier, however more slightly than in Brazil. 

 

6. The average survival rate from ICU admission due to COVID-19 in Brazil is approximately 65%, which is higher than most countries. 

 

7. The average duration of stay in ICU due to COVID-19 is shorter than in most countries, only 8 days.

 

8. The average duration of mechanical ventilation is also shorter, at an average of 10 days. 

 

9. Masks are mandatory in all public spaces in Brazil since 27 April 2020 and in commercial establishments throughout Brazil since 1 May 2020. 

 

10. Guildelines for out-of-hospital use of hydroxychloroquine plus azithromycin were published on 20 May 2020.

 

Let us hope the situation becomes under control in Brazil soon and we learn the reason why its mortality rate from COVID-19 is decreasing to extract lessons that can be used even more effectively in the country and worldwide.

 

M. Jorge Guimarães & Marta Temporão

ALERT Life Sciences Computing

jorge.guimaraes@alert-online.com

marta.temporao@alert-online.com