JMIR Publications

ABSTRACT

Background:

The global impact of COVID-19 has been dreadful, undermining public health, considered to be the most severe, ever observed, as a respiratory disease, in the last years. It takes on a rapid dissemination, risking the health of a huge number of people, and consequently overburdening healthcare infrastructure, leading to eventual collapse. Nowadays, a country that draws a lot of attention is Brazil, which has shown expressive number of cases and deaths in comparison to other countries. Thus, there is a high chance that the actual number of infected in Brazil is far larger than those notified, and it is very likely that the actual growth of the disease is being underestimated. A proper estimation of the underreported or wrongly reported cases becomes paramount in order to have a better understanding of the actual epidemic scenario, allowing necessary and effective measures

Objective:

This study investigates the mortality underreporting related to COVID-19 in the most affected Brazilian cities in order to identify the real scenario of the pandemic in Brazil.

Methods:

This research used data from the historical series of deaths, due to respiratory problems and other natural causes, from two databases: DATASUS (2010 to 2018) and the Brazilian Transparency Portal of Civil Registry (2019 to 2020). These data were used to build time series models (modular regressions) able to predict the expected behavior of deaths in 2020. The predictions are used to estimate the possible number of death reports that were incorrectly registered during the pandemic in the most affected cities in the country.

Results:

The model found a significant disagreement between the real and expected values. The number of deaths due to SARS was considerably higher in all of the cities, presenting increases between 493% and 5820%. Considering the cities of the case study, an average underreporting of 40.68%, varying between 25.9% and 62.7%, is estimated for deaths related to COVID-19.

Conclusions:

The quite significant rates of underreporting of deaths presented in our research allow us to realize that the officially released numbers to be much lower than the actual numbers, making it impossible for the authorities to take more effective actions. Considering the results and analyzes carried out with different fatality rates, it can be inferred that Brazil has a growing epidemic scenario and the real number of infected would already be between approximately 1,2 million and 5,4 millions, becoming new epicenter of the pandemic.