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. 2022 Apr:8:100177.
doi: 10.1016/j.lana.2021.100177. Epub 2022 Jan 7.

Severe Acute Respiratory Syndrome by SARS-CoV-2 Infection or Other Etiologic Agents Among Brazilian Indigenous Population: An Observational Study from the First Year of Coronavirus Disease (COVID)-19 Pandemic

Nathália M S Sansone  1   2 , Matheus N Boschiero  1 , Manoela M Ortega  1   2 , Isadora A Ribeiro  1   2 , Andressa O Peixoto  3 , Roberto T Mendes  3 , Fernando A L Marson  1   2
Affiliations

Severe Acute Respiratory Syndrome by SARS-CoV-2 Infection or Other Etiologic Agents Among Brazilian Indigenous Population: An Observational Study from the First Year of Coronavirus Disease (COVID)-19 Pandemic

Nathália M S Sansone et al. Lancet Reg Health Am. 2022 Apr.

Abstract

Background: Indigenous peoples are vulnerable to pandemics, including to the coronavirus disease (COVID)-19, since it causes high mortality and specially, the loss of elderly Indigenous individuals.

Methods: The epidemiological data of severe acute respiratory syndrome (SARS) by SARS-CoV-2 infection or other etiologic agents (OEA) among Brazilian Indigenous peoples during the first year of COVID-19 pandemic was obtained from a Brazilian Ministry of Health open-access database to perform an observational study. Considering only Indigenous individuals diagnosed with SARS by COVID-19, the epidemiology data were also evaluated as risk of death. The type of sample collection for virus screening, demographic profile, clinical symptoms, comorbidities, and clinical evolution were evaluated. The primary outcome was considered the death in the Brazilian Indigenous individuals and the secondary outcome, the characteristics of Brazilian Indigenous infected by SARS-CoV-2 or OEA, as the need for intensive care unit admission or the need for mechanical ventilation support. The statistical analysis was done using Logistic Regression Model. Alpha of 0.05.

Findings: A total of 3,122 cases of Indigenous individuals with SARS in Brazil were reported during the first year of the COVID-19 pandemic. Of these, 1,994 were diagnosed with COVID-19 and 730/1,816 (40.2%) of them died. The death rate among individuals with SARS-CoV-2 was three-fold increased when compared to the group of individuals with OEA. Several symptoms (myalgia, loss of smell, and sore throat) and comorbidities (cardiopathy, systemic arterial hypertension, and diabetes mellitus) were more prevalent in the COVID-19 group when compared to Indigenous individuals with OEA. Similar profile was observed considering the risk of death among the Indigenous individuals with COVID-19 who presented several symptoms (oxygen saturation <95%, dyspnea, and respiratory distress) and comorbidities (renal disorders, cardiopathy, and diabetes mellitus). The multivariate analysis was significant in differentiating between the COVID-19-positive and non-COVID-19 patients [X2 (7)=65.187; P-value<0.001]. Among the patients' features, the following contributed in relation to the diagnosis of COVID-19: age [≥43 years-old [y.o.]; OR=1.984 (95%CI=1.480-2.658)]; loss of smell [OR=2.373 (95%CI=1.461-3.854)]; presence of previous respiratory disorders [OR=0.487; 95%CI=0.287-0.824)]; and fever [OR=1.445 (95%CI=1.082-1.929)]. Also, the multivariate analysis was able to predict the risk of death [X2 (9)=293.694; P-value<0.001]. Among the patients' features, the following contributed in relation to the risk of death: male gender [OR=1.507 (95%CI=1.010-2.250)]; age [≥60 y.o.; OR=3.377 (95%CI=2.292-4.974)]; the need for ventilatory support [invasive mechanical ventilation; OR=24.050 (95%CI=12.584-45.962) and non-invasive mechanical ventilation; OR=2.249 (95%CI=1.378-3.671)]; dyspnea [OR=2.053 (95%CI=1.196-3.522)]; oxygen saturation <95% [OR=1.691 (95%CI=1.050-2.723)]; myalgia [OR=0.423 (95%CI=0.191-0.937)]; and the presence of kidney disorders [OR=3.135 (95%CI=1.144-8.539)].

Interpretation: The Brazilian Indigenous peoples are in a vulnerable situation during the COVID-19 pandemic and presented an increased risk of death due to COVID-19. Several factors were associated with enhanced risk of death, as male sex, older age (≥60 y.o.), and need for ventilatory support; also, other factors might help to differentiate SARS by COVID-19 or by OEA, as older age (≥43 y.o.), loss of smell, and fever.

Funding: Fundação de Amparo à Pesquisa do Estado de São Paulo (Foundation for Research Support of the State of São Paulo; #2021/05810-7).

Keywords: %, Percentage; 95%CI, 95% Confidence Interval; COVID-19; COVID-19, Coronavirus Disease (2019); Ethnicity; H1N1, H1N1 Strain of the Flu (Influenzae) virus; HRCT, High-Resolution Computed Tomography; ICU, Intensive Care Unit; Indigenous; Intensive Care Unit; MV, Mechanical Ventilation; NA, Not Applicable; OEA, Other Etiologic Agents; OR, Odds Ratio; Pandemic; RT-PCR, Real Time-Polymerase Chain Reaction; Race; Respiratory Disease; SAH, Systemic Arterial Hypertension; SARS, Severe Acute Respiratory Syndrome; SARS-CoV, Severe Acute Respiratory Syndrome Coronavirus; SARS-CoV-2, Severe Acute Respiratory Syndrome Coronavirus 2; SIVEP-Gripe, Information System for Epidemiological Surveillance of Influenza (Sistema de Informação de Vigilância Epidemiológica da Gripe); SUS, Sistema Único de Saúde (Brazilian Public Health System); Severe Acute Respiratory Syndrome; Virus; y.o., Years Old.

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Conflict of interest statement

None.

Figures

Figure 1
Figure 1
The distribution of Brazilian Indigenous individuals with severe acute respiratory syndrome (SARS) due to coronavirus disease (COVID)-19 and other etiologic agents during the first year of COVID-19 pandemic, according to the Brazilian states and Federal District. A. Shows COVID-19 cases. B. Shows SARS cases by other etiologic agents. C. Shows the total number of SARS cases in the Indigenous peoples. % percentage; SARS, severe acute respiratory syndrome. It was presented the ratio between the number of cases of COVID-19 and/or SARS of Indigenous individuals and the number of Indigenous inhabitants according to the Brazilian states and Federal District. The absolute number is shown in the Supplementary Table 6.
Figure 2
Figure 2
Epidemiological week data for severe acute respiratory syndrome (SARS) in Brazilian Indigenous individuals during the first 57 epidemiologic weeks (period of January 01, 2020, to January 28, 2021) of the coronavirus disease (COVID)-19 pandemic. A. Epidemiological week of filling out the notification form for the Brazilian Indigenous individuals with SARS due to COVID-19 and other etiologic agents during the first year of COVID-19 pandemic. B. Epidemiological week of the first symptoms for the Brazilian Indigenous individuals with SARS due to COVID-19 and other etiologic agents during the first year of COVID-19 pandemic. The data described were obtained from the Brazilian Ministry of Health. Epidemiologic weeks according months: (Weeks from 1 to 5) January 2020; (Weeks from 6 to 9) February 2020; (Weeks from 10 to 14) March 2020; (Weeks from 14 to 18) April 2020; (Weeks from 14 to 18); May 2020 (Weeks 18 to 23); June 2020 (Weeks 23 to 27); July 2020 (Weeks from 27 to 31); August 2020 (Weeks from 31 to 36); September 2020 (Weeks from 36 to 40); October 2020 (Weeks from 40 to 44); November 2020 (Weeks from 45 to 49); December 2020 (Weeks from 49 to 53); and January 2021 (Weeks from 53 to 57).
Figure 3
Figure 3
Epidemiology data with positive association (P-value <0.05) with the risk of death by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in Brazilian Indigenous individuals during the first 57 epidemiologic weeks of the coronavirus disease (COVID)-19 pandemic. The data are presented as odds ratios (OR) and 95% confidence intervals (95%CI – lower and upper limits). In the figure it was not plotted the data for other findings in the chest X-ray (OR=4.619; 95%CI=2.114-10.09); interstitial infiltrate (OR=4.726; 95%CI=2.338-9.555); need for intensive care unit (OR=5.584; 95%CI=4.319-7.221); presence of consolidation (OR=13.34; 95%CI=4.904-36.29), and mixed findings in the chest X-ray (OR=6.8; 95%CI=2.953-15.06); and invasive mechanical ventilation (OR=22.23; 95%CI=14.98-33.0). MV, mechanical ventilation; y.o.; years old; % percentage.
Figure 4
Figure 4
Clinical symptoms in Brazilian Indigenous individuals with severe acute respiratory syndrome (SARS) during the first year of coronavirus disease (COVID)-19 pandemic. A. The data demonstrated the prevalence of the clinical symptoms for both groups, SARS-CoV-2 (COVID-19 group), and Indigenous individuals with SARS due to other etiologic agents. B. The data shows the prevalence of the clinical symptoms for both groups, Indigenous individuals who died due to SARS-CoV-2 infection and Indigenous individuals who had clinical recovery after the SARS-CoV-2 infection. % percentage; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2.
Figure 5
Figure 5
Comorbidities in Brazilian Indigenous individuals with severe acute respiratory syndrome (SARS) during the first year of coronavirus disease (COVID)-19 pandemic. A. The data shows the prevalence of the comorbidities for both groups, SARS-CoV-2 (COVID-19 group) and Indigenous individuals with SARS due to other etiologic agents. B. The data demonstrated the prevalence of the comorbidities for both groups, Indigenous individuals who died due to SARS-CoV-2 infection and Indigenous individuals who had clinical recovery after the SARS-CoV-2 infection. SARS-CoV-2, severe acute respiratory syndrome coronavirus 2.
Figure 6
Figure 6
Epidemiology data with positive association (P-value <0.05) with the risk of severe acute respiratory syndrome (SARS) coronavirus 2 (SARS-CoV-2) infections compared with SARS by other etiologic agents in Brazilian Indigenous individuals during the first 57 epidemiologic weeks of the coronavirus disease (COVID)-19 pandemic. The data are presented as odds ratios (OR) and 95% confidence intervals (95%CI – lower and upper limits). MV, mechanical ventilation; y.o.; years old; % percentage.
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