Explosion in mortality in the Amazonian epicenter of the COVID-19 epidemic 19

Manaus, the capital of the Brazilian State of Amazonas, is the current epicenter of the COVID-19 epidemic in Amazonia. The sharp increase in deaths is a huge concern for health system administrators and society. The study aimed to analyze excess overall mortality according to Epidemiological Week (EW) in order to identify changes potentially associated with the epidemic in Manaus. Overall and cause-specific mortality data were obtained from the Central Database of the National Civil Registry and the Mortality Information System for 2018, 2019, and 2020. The study analyzed age bracket, sex, place of death, EW, calendar year, and causes of death. Ratios were calculated between deaths in 2019/2018 and 2020/2019 to estimate excess deaths, with 5% confidence intervals. No significant excess overall mortality was seen in the ratios for 2019/2018, independently of EW. Meanwhile, the ratios for 2020/2019 increased from 1.0 (95%CI: 0.9-1.3) in EW 11 to 4.6 (95%CI: 3.9-5.3) in EW 17. Excess overall mortality was observed with increasing age, especially in individuals 60 years or older, who accounted for 69.1% (95%CI: 66.8-71.4) of the deaths. The ratios for 2020/2019 for deaths at home or on public byways were 1.1 (95%CI: 0.7-1.8) in EW 12 and 7.8 (95%CI: 5.4-11.2) in EW 17. The explosion in overall mortality in Manaus and the high proportion of deaths at home or on public byways reveals the epidemic’s severity in contexts of heavy social inequality and weak effectiveness of government policies, especially policies meant to deal with social inequalities and strengthen the Unified Health System.

马瑙斯作为巴西亚马孙州首府，当前为亚马孙地区新冠疫情的震中。死亡病例数的急剧攀升，已成为卫生系统管理者与社会各界的重大关切。本研究旨在按流行病学周（Epidemiological Week, EW）分析总超额死亡率，以识别马瑙斯地区与疫情潜在相关的死亡变化特征。研究获取了2018、2019及2020年的总死亡率与死因别死亡率数据，数据源自国家民事登记中央数据库及死亡信息系统。本研究的分析维度涵盖年龄组、性别、死亡地点、流行病学周、日历年及死因类别。以95%置信区间计算2019年相较2018年、2020年相较2019年的死亡数比值，以此估算超额死亡人数。2019年相较2018年的死亡比值未出现显著的总超额死亡率，且不受流行病学周的影响。与此同时，2020年相较2019年的死亡比值从第11流行病学周的1.0（95%置信区间：0.9~1.3）攀升至第17流行病学周的4.6（95%置信区间：3.9~5.3）。总超额死亡率随年龄增长而升高，尤其在60岁及以上人群中表现显著，该人群的死亡数占总死亡数的69.1%（95%置信区间：66.8%~71.4%）。2020年相较2019年中，在家中或公共道路死亡的病例数比值在第12流行病学周为1.1（95%置信区间：0.7~1.8），第17流行病学周则升至7.8（95%置信区间：5.4~11.2）。马瑙斯地区总死亡率的激增，以及在家中或公共道路死亡病例的高占比，揭示了在社会不平等程度深重、政府政策（尤其是针对缓解社会不平等与强化统一卫生系统的政策）效能不足的背景下，本次疫情的严峻程度。