COVID-19 Underreporting in Brazil among Patients with Severe Acute Respiratory Syndrome during the Pandemic: An Ecological Study

Tainá Momesso Lima; Camila Vantini Capasso Palamim; Vitória Franchini Melani; Matheus Ferreira Mendes; Letícia Rojina Pereira; Fernando Augusto Lima Marson

doi:10.3390/diagnostics12061505

COVID-19 Underreporting in Brazil among Patients with Severe Acute Respiratory Syndrome during the Pandemic: An Ecological Study

Diagnostics (Basel). 2022 Jun 20;12(6):1505. doi: 10.3390/diagnostics12061505.

Authors

Tainá Momesso Lima^{1

2}, Camila Vantini Capasso Palamim^{1

2}, Vitória Franchini Melani^{1

2}, Matheus Ferreira Mendes^{1

2}, Letícia Rojina Pereira^{1

2}, Fernando Augusto Lima Marson^{1

2}

Affiliations

¹ Laboratory of Human and Medical Genetics, Postgraduate Program in Health Sciences, São Francisco University, Avenida São Francisco de Assis, 218. Jardim São José, Bragança Paulista, Sao Paulo 12916-900, Brazil.
² Laboratory of Cellular and Molecular Biology and Bioactive Compounds, Postgraduate Program in Health Science, São Francisco University, Avenida São Francisco de Assis, 218. Jardim São José, Bragança Paulista, Sao Paulo 12916-900, Brazil.

Abstract

Underreporting of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection is a global problem and might hamper Coronavirus Disease (COVID-19) epidemiological control. Taking this into consideration, we estimated possible SARS-CoV-2 infection underreporting in Brazil among patients with severe acute respiratory syndrome (SARS). An ecological study using a descriptive analysis of the SARS report was carried out based on data supplied by the Influenza Epidemiological Surveillance Information (SIVEP)-Flu (in Brazilian Portuguese, Sistema de Vigilância Epidemiológica da Gripe) in the period between January 2015 and March 2021. The number of SARS cases and related deaths after infection by SARS-CoV-2 or Influenzae was described. The estimation of underreporting was evaluated considering the relative increase in the number of cases with undefined etiological agent comparing 2020 to 2015−2019; and descriptive analysis was carried out including data from January−March/2021. In our data, SARS-CoV-2 infection and the presence of SARS with undefined etiological agent were associated with the higher number of cases and deaths from SARS in 2020/2021. SARS upsurge was six times over that expected in 2020, according to SARS seasonality in previous years (2015−2019). The lowest possible underdiagnosis rate was observed in the age group < 2 y.o. and individuals over 30 y.o., with ~50%; while in the age groups 10−19 and 20−29 y.o., the rates were 200−250% and 100%, respectively. For the remaining age groups (2−5 and 5−9 y.o.) underreporting was over 550%, except for female individuals in the age group 2−5 y.o., in which a ~500% rate was found. Our study described that the SARS-CoV-2 infection underreporting rate in Brazil in SARS patients is alarming and presents different indices, mainly associated with the patients’ age groups. Our results, mainly the underreporting index according to sex and age, should be evaluated with caution.

Keywords: COVID-19; SARS-CoV-2; pandemic; severe acute respiratory syndrome; underreporting; undocumented.

Grants and funding

The authors wish to thank the Brazilian National Research Council (CNPq) for the grants for Tainá Momesso Lima, Vitória Franchini Melani, Matheus Ferreira Mendes, and Letícia Rogini Pereira.