Unprecedented increase in demand for resources and treatments outstripped the care capacity of medical centers around the world

 During the height of the first wave of Covid-19, in 2020, patients admitted to Hospital das Clínicas (HC), one of the largest reference centers for the treatment of the disease in the country, had a 33% increase in mortality risk. This is what reveals a new study conducted by doctors and researchers from the Faculty of Medicine of USP (FMUSP) and HC.

According to the research, published September 28 in the journal PLOS One, this increase can be attributed to the enormous demand for clinical resources, above the hospital's availability.

 “Whenever the increase in demand for assistance or resources greatly outweighs the capacity to provide care, a disaster situation is set,” says Dr. Izabel Marcilio, first author of the study and an epidemiologist who coordinated the Epidemiological Surveillance Center at Hospital das Clínicas of FMUSP (HCFMUSP) in the first year of the pandemic. “Covid-19 brought an even greater challenge, as patients affected by the disease required intensive care and a large proportion of them arrived at HCFMUSP demanding ventilatory support, hemodialysis, among other advanced therapies.”

Faced with this unprecedented global increase in hospital demand, Dr. Marcilio reports that she began to observe longer delays for emergency care, exhausted professionals and limited supplies in the entire healthcare network in the city of São Paulo (from Emergency care units, to ambulances, to public and private hospitals). By analyzing the cases of 2,949 patients with Covid-19 at HCFMUSP, the new study found that being admitted to the hospital during the peak of the first wave was associated with a 33% higher risk of mortality.

For the researcher, this reveals a broader paradigm. “These findings can be extrapolated to other medical centers not only in the country, but also worldwide”, she says. “What our study showed is that, within the same institution - that is, where the quality of care is uniform - even after controlling for other risk factors, such as age, sex and comorbidities, the risk of mortality was higher.”

As a result, the pandemic has reinforced the need for institutional protocols that include evidence-based practices and resource allocation. For Prof. Nelson Gouveia, co-author of the study and professor at the Department of Preventive Medicine at FMUSP, “this guides everyone in the health service, from the clinical staff, technicians and support staff to have a more effective and faster response”.

In the same vein, Dr. Izabel Marcilio notes that “all over the world, the best results were obtained in countries where a preparedness and response plan existed”. In the case of HCFMUSP, the Crisis Committee system linked to the Clinical Board already existed, having been activated in other emergency situations. “That's why it was the public hospital in the State of São Paulo that first managed to respond to the pandemic, with the opening of 300 ICU beds in record time”, she points out.

During the period, HC transformed its largest inpatient institute - Instituto Central (Central Institute, IC) - into a hospital entirely dedicated to Covid-19 assistance. To this end, it was necessary to establish partnerships, hire and train personnel and acquire material resources in addition to other actions that, despite the unprecedented nature of the situation, were ble to be carried out thanks to institutional preparation. “Despite the tragic situation that the pandemic represented, it was a success story that should make the people who were directly involved proud”, says Dr. Marcilio. “Undoubtedly, having a Crisis Committee prepared to respond quickly to emergency situations is critical to mitigating the risk and preventing deaths.”