Data indicates more deaths from Covid-19 than the number released by the Ministry of Health.

247 - With a new record of deaths in a 24-hour period (60 victims), the number of deaths from the coronavirus reached a total of 359, according to data from the Ministry of Health. However, UOL has gathered a series of indications that these numbers... do not reflect reality.

These are seven reasons that demonstrate that there are probably more deaths from Covid-19 than are reported by the government.

See the list published by UOL:

Hospitalizations for severe respiratory failure skyrocket.

Brazil has experienced a surge in hospitalizations for severe acute respiratory infection (SARI), according to data from the Ministry of Health. The 12th epidemiological week—which runs from March 15 to 21—saw 8.093 hospitalizations for SARI, compared to 1.061 in the same period last year. Of these, only 780 tested positive for COVID-19. 

In the 13th week, which ran from March 23 to 29, there were 7.216 hospitalizations, compared to 1.123 in 2019. In total, since the beginning of the year, there have been 25.675 hospitalizations due to SARI (Severe Acute Respiratory Infection). Of these, only 1.769 were confirmed for Covid-19, a rate of 7%. 

Although an increase in cases of severe respiratory syndrome is common during the autumn period due to the dry weather, this year the peak occurred earlier. "During the autumn there is much more dust in the air, so those with respiratory symptoms, people with asthma, bronchitis, rhinitis, experience more severe symptoms, and this increases the number of people seeking care for respiratory causes. But it is actually a little above the expected pattern," says Natanael Adiwardana, an infectious disease specialist from the Emílio Ribas Institute.

Suspected cases without autopsy

A resolution published on March 20th determined that autopsies cannot be performed to confirm death in suspected cases of coronavirus due to the risk of contamination through the bodies. According to the government, these determinations come from the WHO itself. 

Deaths due to severe acute respiratory infection (SARI) without a precise diagnosis, and suspected cases not tested during life, should have nasal and oropharyngeal swabs collected within 24 hours, and the autopsy report should state that the examination is pending. For all other cases, the death certificate should be completed by the physician who attended the patient or who confirmed the death. If the information in the medical record is insufficient to determine the cause, a verbal questionnaire is administered to the family. 

In cases where the autopsy is performed using a verbal questionnaire, even if the result closely points to death by coronavirus, the death will not be included in the official count because it is considered an untested case, according to Adiwardana. "Otherwise, you start to have very distorted data, and then you can't trust your data later."

Failure to report by private hospitals

The Public Prosecutor's Office of São Paulo is investigating a possible case of failure to report five deaths resulting from Covid-19 in two hospitals in São Paulo. 

"According to the São Paulo Municipal Health Department, the epidemiological inspection at the aforementioned hospital found the existence of suspected cases of coronavirus that were not reported at the unit, a fact that allegedly prevented health surveillance from adopting the necessary measures," reports Criminal Prosecutor Celeste Leite dos Santos. 

Regarding the second hospital, the prosecutor says that it "reported on 03/20/2020 the death of a 70-year-old patient who was a victim of the new coronavirus, a case not confirmed by the State Health Department." According to her, "this constitutes a failure to report an extremely serious disease that has been growing exponentially on all continents of the world."

Civil Registry reports more confirmed or suspected Covid-19 deaths.

The civil registry website listed 368 deaths as suspected or confirmed COVID-19 deaths, according to transparency data. This number represents deaths registered up to April 1st, Wednesday, by the Association of Registrars of Natural Persons, which brings together registry offices across Brazil. Compared to the Ministry of Health's data for that date, this represents 127 more deaths than those reported. 

And that number wouldn't include all confirmed COVID-19 deaths either. In Minas Gerais, only one case was registered as a death suspected or confirmed to be from the disease in the official records, while national statistics show four cases. Rio de Janeiro and São Paulo have higher records of deaths suspected to be from coronavirus compared to the federal government's data. 

A decree from the Ministry of Health and the National Council of Justice, dated March 31, authorized burials and cremations without a death certificate due to the COVID-19 epidemic. According to the decree, when a death occurs due to a respiratory illness suspected to be COVID-19 but not confirmed, it must be described in the record as a probable victim or suspected case of infection with the disease.

Deaths under investigation through testing exceed official death tolls.

There is a group of deceased individuals who have been tested for coronavirus, but the results are still pending due to laboratory delays. It's impossible to know the exact number for the entire country because the Ministry of Health no longer releases information on suspected cases, something it did until March 21st. Not all state health departments have this data publicly available. 

In the Southeast region, this number is 305 deceased individuals awaiting results, considering the states of Rio de Janeiro, São Paulo, and Minas Gerais. In these states alone, the total number of deaths is 233, which is lower than the number of suspected cases. The Rio de Janeiro state health department, for example, has maintained 49 cases under investigation for three days, demonstrating the delay in delivering the test results.

Tests are lacking.

The Ministry of Health had distributed only 54 PCR tests for coronavirus to the states by April 1st. These are the most reliable tests, performed using blood samples. This is a small number considering that the Ministry of Health expects to purchase and use 14,9 million tests to combat the epidemic. The ministry began sending 500 rapid tests to address the shortage, although these tests are not definitive in determining infection. 

In their press conferences, the ministry team has admitted that there will be an increase in numbers in the coming weeks as the volume of tests performed on the population increases. 

"There is a backlog of testing, and these numbers will grow significantly by the end of next weekend. It's much lower than the numbers circulating in society," stated Minister Luiz Henrique Mandetta on Wednesday. 

One problem is the lack of supplies for producing the tests, as there is a global race among countries for these substances, since they are produced in only a few countries and there is excess demand due to the epidemic.

Relatives and funeral homes have reported problems detecting COVID-19.

Reports from relatives, cemeteries, and funeral homes in Rio de Janeiro and São Paulo, given to UOL, indicate that there are deaths where no tests for COVID-19 are performed, nor is the disease suspected. Theoretically, all cases of death with respiratory failure should be investigated, but this is not what has been happening. 

The deaths began to occur the week the quarantine started, on March 24th, and have been accumulating since then. The city of São Paulo has hired extra gravediggers in public cemeteries, and more graves are being opened than usual in these locations.

Underreporting affects decisions about the duration of social isolation.

One of the consequences of underreporting cases and deaths from the new coronavirus is that it leads to less certainty in decisions about when to implement, and when to relax, social isolation measures. 

Restrictions on the movement of people have been widely adopted by governors as a way to slow the spread of the virus. Classes have been suspended, some businesses have been closed, and people are being advised to stay home as much as possible. 

The logic is that nowhere in the world could the healthcare system absorb a sudden explosion in the number of cases, and therefore the most important thing now is to curb the transmission of the virus. 

But at what point can these measures be suspended or relaxed? To answer this question, health authorities and researchers are working with the projection that only when 50% to 60% of the population has antibodies against the coronavirus will there be a significant decrease in the number of new cases, thus reducing the pressure on the health system. 

"That's why testing is important. Imagine a city in quarantine; if you know that 60% of the population is immune, you already know that the number of cases won't explode anymore," says epidemiologist Guilherme Werneck, vice-president of Abrasco (Brazilian Association of Collective Health) and professor at IMS/Uerj (Institute of Studies in Collective Health of the Federal University of Rio de Janeiro). 

The Minister of Health, Luiz Henrique Mandetta, acknowledged that the lack of precision in the data on virus cases hinders the definition of public actions, but stated that it would be possible to obtain estimates more faithful to reality through mathematical models that use the number of deaths to project the total number of cases. 

"It's detrimental. However, since we have mathematical models that we use as a basis for our projections, we can compensate for this with mathematical models," said the minister. 

"So, if we know that the lethality rate is so high and we know the number of deaths, we can work backwards. There are several ways to do it. We are able to anticipate its movement [the transmission curve of the virus]," Mandetta stated.