COVID-19 Mortality in Brazil, 2020-21: Consequences of the pandemic inadequate management

Background: The COVID-19 pandemic brought countless challenges to public health and highlighted the Brazilian health system vulnerabilities to face the emergency situation. In this article, we analyze data on COVID-19-related deaths in Brazil in 2020-21 to show the tragic consequences of the pandemic on the Brazilian population. Methods The Mortality Information System and the Live Birth Information System were the main information sources. We used the population estimates in 2020-21 to calculate COVID-19 specific mortality rates by age and sex and educational level. Considering the total number of deaths in 2020-21, the COVID-19 proportional mortality (%) was estimated for each age group and sex. A graph of the daily deaths from January 2020 to December 2021 by sex was elaborated to show the temporal evolution of COVID-19 deaths in Brazil. In addition, four indicators related to COVID-19 mortality were estimated: infant mortality rate; maternal mortality ratio (MMR); number of orphans due to mother's death; average number of years lost. Results The overall COVID-19 mortality rate was 14.8 (/10,000). The mortality rates increase with age and show a decreasing gradient with higher schooling. Among illiterate people, the rate was 38.8/10,000, three times higher than those with college education. Male mortality was 31% higher than female mortality. COVID-19 deaths represented 19.1% of all deaths, with the highest proportions in the median age groups. The average number of years lost due to COVID-19 was 19 years. The MMR due to COVID-19 was 35.7 per 100,000 LB, representing 37.4% of the overall MMR. Regarding the number of orphans due to COVID-19, we estimated that 40,830 children under 18 years old lost their mothers during the pandemic, with an orphans' rate of 7.5/10,000 children aged 0–17 years. The pandemic peak occurred in March 2021, reaching almost 4,000 deaths per day, higher than the average number of deaths per day from all causes in 2019. Conclusions The COVID-19 lethality rate in Brazil was 2.2%, twice the global lethality rate. The delay in adopting public health measures necessary to control the epidemic has exacerbated the spread of the disease, resulting in several avoidable deaths.