ArticleTropical medicine & international health : TM & IH2021
How many more? Under-reporting of the COVID-19 deaths in Brazil in 2020.
Article in Tropical medicine & international health : TM & IH, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 24 papers, 1 of them a synthesis that pooled it.
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Who cites it
24 citing papers in PubMed, 1 synthesis or guideline pooled it, 60 citations in OpenAlex.
- Estimating excess mortality due to the COVID-19 pandemic: a systematic analysis of COVID-19-related mortality, 2020-21.Lancet (London, England) · 2022Pooled it
- Estimation of under-reporting influenza cases in Hong Kong based on bayesian hierarchical framework.Infectious Disease Modelling · 2025Article
- Impacts of the COVID-19 pandemic on excess deaths: descriptive study, Pernambuco, 2020-2022.Epidemiologia e servicos de saude : revista do Sistema Unico de Saude do Brasil · 2025Article
- Article
- Demographic and Geographic Characterization of Excess Mortality During the COVID-19 Pandemic in Baltimore City, Maryland, March 2020 to March 2021.American journal of epidemiology · 2024Article
- Protecting Life and Lung: Protected Areas affect fine particulate matter and respiratory hospitalizations in the Brazilian Amazon Biome.Environmental & resource economics · 2024Article
- Characterizing deaths among adult patients with severe acute respiratory infection: during the pre- and COVID-19 pandemic periods in Bangladesh, 2018-2022.Tropical medicine and health · 2023Article
- Gender differences in estimated excess mortality during the COVID-19 pandemic in Thailand.BMC public health · 2023Article
- Long-term monitoring of COVID-19 prevalence in raw and treated wastewater in Salvador, the largest capital of the Brazilian Northeast.Scientific reports · 2023Article
- Clinical and epidemiological aspects of severe acute respiratory infection: before and during the first year of the COVID-19 pandemic in Brazil.Transactions of the Royal Society of Tropical Medicine and Hygiene · 2023Article
- Article
- The relationship between staying at home during the pandemic and the number of conceptions: A national panel data analysis.PloS one · 2023Article
- Ethnic/Racial Disparity in Mortality from COVID-19: Data for the Year 2020 in Brazil.Spatial demography · 2023Article
- Evaluation of SARS-CoV-2 concentrations in wastewater and river water samples.Case studies in chemical and environmental engineering · 2022Article
- Wastewater-based epidemiology: A Brazilian SARS-COV-2 surveillance experience.Journal of environmental chemical engineering · 2022Article
- Article
- Article
- Commentary: Measuring excess mortality due to the COVID-19 pandemic: progress and persistent challenges.International journal of epidemiology · 2022Article
- Measuring misclassification of Covid-19 as garbage codes: Results of investigating 1,365 deaths and implications for vital statistics in Brazil.PLOS global public health · 2022Article
- Seroprevalence, Prevalence, and Genomic Surveillance: Monitoring the Initial Phases of the SARS-CoV-2 Pandemic in Betim, Brazil.Frontiers in microbiology · 2022Article
Corrections and comments
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Authors and funding
1 author at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo evaluate the magnitude of under-reporting the number of deaths due to COVID-19 in Brazil in 2020, previously shown to occur due to low rate of laboratory testing for SARS-CoV-2, reporting delay, inadequate access to medical care, and its poor quality, leading to the low sensitivity of epidemiological surveillance and poor outcomes, often without laboratory confirmation of the cause of death.
methodsExcess mortality due to COVID-19 was estimated directly based on various data sources, and indirectly, based on the difference between the observed and expected number of deaths from serious acute respiratory infection (SARI) and all-natural causes in 2020 had there been no COVID-19. The absence of laboratory testing for SARS-CoV-2 was adjusted based on the proportion of those who tested positive among the tested individuals whose death was attributed to COVID-19. Least absolute shrinkage and selection operator (lasso) were used to improve prediction of likely mortality without COVID-19 in 2020.
resultsUnder-reporting of COVID-19 deaths was 22.62%, with a corresponding mortality rate per 100 000 inhabitants of 115 by the direct method, 71-76 by the indirect methods based on the excess SARI mortality and 95-104 by excess mortality due to natural causes. COVID-19 was the third cause of mortality that contributed directly with 18%, and indirectly with additional 10-11% to all deaths in Brazil in 2020.
conclusionsUnderestimation of COVID-19 mortality between 1:5 and 1:4 is likely its lower bound. Timely and accurate surveillance of death causes is of the essence to evaluate the COVID-19 burden.
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