@Article{SilvaASTGCSVCCF:2020:AnDaGo,
               author = "Silva, Lena Veiga e and Abi Harb, Maria da Penha de Andrade and 
                         Santos, Aurea Milene Teixeira Barbosa dos and Teixeira, Carlos 
                         Andr{\'e} de Mattos and Gomes, Vitor Hugo Macedo and Cardoso, 
                         Evelin Helena Silva and Silva, Marcelino S. da and Vijaykumar, 
                         Nandamudi Lankalapalli and Carvalho, Solon Ven{\^a}ncio de and 
                         Carvalho, Andr{\'e} Ponce de Leon Ferreira de and Frances, Carlos 
                         Renato Lisboa",
          affiliation = "{Universidade Federal do Par{\'a} (UFPA)} and {Universidade 
                         Federal do Par{\'a} (UFPA)} and {Universidade Federal do 
                         Par{\'a} (UFPA)} and {Universidade Federal do Par{\'a} (UFPA)} 
                         and {Universidade Federal do Par{\'a} (UFPA)} and {Universidade 
                         Federal do Par{\'a} (UFPA)} and {Universidade Federal do 
                         Par{\'a} (UFPA)} and {Instituto Nacional de Pesquisas Espaciais 
                         (INPE)} and {Instituto Nacional de Pesquisas Espaciais (INPE)} and 
                         {Universidade de S{\~a}o Paulo (USP)} and {Universidade Federal 
                         do Par{\'a} (UFPA)}",
                title = "COVID-19 mortality underreporting in Brazil: analysis of data from 
                         government internet portals",
              journal = "Journal of Medical Internet Research",
                 year = "2020",
               volume = "22",
               number = "8",
                pages = "e21413",
                month = "Aug.",
             keywords = "Brazil, COVID-19, mortality, underreporting, respiratory system 
                         diseases, public health, pandemic, time series, forecasting.",
             abstract = "BACKGROUND: In Brazil, a substantial number of coronavirus disease 
                         (COVID-19) cases and deaths have been reported. It has become the 
                         second most affected country worldwide, as of June 9, 2020. 
                         Official Brazilian government sources present contradictory data 
                         on the impact of the disease; thus, it is possible that the actual 
                         number of infected individuals and deaths in Brazil is far larger 
                         than those officially reported. It is very likely that the actual 
                         spread of the disease has been underestimated. OBJECTIVE: This 
                         study investigates the underreporting of cases and deaths related 
                         to COVID-19 in the most affected cities in Brazil, based on public 
                         data available from official Brazilian government internet 
                         portals, to identify the actual impact of the pandemic. METHODS: 
                         We used data from historical deaths due to respiratory problems 
                         and other natural causes from two public portals: DATASUS 
                         (Department of Informatics of the Unified Healthcare System) 
                         (2010-2018) and the Brazilian Transparency Portal of Civil 
                         Registry (2019-2020). These data were used to build time-series 
                         models (modular regressions) to predict the expected mortality 
                         patterns for 2020. The forecasts were used to estimate the 
                         possible number of deaths that were incorrectly registered during 
                         the pandemic and posted on government internet portals in the most 
                         affected cities in the country. RESULTS: Our model found a 
                         significant difference between the real and expected values. The 
                         number of deaths due to severe acute respiratory syndrome (SARS) 
                         was considerably higher in all cities, with increases between 493% 
                         and 5820%. This sudden increase may be associated with errors in 
                         reporting. An average underreporting of 40.68% (range 25.9%-62.7%) 
                         is estimated for COVID-19-related deaths. CONCLUSIONS: The 
                         significant rates of underreporting of deaths analyzed in our 
                         study demonstrate that officially released numbers are much lower 
                         than actual numbers, making it impossible for the authorities to 
                         implement a more effective pandemic response. Based on analyses 
                         carried out using different fatality rates, it can be inferred 
                         that Brazil's epidemic is worsening, and the actual number of 
                         infectees could already be between 1 to 5.4 million.",
                  doi = "10.2196/21413",
                  url = "http://dx.doi.org/10.2196/21413",
                 issn = "1439-4456",
             language = "en",
           targetfile = "silva_covid.pdf",
        urlaccessdate = "27 abr. 2024"
}