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Revista da Sociedade Brasileira de Medicina Tropical

Print version ISSN 0037-8682On-line version ISSN 1678-9849

Rev. Soc. Bras. Med. Trop. vol.53  Uberaba  2020  Epub Oct 21, 2020

https://doi.org/10.1590/0037-8682-0608-2020 

Letter

Increasing Demand for Chest CT Due to COVID-19 in Brazil

Creuza Rachel Vicente1 
http://orcid.org/0000-0003-0182-7969

Mariana Coelho Silva Sant'Ana2 

Aline Pinto Reis2 

Carla Fanchiotti Costa2 

Crispim Cerutti Junior1 

Caio Martins Lanes3 

Geyzzara Oliveira Ferreira Diniz2 

Iuri Drumond Louro4 

1Universidade Federal do Espírito Santo, Departamento de Medicina Social, Vitória, ES, Brasil.

2Telelaudo, Vitória, ES, Brasil.

3The Masters School, New York, NY, United States of America.

4Universidade Federal do Espírito Santo, Departamento de Ciências Biológicas, Vitória, ES, Brasil.


Dear Editor:

Diagnosis of coronavirus disease 2019 (COVID-19) has been challenging since the identification of this new human infection, especially after it spread to most countries and territories of the world in the following months, increasing the worldwide demand for reverse-transcriptase polymerase chain reaction (RT-PCR) tests, the laboratory test which confirms the infection. Therefore, in settings where this test is unavailable, or results are delayed or negative in the presence of symptoms suggestive of COVID-19, chest imaging has been used in the diagnosis, clinical evaluation, and management of suspected cases1. Chest computed tomography (CT) contributes to a lower diagnostic loss2, presenting a sensitivity of 92% (95% confidence interval, 86-96%)3, and is recommended even in cases with a positive RT-PCR test if the patient presents mild, moderate, or severe symptoms of the disease1. Consensus shows some typical characteristics of images in COVID-19 cases, such as bilateral (multilobar) and peripheral opacities with an aspect of ground glass, with or without consolidations or interlobular and intralobular septal thickening (mosaic paving), multifocal and round ground-glass opacities with or without mosaic paving, and reverse halo sign4,5.

Since the beginning of the epidemic in Brazil on February 26, 2020, the demand for chest CT has increased, possibly due to the long wait times for the release of RT-PCR test results in some regions6 thereby affecting the application of the results in the clinical management of the patients. In 94 hospitals and diagnostic centers from 14 Brazilian states, serviced by Telelaudo, an increase of 192% in the demand for chest CT was observed from March 1 to June 30, 2020 (n = 14,111) when compared to the same period in 2019 (n = 4,837); increases of more than 1,000% were seen in the states of Pará in May and June, and Ceará in June. States from the North (Amazonas and Pará) and the Northeast (Ceará, Pernambuco, and Sergipe) regions had the highest increases in chest CT. These regions placed health systems in a critical situation7, with collapse occurring in some states, such as Amazonas8 and Ceará9 (Table 1). Especially in territories with a difficult epidemic situation, chest CT can be an effective, convenient, and fast method to recognize COVID-19 cases, thus supporting the containment of the epidemic3. Nevertheless, further preventive measures must be adopted in addition to the diagnosis and isolation of cases. This survey shows the impact of COVID-19 on the health services in Brazil, particularly high demand for diagnostic imaging tests to support the clinical response to the disease, in a severe epidemiological scenario which had the second-highest number of incident cases and deaths in the world in August 202010.

TABLE 1: Number of requests for chest computed tomography by hospitals of Brazilian states from January to June, 2019 and 2020 

State March April May June
2019 2020 Difference 2019 2020 Difference 2019 2020 Difference 2019 2020 Difference
North region
Amazonas 92 203 +121% 118 1169 +891% 123 993 +707% 150 245 +63%
Pará 31 48 +55% 39 89 +128% 46 788 +1613% 60 1172 +1853%
Northeast region
Bahia 92 93 +1% 126 143 +13% 120 335 +179% 121 225 +86%
Ceará 49 76 +55% 67 147 +119% 62 315 +408% 31 435 +1303%
Paraíba 75 62 -17% 64 88 +38% 80 169 +111% 66 71 +8%
Pernambuco 35 49 +40% 39 170 +336% 39 368 +844% 50 184 +268%
Sergipe 14 40 +186% 31 59 +90% 17 171 +906% 15 116 +673%
Midwest region
Distrito Federal 45 153 +240% 54 120 +122% 65 179 +175% 67 133 +99%
Goiás 52 103 +98% 92 66 -28% 93 108 +16% 76 47 -38%
Mato Grosso 104 161 +55% 117 60 -49% 136 174 +28% 119 603 +407%
Southeast region
Minas Gerais 119 192 +61% 116 315 +172% 128 328 +156% 131 258 +97%
Rio de Janeiro 205 292 +42% 219 668 +205% 322 715 +122% 228 223 -2%
São Paulo 107 200 +87% 88 309 +251% 123 338 +175% 134 195 +46%
South region
Paraná 10 17 +70% 9 23 +156% 14 36 +157% 12 72 +500%

REFERENCES

1. World Health Organization (WHO). Use of chest imaging in COVID-19: a rapid advice guide. Geneva: WHO; 2020. 42 p. [ Links ]

2. Li Y, Xia L. Coronavirus disease 2019 (COVID-19): role of chest CT in diagnosis and management. AJR Am J Roentgenol. 2020;214:1280-6. [ Links ]

3. Xu B, Xing Y, Peng J, Zheng Z, Tang W, Sun Y, et al. Chest CT for detecting COVID-19: a systematic review and meta-analysis of diagnostic accuracy. Eur Radiol. 2020;15:1-8. [ Links ]

4. Simpson S, Kay FU, Abbara S, Bhalla S, Chung JH, Chung M, et al. Radiological Society of North America expert consensus statement on reporting chest CT findings related to COVID-19 endorsed by the Society of Thoracic Radiology, the American College of Radiology, and RSNA. Radiol Cardiothorac Imaging. 2020;https://doi.org/10.1148/ryct.2020200152. [ Links ]

5. Kong W, Agarwal PP. Chest imaging appearance of COVID-19 infection. Radiol Cardiothorac Imaging. 2020;https://doi.org/10.1148/ryct.2020200028. [ Links ]

6. Brasil. Ministério da Saúde (MS). Boletim epidemiológico especial COE-COVID-19 - 16. Brasília: MS; 2020. 67 p. [ Links ]

7. Ferraz D, Mariano EB, Morceiro P, Moralles HF, Manzine PR, Rebelatto DAN. COVID-Index: the collapse of the Brazilian hospital system [Internet]. Available from: https://www.researchgate.net/publication/341164388_COVID-Index_the_collapse_of_the_Brazilian_Hospital_System. [ Links ]

8. Orellana JDY, Cunha GM, Marrero L, Horta BL, Leite IC. Explosion in mortality in the Amazonian epicenter of the COVID-19 epidemic 19. Cad Saúde Pública. 2020;36:e00120020. [ Links ]

9. Lemos DRQ, D’Angelo SM, Farias LABG, Almeida MM, Gomes RG, Pinto GP, et al. Health system collapse 45 days after the detection of COVID-19 in Ceará, Northeast Brazil: a preliminary analysis. Rev Soc Bras Med Trop. 2020;53:e20200354. [ Links ]

10. Worldometer. COVID-19 coronavirus pandemic [Internet]. Dover: Worldometer; 2020 [updated 2020 Aug 28; cited 2020 Aug 28]. Available from: Available from: https://www.worldometers.info/coronavirus/ . [ Links ]

Received: August 28, 2020; Accepted: September 17, 2020

Corresponding author: Creuza Rachel Vicente. e-mail:vicentecrachel@gmail.com

Author’s contribution: CRV: Conception and design of the study, analysis and interpretation of data, drafting the article; MCSS: Drafting the article, final approval of the version to be submitted; APR: Acquisition of data, final approval of the version to be submitted; CFC: Acquisition of data, final approval of the version to be submitted; CCJ: Drafting the article, final approval of the version to be submitted; CML: Acquisition of data, final approval of the version to be submitted; GOFD: Acquisition of data, final approval of the version to be submitted; IDL: Conception and design of the study, final approval of the version to be submitted.

Conflict of Interest: MCSS, APR, CFC, and GOFD are employed by Telelaudo, a diagnostic company that provided the chest CT data.

Creative Commons License This is an open-access article distributed under the terms of the Creative Commons Attribution License