As the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has spread throughout the globe, it has currently remained in Latin America. As on September 3rd, 2020, Mexico has become the seventh nation with confirmed cases and the third regarding SARS-CoV-2 related deaths worldwide, lagging only Brazil as the second country with the highest death toll worldwide [1]. Current reports have shown a mortality rate ranging from 8 to 21% in patients hospitalized for SARS-CoV-2 pneumonia, and up to 16 to 78% in those requiring ICU admission [25]. In the case of Latin America, a recent report from Honduras showed a crude in-hospital mortality of 39% and as high as 72% in mechanically ventilated patients [6].

It has been reported that socioeconomic factors such as higher poverty rates, high public transportation use, lack of health insurance, poor level of formal education as well as overcrowding housing (and other factors that preclude social distancing and precautionary measures) are associated with an increased rate of in-hospital mortality [710]. Besides the unfavorable socioeconomic landscape of Mexico, the high rates of hypertension, type 2 diabetes and obesity pose an imminent threat for in-hospital survival [11]. In addition, health care system associated factors, particularly the high requirements for intensive care unit (ICU) beds reported during this pandemic [12] might have an essential role regarding in-hospital mortality. To face this onslaught, Mexico’s ICU bed availability per 100,000 habitants approaches 1.5 [13], which represents half of those initially contemplated in China, around 10% of those in Italy and between 0.04–0.05% of Germany and USA’s total capacity, respectively [1416]. This high demand for ICU beds might lead to a delay in ICU admission, which is a well-known, time-dependent factor associated with increased mortality [17]. Besides ICU saturation, the effect of both in-hospital and emergency department overcrowding are associated with unfavorable outcomes and might have an impact in major outcomes (mortality) in the circumstances the country faces [18]. In this study, we aimed to describe the in-hospital mortality in adult patients with confirmed SARS-CoV-2 pneumonia as well as risk factors associated with mortality in those who received the standard of care in a tertiary care center in Mexico City. The impact of hospital overcrowding was explored as well.

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In-hospital mortality from severe COVID-19 in a tertiary care center in Mexico City; causes of death, risk factors and the impact of hospital saturation (