Hierarchy of Covid-19-Related Flu Symptoms According to Sex and Color or Race in Reports of Patients with Severe Acute Respiratory Syndrome in Brazil

Main Article Content

João Francisco Severo- Santos
Dimítria Dahmer Santos


The COVID-19 is a disease that presents a wide variety of combinations and intensities of symptoms, characteristic of a Flu Syndrome (FS), which can quickly evolve to a Severe Acute Respiratory Syndrome (SARS). The objectives of this study were to evaluate the hierarchy of symptoms of FS in patients with SARS caused by COVID-19 and to develop a prediction model for potential cases based on sex and race. Binary logistic regression modeling was used in 405,419 records selected from the database of the Ministry of Health of Brazil. It was found that men were more affected by the disease, with a 15.5% higher risk than women. They also died more, with a 13.8% and 15% higher risk for all causes and for COVID-19, respectively. The chances of more than one non-white patient dying from all causes ranged from 18.4% to 38.7% and for Covid-19 it ranged from 16.7% to 64.3% according to race. Fever, muscle pain and loss of smell or taste alternate in the first three positions of the symptom hierarchy, according to sex and race. Cough was only relevant for white men and sore throat for black men. Vomiting was only relevant for black women. The best prediction model developed encompassed seven symptoms adjusted for age, sex and race, but was able to explain only 63% of the cases of COVID-19. Possibly racial diversity, and the socioeconomic inequality associated with it, make the challenge of estimating probabilities of infection by COVID-19, based on symptoms, more complicated in Brazil than in other countries.

Black, COVID-19, disparity, race, sex.

Article Details

How to Cite
Santos, J. F. S.-, & Santos, D. D. (2020). Hierarchy of Covid-19-Related Flu Symptoms According to Sex and Color or Race in Reports of Patients with Severe Acute Respiratory Syndrome in Brazil. Advances in Research, 21(11), 67-78. https://doi.org/10.9734/air/2020/v21i1130271
Original Research Article


Alfradique ME, Bonolo PF, Dourado I, Lima-Costa MF, Macinko J, Mendonça CS, Oliveira VB, Sampaio LFR, Simoni C, Turci MA. Hospitalizations for conditions sensitive to primary care: The construction of the Brazilian list as a tool to measure the performance of the health system (Project ICSAP - Brazil). Reports in Public Health. 2009;25(6):1337-1349.

Cardoso CS, Pádua CM, Rodrigues-Júnior AA, Guimarães DA, Carvalho SF, Valentin RF, Abrantes R, Oliveira CDL. Contribution of hospitalizations for primary care-sensitive conditions to the profile of admissions in the public health care system. Pan American Journal of Public Health. 2013;34(4):227-234.

Stellrecht KA. Molecular testing for respiratory viruses. In: Coleman WB, Tsongalis GJ, editors. Diagnostic molecular pathology: A guide to applied molecular testing. Academic Press. 2016;123-137.

Ministry of health (Brazil). Ordinance n° 454, of March 20, 2020. It declares, throughout the national territory, the state of community transmission of the coronavirus (COVID-19); 2020. Accessed 07 September 2020. Available:https://www.in.gov.br/en/web/dou/-/portaria-n-454-de-20-de-marco-de-2020-249091587

State department of health (Paraíba, Brazil). Protocols: State center for the dissemination of health evidence from COVID-19 of the Paraíba state health secretariat (CDES-COVID19); 2020. Accessed 07 September 2020. Available:https://paraiba.pb.gov.br/diretas/saude/coronavirus/evidencias-cientificas/arquivos/criterios-para-internacao-hospitalar-em-enfermaria-ou-uti-no-cenario.pdf

Dong J, Ismail N, Walker DH. Molecular testing in emerging infectious diseases. In: Coleman WB, Tsongalis GJ, editors. Diagnostic molecular pathology: A guide to applied molecular testing. Academic Press. 2016;179-200.

Nedel FB, Facchini LA, Martín M, Navarro A. Primary health care risk factors for hospitalization for ambulatory care sensitive conditions: Systematic literature review. Epidemiology and Health Services. 2010;19(1):61-75.

Hamre D, Procknow JJ. A new virus isolated from the human respiratory tract. Proc Soc Exp Biol Med. 1966;121(1):190-193.

Oliveira FMS. Human coronavirus detection in pediatric patients with pneumonia treated at a reference hospital in Fortaleza-CE in the years 2011 and 2012; 2014. Accessed 07 September 2020. Available:http://www.repositorio.ufc.br/handle/riufc/15383

Memish ZA, Perlman S, Kerkhove MDV, Zumla A. Middle East respiratory syndrome. Lancet. 2020;395(10229):1063-1077.

Gulati A, Pomeranz C, Qamar Z, Thomas S, Frisch D, George G, Summer R, DeSimone J, Sundaram B. A comprehensive review of manifestations of novel coronaviruses in the context of deadly COVID-19 global pandemic. The American Journal of the Medical Sciences. 2020;360(1):5-34.

Bastos LS, Niquini RP, Lana RM, Villela DAM, Cruz OG, Coelho FC, Codeço CT, Gomes MFC. COVID-19 and hospitalizations for SARS in Brazil: A comparison until the 12th epidemiological week of 2020. Reports in Public Health. 2020;36(4):e00070120.

Sun L, Song F, Shi N, Liu F, Li S, Li P, Zhang W, Jiang X, Zhang Y, Sun L, Chen X, Shi Y. Combination of four clinical indicators predicts the severe/critical symptom of patients infected COVID-19. Journal of Clinical Virology. 2020;128: 104431.

Menni C, Valdes AM, Freidin MB, Sudre CH, Nguyen LH, Drew DA, Ganesh S, Varsavsky T, Cardoso MJ, Moustafa JSE, Visconti A, Bowyer PHRCE, Mangino M, Falchi M, Wolf J, Ourselin S, Chan AT, Steves CJ, Spector TD. Real-time tracking of self-reported symptoms to predict potential COVID-19. Nature Medicine. 2020;26(7):1037-1040.

Liu J, Xie W, Wang Y, Xiong Y, Chen S, Han J, Wu Q. A comparative overview of COVID-19, MERS and SARS: Review article. International Journal of Surgery. 2020;81:1-8.

Menni C, Sudre CH, Steves CJ, Ourselin S, Spector TD. Quantifying additional COVID-19 symptoms will save lives. Lancet. 2020;395(10241):107-108.

Brazilian institute of geography and statistics. Continuous national household sample survey (PNAD) COVID-19; 2020. Accessed 07 September 2020. Available:https://www.ibge.gov.br/estatisticas/sociais/trabalho/27946-divulgacao-semanal-pnadcovid1.html?=&t=microdados

Advancing sex and gender equity in research – GENDRO. A call for urgent action: A renewed commitment to gender responsive research for health equity and human rights in the context of COVID-19 Pandemic; 2019. Accessed 07 September 2020. Available:https://www.gendro.org/statements

Ministry of health (Brazil). SRAG 2020 - Severe Acute Respiratory Syndrome Database - including data from COVID-19; 2020. Accessed 07 September 2020. Available:https://opendatasus.saude.gov.br/dataset/bd-srag-2020

Byrne S. A note on the use of empirical AUC for evaluating probabilistic forecasts. Electronic Journal of Statistics. 2016;10(1): 380-393.

LeDell E, Petersen M, Laan MVD. Computationally efficient confidence intervals for cross-validated area under the ROC curve estimates. Electronic Journal of Statistics. 2015;9(1):1583-1607.

Hosmer D, Lemeshow S. Applied logistic regression. 3rd ed. Hoboken, New Jersey: John Wiley & Sons Inc; 2013.

Cota W. Monitoring the number of COVID-19 cases and deaths in Brazil at municipal and federative units level. SciELO Preprint; 2020. Accessed 07 September 2020. Available:https://preprints.scielo.org/index.php/scielo/preprint/view/362

Pires LN, Carvalho L, Xavier LL. COVID-19 and inequality: The distribution of risk factors in Brazil. Experimental Findings; 2020. Accessed 07 September 2020. Available:https://www.researchgate.net/publication/340452851_COVID-19_e_Desigualdade_no_Brasil

Rossman H, Keshet A, Shilo S, Gavrieli A, Bauman T, Cohen O, Shelly E, Balicer R, Geiger B, Dor Y, Segal E. A framework for identifying regional outbreak and spread of COVID-19 from one-minute population-wide surveys. Nature Medicine. 2020; 26(5):634-638.

Calmon TVL. Objective conditions for confronting COVID 19: Brazilian social abyss, racism, and social development perspectives as determinants. NAU social magazine. 2020;11(20):131–136.

Brazilian Institute of geography and statistics. Social inequalities by color or race in Brazil. Rio de Janeiro: IBGE; 2019.

Dye TDV, Muir E, Farovitch L, Siddiqi S, Sharma S. Critical medical ecology and SARS-COV-2 in the urban environment: A pragmatic, dynamic approach to explaining and planning for research and practice. Infect Dis Poverty. 2020;9(1):71-78.

Victora CG. Socioeconomic inequalities in Health: Reflections on the academic production from Brazil. International journal for equity in health. 2016;15(1):164-167.

zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, Xiang J, Wang Y, Song B, Gu X, Guan L, Wei Y, Li H, Wu X, Xu J, Tu S, Zhang Y, Chen H, Cao B. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: A retrospective cohort study. Lancet. 2020; 395(10229):1054-1062.

Jiang F, Deng L, Zhang L, Cai Y, Cheung CW, Xia Z. Review of the clinical characteristics of coronavirus disease 2019 (COVID-19). Journal of general internal medicine. 2020;35(9):1545–1549.

Ministry of health (Brazil). Coronavirus; 2020. Accessed 07 September 2020. Available:https://coronavirus.saude.gov.br/sobre-a-doenca

Spinato G, Fabbris C, Polesel J, Cazzador D, Borsetto D, Hopkins C, Boscolo-Rizzo P. Alterations in smell or taste in mildly symptomatic outpatients with SARS-CoV-2 infection. JAMA. 2020;323(20):2089-90.

Bagheri SHR, Asghari AM, Farhadi M, Shamshiri AR, Kabir A, Kamrava SK. Coincidence of COVID-19 epidemic and olfactory dysfunction outbreak. medRxiv; 2020. Available:http://dx.doi.org/10.1101/2020.03.23.20041889

Mao L, Wang M, Chen S, He Q, Chang J, Hong Cc. Neurological manifestations of hospitalized patients with COVID-19 in Wuhan, China: A retrospective case series study. JAMA Neurol. 2020;77:683-90.

Eslami H, Jalili M. The role of environmental factors to transmission of SARS-CoV-2 (COVID-19). AMB Expr. 2020;10(1):92.

Penna GO, Silva JAA, Neto CJ, Temporão JG, Pinto LF. PNAD COVID-19: A powerful new tool for public health surveillance in Brazil. Collective science and health. 2020; 25(9):3567-3571.