<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>1679-4974</journal-id>
<journal-title><![CDATA[Epidemiologia e Serviços de Saúde]]></journal-title>
<abbrev-journal-title><![CDATA[Epidemiol. Serv. Saúde]]></abbrev-journal-title>
<issn>1679-4974</issn>
<publisher>
<publisher-name><![CDATA[Secretaria de Vigilância em Saúde e Ambiente - Ministério da Saúde do Brasil]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S1679-49742021000400316</article-id>
<article-id pub-id-type="doi">10.1590/s1679-49742021000400024</article-id>
<title-group>
<article-title xml:lang="pt"><![CDATA[Letalidade hospitalar por COVID-19 em quatro capitais brasileiras e sua possível relação temporal com a variante Gama, 2020-2021]]></article-title>
<article-title xml:lang="es"><![CDATA[Letalidad hospitalaria por COVID-19 en cuatro capitales brasileñas y su posible relación temporal con la variante Gamma, 2020-2021]]></article-title>
<article-title xml:lang="en"><![CDATA[In-hospital case fatality ratio due to COVID-19 in four Brazilian state capitals and its possible temporal relationship with the Gamma variant, 2020-2021]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Orellana]]></surname>
<given-names><![CDATA[Jesem Douglas Yamall]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Marrero]]></surname>
<given-names><![CDATA[Lihsieh]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Horta]]></surname>
<given-names><![CDATA[Bernardo Lessa]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Fundação Oswaldo Cruz Instituto Leônidas e Maria Deane ]]></institution>
<addr-line><![CDATA[Manaus AM]]></addr-line>
<country>Brazil</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,Universidade do Estado do Amazonas Escola Superior de Ciências da Saúde ]]></institution>
<addr-line><![CDATA[Manaus AM]]></addr-line>
<country>Brazil</country>
</aff>
<aff id="Af3">
<institution><![CDATA[,Universidade Federal de Pelotas Faculdade de Medicina ]]></institution>
<addr-line><![CDATA[Pelotas RS]]></addr-line>
<country>Brazil</country>
</aff>
<pub-date pub-type="pub">
<day>31</day>
<month>12</month>
<year>2021</year>
</pub-date>
<pub-date pub-type="epub">
<day>31</day>
<month>12</month>
<year>2021</year>
</pub-date>
<volume>30</volume>
<numero>4</numero>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://scielo.iec.gov.br/scielo.php?script=sci_arttext&amp;pid=S1679-49742021000400316&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.iec.gov.br/scielo.php?script=sci_abstract&amp;pid=S1679-49742021000400316&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.iec.gov.br/scielo.php?script=sci_pdf&amp;pid=S1679-49742021000400316&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="pt"><p><![CDATA[Resumo  Objetivo Descrever a letalidade por COVID-19 - hospitalar e em unidade de terapia intensiva (UTI) - em quatro capitais brasileiras, em meses de picos epidêmicos e nos meses anteriores.  Métodos  Estudo ecológico com dados mensais de 2020-2021 do Sistema de Informação da Vigilância Epidemiológica da Gripe, em indivíduos com 20 anos ou mais. Foram estimadas letalidade e mortalidade, com intervalos de confiança de 95% (IC95%).  Resultados  Em Manaus, a letalidade em UTI nos &gt;59 anos foi menor em dezembro/2020 (80,9%; IC95% 78,4;83,3) e no pico de janeiro/2021 (79,9%; IC95% 77,4;82,5), em comparação ao pico de abril/2020 (88,2%; IC95% 86,1;90,3). Em São Paulo, Curitiba e Porto Alegre, observou-se queda ou estabilidade na letalidade hospitalar e em UTI, em janeiro/2021, em comparação ao mês de referência de 2020.  Conclusão  Em janeiro/2021, a letalidade hospitalar e em UTI caiu ou manteve-se estável nas quatro capitais, especialmente em Manaus e durante o pico epidêmico com predomínio da variante Gama.]]></p></abstract>
<abstract abstract-type="short" xml:lang="es"><p><![CDATA[Resumen  Objetivo  Describir la tasa de letalidad hospitalaria y en unidad de cuidados intensivos (UCI) por Covid-19 en cuatro capitales brasileñas, durante picos epidémicos y en meses anteriores.  Métodos  Estudio ecológico con datos del Sistema de Información de Vigilancia Epidemiológica de la Influenza, durante 2020-2021, en personas de 20 años o más. Se estimaron tasas de mortalidad y letalidad, con intervalos de confianza del 95,0% (IC95%).  Resultados  En Manaus, la letalidad en UCI en &gt;59 años fue menor en el pico de enero/2021 (79,9%; IC95% 77,4;82,5) y diciembre/2020 (80,9%; IC95% 78,4;83,3), comparado al pico de abril/2020 (88,2%; IC95% 86,1;90,3). En São Paulo, Curitiba y Porto Alegre hubo disminución o estabilidad para letalidad hospitalaria y en UCI, comparada con la referencia de 2020.  Conclusión En enero/2021, la letalidad hospitalaria y en UCI disminuyó o se mantuvo estable en las cuatro capitales, especialmente en Manaus, y durante el pico epidémico con predominio de la variante Gamma.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract  Objective To describe in-hospital and intensive care unit (ICU) case fatality ratios due to COVID-19 in four Brazilian state capitals, during the months of epidemic peaks and previous months.  Methods  This was an ecological study using monthly data from the Influenza Epidemiological Surveillance Information System, between 2020-2021, in individuals aged 20 years or older. Case fatality ratio and mortality rate were estimated with 95% confidence intervals (95%CI).  Results  In Manaus, the capital city of the state of Amazonas, ICU case fatality ratio among those &gt;59 years old was lower in December/2020 (80.9%; 95%CI 78.4;83.3) and during the peak in January/2021 (79.9%; 95%CI 77.4;82.5), compared to the peak in April/2020 (88.2%; 95%CI 86.1;90.3). In São Paulo, the capital city of the state of São Paulo, Curitiba, the capital city of the state of Paraná, and Porto Alegre, the capital city of the state of Rio Grande do Sul, there was a decrease or stability in ICU and in-hospital case fatality ratio in January/2021, compared to the reference month in 2020.  Conclusion  In January/2021, in-hospital and ICU case fatality ratios decreased or remained stable in the four state capitals, especially in Manaus, and during the epidemic peak with the prevalence of the Gamma variant.]]></p></abstract>
<kwd-group>
<kwd lng="pt"><![CDATA[Mortalidade Hospitalar]]></kwd>
<kwd lng="pt"><![CDATA[Brasil]]></kwd>
<kwd lng="pt"><![CDATA[COVID-19]]></kwd>
<kwd lng="pt"><![CDATA[Síndrome Respiratória Aguda Grave]]></kwd>
<kwd lng="pt"><![CDATA[Infecções por Coronavírus]]></kwd>
<kwd lng="pt"><![CDATA[Estudos Ecológicos]]></kwd>
<kwd lng="es"><![CDATA[Mortalidad Hospitalaria]]></kwd>
<kwd lng="es"><![CDATA[Brasil]]></kwd>
<kwd lng="es"><![CDATA[COVID-19]]></kwd>
<kwd lng="es"><![CDATA[Síndrome Respiratorio Agudo Grave]]></kwd>
<kwd lng="es"><![CDATA[Infecciones por Coronavirus]]></kwd>
<kwd lng="es"><![CDATA[Estudios Ecológicos]]></kwd>
<kwd lng="en"><![CDATA[Hospital Mortality]]></kwd>
<kwd lng="en"><![CDATA[Brazil]]></kwd>
<kwd lng="en"><![CDATA[COVID-19]]></kwd>
<kwd lng="en"><![CDATA[Severe Acute Respiratory Syndrome]]></kwd>
<kwd lng="en"><![CDATA[Coronavirus Infections]]></kwd>
<kwd lng="en"><![CDATA[Ecological Studies]]></kwd>
</kwd-group>
</article-meta>
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