RÉSUMÉ
ABSTRACT Objective: This work aimed to estimate the avoidable COVID-19 cases and deaths with the anticipation of vaccination, additional doses, and effective non-pharmacological interventions in Brazil. Methods: We developed a susceptible-exposed-infectious-recovered-susceptible model based on epidemiological indicators of morbidity and mortality derived from data obtained from the Health Information System of the Ministry of Health of Brazil. The number of cases and deaths was estimated for different scenarios of vaccination programs and non-pharmacological interventions in the states of Brazil (from March 8, 2020, to June 5, 2022). Results: The model-based estimate showed that 40 days of vaccination anticipation, additional vaccine doses, and a higher level the nonpharmacological interventions would reduce and delay the pandemic peak. The country would have 17,121,749 fewer COVID-19 cases and 391,647 avoidable deaths Conclusion: The results suggest that if 80% of the Brazilian population had been vaccinated by May 2021, 59.83% of deaths would have been avoided in Brazil.
RESUMO Objetivo: Este trabalho visou estimar os casos e óbitos evitáveis de COVID-19 com a antecipação da vacinação, doses adicionais de vacinas e intervenções não farmacológicas eficazes no Brasil. Métodos: Propôs-se um modelo suscetível-exposto-infectado-recuperado-suscetível baseado em indicadores epidemiológicos de morbidade e mortalidade obtidos de Sistemas de Informação em Saúde do Ministério da Saúde do Brasil. O número de casos e mortes evitáveis foi estimado para diferentes cenários de programas de vacinação e intervenções não farmacológicas nos estados do Brasil (de 8 de março de 2020 a 5 de junho de 2022). Resultados: A estimativa baseada no modelo mostrou que 40 dias de antecipação da vacinação, doses adicionais de vacina e um nível mais alto de intervenções não farmacológicas reduziriam e retardariam o pico da pandemia. Haveria 17.121.749 casos a menos de COVID-19 e 391.647 mortes evitáveis no país. Conclusão: Os resultados sugerem que, se 80% da população brasileira tivesse sido vacinada até maio de 2021, haveria 59,83% de mortes evitadas no Brasil.
RÉSUMÉ
Abstract The specialized care level of the public Brazilian national health system is critical and chronically underfunded. Few studies have evaluated public secondary care planning on a strategic level, so there are open issues yet to examine. This study aims at locating medical centers and sizing equipment based on a two-step optimization process to meet the population's needs. The models consider physicians' propensity for working on a metropolis and the patients' choice on moving the least from their municipalities, therefore, conflicting decisions. The models provide the location of medical centers, the assignment of equipment to such locations, and the additional hours of specialists required to meet official standards of demand. Available equipment with idle capacity should partly satisfy the requirement for exams within the current infrastructure. For the remaining uncovered demand, the second step of the optimization model suggests the acquisition of additional equipment for the elected medical centers to meet established needs. The proposed location of secondary care facilities covers 834 municipalities, corresponding to 97.77% of the estate, with an average patient displacement of 58.73 km (CI95%: 56.18 km - 61.28 km). In general, 39 out of 77 health regions should hire additional hours of medical specialties. Pediatrics and gynecology represent the major gap.
Resumo A atenção especializada do sistema público de saúde brasileiro é crítica e subfinanciada. Poucos estudos avaliaram o planejamento da atenção secundária em um nível estratégico, portanto ainda há questões em aberto a serem examinadas. Este estudo objetiva determinar a localização de centros médicos e a quantidade de equipamentos com base em um processo de otimização em duas etapas para atender a população. Balanceamos decisões conflitantes de propensão dos médicos em trabalharem em metrópoles e de pacientes em mudarem o mínimo de seus municípios para fornecer a localização dos centros médicos, e equipamentos a esses locais e as horas adicionais de especialistas para atender aos padrões oficiais de demanda. Para a demanda restante, a segunda etapa do modelo de otimização sugere a aquisição de equipamento para os centros médicos eleitos, para atender às necessidades. A localização proposta das unidades de atendimento secundário abrange 834 municípios, correspondendo a 97,77% do estado, com um deslocamento médio de pacientes de 58,73 km (IC95%: 56,18 km - 61,28 km). Em geral, 39 das 77 regiões de saúde devem contratar horas adicionais de especialidades médicas. Pediatria e ginecologia representam a maior lacuna.
Sujet(s)
Humains , Enfant , Médecins , Spécialisation , Brésil , Prestations des soins de santéRÉSUMÉ
ABSTRACT BACKGROUND: The fragility of healthcare systems worldwide had not been exposed by any pandemic until now. The lack of integrated methods for bed capacity planning compromises the effectiveness of public and private hospitals' services. OBJECTIVES: To estimate the impact of the COVID-19 pandemic on the provision of intensive care unit and clinical beds for Brazilian states, using an integrated model. DESIGN AND SETTING: Experimental study applying healthcare informatics to data on COVID-19 cases from the official electronic platform of the Brazilian Ministry of Health. METHODS: A predictive model based on the historical records of Brazilian states was developed to estimate the need for hospital beds during the COVID-19 pandemic. RESULTS: The proposed model projected in advance that there was a lack of 22,771 hospital beds for Brazilian states, of which 38.95% were ICU beds, and 61.05% were clinical beds. CONCLUSIONS: The proposed approach provides valuable information to help hospital managers anticipate actions for improving healthcare system capacity.