Impact on Fatality Rates and Years of Life Lost During the COVID-19 Pandemic: The Experience of the Mexican Public Health Incident Management Command.

BACKGROUND: The SARS-CoV-2 pandemic challenged health systems worldwide. In Mexico, the Public Health Incident Management Command (COISS) strategy was implemented to improve health care for patients with COVID-19 who required hospitalization. AIM: To evaluate the impact of the COISS strategy on case fatality rates (CFR) and years of life lost (YLL) in hospitalized patients with COVID-19. MATERIALS AND METHODS: The COISS strategy included eight actions implemented in states with high epidemic risk (COISS states). A secondary analysis of the public database from the Mexican Ministry of Health was performed considering patients with confirmed diagnoses of SARS-CoV-2 infection. The COISS strategy effectiveness was evaluated by its impact on in-hospital CFR and YLL at the beginning (T0) and end (T1) of the third wave, and at the end of the fourth wave (T2) and compared to states without intervention (non-COISS states). RESULTS: At T0, COISS states showed a higher CFR for hospitalized patients than non-COISS states, which decreased after the strategy implementation. After correction for baseline conditions, lower relative CFR at T1 and T2, compared to T0, and a protective effect in different age groups, especially in those ≥65 years, were found in hospitalized patients in COISS states. The COISS strategy was associated with lower CFR in hospitalized patients with COVID-19 at both T1 and T2. At T0, YLLs were higher in COISS states, but there were no significant differences at T1 and T2. CONCLUSIONS: COISS interventions effectively reduced CFR in hospitalized patients with COVID-19, providing protection to vulnerable patients and reducing the YLL gap.

Strengthening Essential Health Services Recovery Policy after the COVID-19 Pandemic. Evidence from the Mexican Institute of Social Security.

AIM: To evaluate the progress of the Mexican Institute of Social Security Recovery Policy (IMSS-RP) in addressing the decline in essential health services caused by the COVID-19 pandemic. METHODS: We analyzed eleven indicators of essential health services from 35 IMSS state delegations. The assessment included ambulatory and hospital care indicators such as breast and cervical cancer screening, family medicine, dental and specialty visits, diabetes and hypertension visits and health outcomes, deliveries, and elective surgeries. We analyzed the period before (January 2018-March 2021) and during (April 2021-June 2023) the implementation of the IMSS-RP. Statistical analysis to determine the association of the policy with service indicators and the change in their trends included an interrupted time series analysis and Poisson Generalized Estimating Equation models. RESULTS: The volume of services showed substantial declines during the first year of the COVID-19 pandemic, reaching between 11 and 81% of pre-pandemic levels. All services increased significantly during the first 27 months of the IMSS-RP implementation; specialty visits, cervical and breast cancer screening, and diabetes control exceeded pre-pandemic levels (103%,112%,103%, and 138%, respectively). However, only deliveries and the percentage of patients with controlled diabetes and hypertension showed a stable increase following the IMSS-RP implementation, whereas the remaining services showed an initial increase but began to decrease over time. CONCLUSIONS: After 27 months of implementation, IMSS-RP achieved progress in increasing the volume of essential health services and improving chronic disease control. However, declining trends in several services signal the need to focalize the policy.

Outbreak of Fusarium solani Meningitis in Immunocompetent Persons Associated With Neuraxial Blockade in Durango, Mexico, 2022-2023.

Background: Fungal meningitis can be associated with epidural anesthesia procedures. Fusariosis is a rare infection typically affecting immunocompromised patients and rarely causes meningitis. During 2022-2023, public health officials responded to a large outbreak of Fusarium solani meningitis associated with epidural anesthesia in Durango, Mexico. Methods: The public health response and epidemiological and clinical features of patients affected by this outbreak were described. Coordinated actions were addressed to identify the etiological agent, determine its drug susceptibility, develop diagnostic tests, and implement clinical and epidemiological protocols. Retrospective analyses of clinical variables and outcomes were performed to determine association with better patient survival. Results: A total of 1801 persons exposed to epidural anesthesia were identified, of whom 80 developed meningitis. Fusarium solani was found in 3 brain biopsies and showed susceptibility to voriconazole and amphotericin B. After F solani polymerase chain reaction (PCR) implementation, 57 patients with meningitis were PCR-screened, and 31 (38.8%) had a positive result. Most patients were female (95%), and cesarean section was the most common surgical procedure (76.3%). The case fatality rate was 51.3% (41 patients) and the median hospitalization duration was 39.5 days (interquartile range, 18-86 days). Seventy-one patients (88.8%) received voriconazole/amphotericin B and 64 subjects (80%) additionally received steroids. Cox regression analysis showed an increased lethality risk in patients who received antifungal treatment after 5 days (hazard ratio, 2.1 [95% confidence interval, 1.01-4.48], P < .05). Conclusions: The F solani meningitis outbreak in Durango was an unprecedented medical challenge. Timely treatment and effective healthcare management were associated with better survival outcomes.

La Encuesta Nacional de Salud y Nutrición 2022.

¿Qué pasaría si tuviéramos la capacidad de enviar en un solo evento a todo un país para una revisión con el médico? ¿Qué información obtendríamos? ¿Para qué nos serviría? Lo obtenido de este maratónico esfuerzo sería crucial para saber por qué los mexicanos enfermamos y de qué enfermamos, conoceríamos más sobre cómo hacer frente a los factores [...].

[Infarction Code care protocol, towards the federalization of IMSS Bienestar]. / Protocolo de atención Código Infarto, hacia la federalización de IMSS Bienestar.

Since 2015, the Instituto Mexicano del Seguro Social (IMSS) has developed and implemented the Infarct Code emergency care protocol, with the aim of improving the diagnosis and treatment of acute myocardial infarction and thus eventually reducing mortality. In the context of the federalization and implementation of the new IMSS Bienestar care model in several states, the possibility of increasing the coverage and extension of the protocol service networks is presented, not only to eligible population but also to those who do not have social security and resides in contexts of social marginalization, to comply with article 4o. constitutional. This document describes how the proposal was made to extend and increase the service network of the Infarct Code care protocol, based on material, human and infrastructure resources of the IMSS Ordinario and Bienestar.

En el Instituto Mexicano del Seguro Social (IMSS) desde el 2015 desarrolló e implementó, el protocolo de atención de urgencias Código Infarto, con el objetivo de mejorar el diagnóstico y tratamiento del infarto agudo de miocardio y así reducir, eventualmente, la mortalidad. En el contexto de la federalización e implementación del nuevo modelo de atención IMSS-Bienestar en varias entidades federativas, se presenta la posibilidad de incrementar la cobertura y extensión de las redes de servicios del protocolo, no solo a población derechohabiente sino también a aquella que no cuenta con seguridad social, capacidad contributiva y reside en contextos de marginación social, para con ello dar cumplimiento al artículo 4º Constitucional. En este documento se describe cómo se realizó la propuesta para extender e incrementar la red de servicios del protocolo de atención Código Infarto, haciendo uso de recursos materiales, humanos y de infraestructura del IMSS Ordinario y Bienestar.