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Rev. enferm. UERJ ; 28: 49570, jan.-dez. 2020.
Artículo en Inglés, Portugués | LILACS, BDENF - Enfermería | ID: biblio-1094832


Objetivo: discutir as experiências e contradições no controle da pandemia de Covid-19 sob a perspectiva da epidemiologia e das políticas públicas brasileiras. Conteúdo: o debate apresentado divide-se em duas seções: a primeira traça a reflexão dos parâmetros epidemiológicos sobre a curva epidêmica do SARS-CoV-2, bem como as experiências internacionais para o controle deste fenômeno. A segunda, ancorada nas políticas públicas brasileiras, apresenta uma análise comparada das experiências nacionais e internacionais, discutindo os potenciais reflexos sobre a pandemia, considerando algumas especificidades sociais. Conclusão: frente à impossibilidade de redução de pessoas susceptíveis por meio de estratégias vacinais, a redução da velocidade da curva epidêmica precisa ocorrer por meio de ações de isolamento físico social. Ademais, a construção de políticas públicas que visem a proteção ao trabalhador e a ampliação do investimento no setor saúde são medidas urgentes.

Objective: to discuss experiences and contradictions in the control of the Covid-19 pandemic from the perspective of epidemiology and Brazilian public policies. Content: the discussion presented is divided into two sections: the first one present epidemiological parameters on the epidemic curve of SARS-CoV-2, as well as the international experiences for the control of this phenomenon. The second, anchored in the Brazilian public policies, presents a comparative analysis of national and international experiences, discussing the potential impacts on the pandemic, considering some specific social issues. Conclusion: in the face of impossibility of reducing susceptible people through vaccination strategies, the reduction of the speed of the epidemic curve needs to occur through actions of social distance. In addition, the construction of public policies aimed at protecting workers and expanding investment in the health sector are urgent measures.

Objetivo: discutir las experiencias y contradicciones en el control de la pandemia Covid-19 desde la perspectiva de la epidemiología brasileña y las políticas públicas. Contenido: el debate presentado se divide en dos secciones. El primero traza la reflexión de los parámetros epidemiológicos en la curva epidémica del SARS-CoV-2, así como las experiencias internacionales para el control de este fenómeno. El segunda seccione, anclada en las políticas públicas brasileñas, presenta un análisis comparativo de las experiencias nacionales e internacionales, discutiendo los posibles impactos en la pandemia, considerando algunas especificidades sociales brasileñas. Conclusión: dada la imposibilidad de reducir a las personas susceptibles a través de estrategias de vacunación, la reducción de la velocidad de la curva epidémica debe ocurrir a través de acciones de aislamiento social y físico. Además, la construcción de políticas públicas destinadas a proteger a los trabajadores y ampliar la inversión en el sector de la salud son medidas urgentes.

Humanos , Neumonía Viral , Infecciones por Coronavirus/economía , Infecciones por Coronavirus/epidemiología , Políticas Públicas de Salud , Pandemias , Política Pública , Betacoronavirus
Sr Care Pharm ; 35(7): 331, 2020 Jul 01.
Artículo en Inglés | MEDLINE | ID: mdl-32600512


The Centers for Medicare & Medicaid Services (CMS) and other federal agencies are busy churning out regulations and guidance documents in response to the COVID-19 crisis. CMS now requires plans to waive cost sharing for COVID-19-related immunizations, testing, and treatment and suspend utilization review requirements related to drug-supply limits unless these limits are related to patient safety.

Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/terapia , Medicaid/organización & administración , Medicare/organización & administración , Neumonía Viral/diagnóstico , Neumonía Viral/terapia , Betacoronavirus , Infecciones por Coronavirus/economía , Infecciones por Coronavirus/prevención & control , Utilización de Medicamentos , Humanos , Pandemias/economía , Pandemias/prevención & control , Neumonía Viral/economía , Neumonía Viral/prevención & control , Estados Unidos
BMJ Glob Health ; 5(7)2020 07.
Artículo en Inglés | MEDLINE | ID: mdl-32675068


Are the steps that have been taken to arrest the spread of COVID-19 justifiable? Specifically, are they likely to have improved public health understood according to widely used aggregate population health measures, such as Quality Adjusted Life Years (QALYs) and Disability Adjusted Life Years (DALYs) as much or more than alternatives? This is a reasonable question, since such measures have been promoted extensively in global and national health policy by influential actors, and they have become almost synonymous with quantification of public health. If the steps taken against COVID-19 did not meet this test, then either the measures or the policies must be re-evaluated. There are indications that policies against COVID-19 may have been unbalanced and therefore not optimal. A balanced approach to protecting population health should be proportionate in its effects across distinct health concerns at a moment, across populations over time and across populations over space. These criteria provide a guide to designing and implementing policies that diminish harm from COVID-19 while also providing due attention to other threats to aggregate population health. They should shape future policies in response to this pandemic and others.

Infecciones por Coronavirus/economía , Salud Global , Pandemias/economía , Pandemias/ética , Neumonía Viral/economía , Salud Poblacional , Salud Pública/economía , Salud Pública/ética , Betacoronavirus , Infecciones por Coronavirus/epidemiología , Política de Salud , Humanos , Neumonía Viral/epidemiología , Años de Vida Ajustados por Calidad de Vida
Monaldi Arch Chest Dis ; 90(3)2020 Jul 22.
Artículo en Inglés | MEDLINE | ID: mdl-32696629


Coronavirus disease 2019, i.e. COVID-19, started as an outbreak in a district of China and has engulfed the world in a matter of 3 months. It is posing a serious health and economic challenge worldwide. However, case fatality rates (CFRs) have varied amongst various countries ranging from 0 to 8.91%. We have evaluated the effect of selected socio-economic and health indicators to explain this variation in CFR. Countries reporting a minimum of 50 cases as on 14th March 2020, were selected for this analysis. Data about the socio-economic indicators of each country was accessed from the World bank database and data about the health indicators were accessed from the World Health Organisation (WHO) database. Various socioeconomic indicators and health indicators were selected for this analysis. After selecting from univariate analysis, the indicators with the maximum correlation were used to build a model using multiple variable linear regression with a forward selection of variables and using adjusted R-squared score as the metric. We found univariate regression results were significant for GDP (Gross Domestic Product) per capita, POD 30/70 (Probability Of Dying Between Age 30 And Exact Age 70 From Any of Cardiovascular Disease, Cancer, Diabetes or Chronic Respiratory Disease), HCI (Human Capital Index), GNI(Gross National Income) per capita, life expectancy, medical doctors per 10000 population, as these parameters negatively corelated with CFR (rho = -0.48 to -0.38 , p<0.05). Case fatality rate was regressed using ordinary least squares (OLS) against the socio-economic and health indicators. The indicators in the final model were GDP per capita, POD 30/70, HCI, life expectancy, medical doctors per 10,000, median age, current health expenditure per capita, number of confirmed cases and population in millions. The adjusted R-squared score was 0.306. Developing countries with a poor economy are especially vulnerable in terms of COVID-19 mortality and underscore the need to have a global policy to deal with this on-going pandemic. These trends largely confirm that the toll from COVID-19 will be worse in countries ill-equipped to deal with it. These analyses of epidemiological data are need of time as apart from increasing situational awareness, it guides us in taking informed interventions and helps policy-making to tackle this pandemic.

Infecciones por Coronavirus/epidemiología , Indicadores de Salud , Neumonía Viral/epidemiología , Adulto , Factores de Edad , Anciano , Infecciones por Coronavirus/economía , Infecciones por Coronavirus/mortalidad , Países en Desarrollo , Salud Global , Humanos , Persona de Mediana Edad , Pandemias/economía , Neumonía Viral/economía , Neumonía Viral/mortalidad , Factores Socioeconómicos
Infect Dis Poverty ; 9(1): 78, 2020 Jun 29.
Artículo en Inglés | MEDLINE | ID: mdl-32600426


BACKGROUND: Coronavirus disease 2019 (COVID-19) is now a global public threat. Given the pandemic of COVID-19, the economic impact of COVID-19 is essential to add value to the policy-making process. We retrospectively conducted a cost and affordability analysis to determine the medical costs of COVID-19 patients in China, and also assess the factors affecting their costs. METHODS: This analysis was retrospectively conducted in Shandong Provincial Chest Hospital between 24 January and 16 March 2020. The total direct medical expenditures were analyzed by cost factors. We also assessed affordability by comparing the simulated out-of-pocket expenditure of COVID-19 cases relative to the per capita disposable income. Differences between groups were tested by student t test and Mann-Whitney test when appropriate. A multiple logistic regression model was built to determine the risk factors associated with high cost. RESULTS: A total of 70 COVID-19 patients were included in the analysis. The overall mean cost was USD 6827 per treated episode. The highest mean cost was observed in drug acquisition, accounting for 45.1% of the overall cost. Total mean cost was significantly higher in patients with pre-existing diseases compared to those without pre-existing diseases. Pre-existing diseases and the advanced disease severity were strongly associated with higher cost. Around USD 0.49 billion were expected for clinical manage of COVID-19 in China. Among rural households, the proportions of health insurance coverage should be increased to 70% for severe cases, and 80% for critically ill cases to avoid catastrophic health expenditure. CONCLUSIONS: Our data demonstrate that clinical management of COVID-19 patients incurs a great financial burden to national health insurance. The cost for drug acquisition is the major contributor to the medical cost, whereas the risk factors for higher cost are pre-existing diseases and severity of COVID-19. Improvement of insurance coverage will need to address the barriers of rural patients to avoid the occurrence of catastrophic health expenditure.

Betacoronavirus , Infecciones por Coronavirus , Costos de la Atención en Salud/estadística & datos numéricos , Gastos en Salud/estadística & datos numéricos , Pandemias , Neumonía Viral , Adolescente , Adulto , Anciano , Niño , Preescolar , China , Infecciones por Coronavirus/economía , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/terapia , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Modelos Económicos , Programas Nacionales de Salud/economía , Pandemias/economía , Neumonía Viral/economía , Neumonía Viral/epidemiología , Neumonía Viral/terapia , Estudios Retrospectivos , Población Rural , Adulto Joven
Rev Lat Am Enfermagem ; 28: e3344, 2020.
Artículo en Inglés, Portugués, Español | MEDLINE | ID: mdl-32609281


OBJECTIVE: to analyze the relationship between per capita income and the cumulative incidence of COVID-19 in the neighborhoods of the city of Rio de Janeiro, RJ, Brazil. METHOD: an ecological study using neighborhoods as units of analysis. The cumulative incidence rate per 100,000 inhabitants and the median of potential confounding variables (sex, race, and age) were calculated. Multiple analysis included quantile regression, estimating the regression coefficients of the variable income for every five percentiles from the 10th to 90th percentiles to verify the relationship between income and incidence. RESULTS: the city's rate was 36.58 new cases per 100,000 inhabitants. In general, the highest rates were observed in the wealthiest regions. Multiple analysis was consistent with this observation since the per capita income affected all percentiles analyzed, with a median regression coefficient of 0.02 (p-value <0.001; R2 32.93). That is, there is an increase of R$ 0.02 in the neighborhood's per capita income for every unit of incidence. CONCLUSION: cumulative incident rates of COVID-19 are influenced by one's neighborhood of residency, suggesting that access to testing is uneven.

Betacoronavirus , Infecciones por Coronavirus/epidemiología , Renta , Pandemias , Neumonía Viral/epidemiología , Características de la Residencia/estadística & datos numéricos , Grupo de Ascendencia Continental Africana/estadística & datos numéricos , Distribución por Edad , Brasil/epidemiología , Ciudades/epidemiología , Infecciones por Coronavirus/economía , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Pandemias/economía , Pandemias/estadística & datos numéricos , Neumonía Viral/economía , Distribución por Sexo , Factores Socioeconómicos
Artículo en Inglés | MEDLINE | ID: mdl-32646034


Korea's Daegu Metropolitan City once had the second highest rate of COVID-19 infection after Wuhan in China. Following the outbreak, the government provided the first national disaster relief fund to citizens as financial aid. This study investigated whether the sense of regional belonging, pride, and mental health among 550 citizens of Daegu differed between the times before and after COVID-19, based on the presence or absence of the disaster relief fund. Frequency analysis, descriptive statistical analysis, and t-tests were conducted using the SPSS 25.0 program. Results showed that the sense of belonging was higher after COVID-19 than before, while pride was lower. Individuals who received the disaster relief fund showed higher levels of regional belonging and pride with statistical significance. The prevalence of melancholy and depression increased after COVID-19, but the presence or absence of the fund did not lead to a significant difference. Thus, in case of a future national disaster level, provision of the disaster relief fund can raise the sense of regional belonging and pride, in order to elicit communication among local residents toward overcoming difficulties. Furthermore, during challenging disaster situations, central and local governments should provide diverse programs for the citizens' mental health care.

Infecciones por Coronavirus/psicología , Desastres/economía , Neumonía Viral/psicología , Factores Sociológicos , Adulto , Anciano , Betacoronavirus , Ciudades , Infecciones por Coronavirus/economía , Emociones , Femenino , Administración Financiera , Humanos , Masculino , Salud Mental , Persona de Mediana Edad , Pandemias/economía , Neumonía Viral/economía , República de Corea , Adulto Joven
PLoS One ; 15(7): e0235597, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32639991


Facing a growing and more affluent world population, changing climate and finite natural resources, world food systems will have to change in the future. The aim of the Agrimonde-Terra foresight study was to build global scenarios linking land use and food security, with special attention paid to overlooked aspects such as nutrition and health, in order to help explore the possible future of the global food system. In this article, we seek to highlight how the resulting set of scenarios contributes to the debate on land use and food security and enlarges the range of possible futures for the global food system. We highlight four main contributions. Combining a scenario building method based on morphological analysis and quantitative simulations with a tractable and simple biomass balance model, the proposed approach improves transparency and coherence between scenario narratives and quantitative assessment. Agrimonde-Terra's scenarios comprise a wide range of alternative diets, with contrasting underlying nutritional and health issues, which accompany contrasting urbanization and rural transformation processes, both dimensions that are lacking in other sets of global scenarios. Agrimonde-Terra's scenarios share some similarities with existing sets of global scenarios, notably the SSPs, but are usually less optimistic regarding agricultural land expansion up to 2050. Results suggest that changing global diets toward healthier patterns could also help to limit the expansion in agricultural land area. Agrimonde-Terra's scenarios enlarge the scope of possible futures by proposing two pathways that are uncommon in other sets of global scenarios. The first proposes to explore possible reconnection of the food industry and regional production within supranational regional blocs. The second means that we should consider that a 'perfect storm', induced by climate change and an ecological crisis combined with social and economic crises, is still possible. Both scenarios should be part of the debate as the current context of the COVID-19 pandemic shows.

Infecciones por Coronavirus/economía , Abastecimiento de Alimentos , Pandemias/economía , Neumonía Viral/economía , Agricultura , Simulación por Computador , Conservación de los Recursos Naturales , Infecciones por Coronavirus/epidemiología , Dieta , Calidad de los Alimentos , Salud Global , Humanos , Neumonía Viral/epidemiología , Urbanización