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1.
HEC Forum ; 33(1-2): 19-33, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33674984

RESUMO

The novel coronavirus of 2019 exposed, in an undeniable way, the severity of racial inequities in America's healthcare system. As the urgency of the pandemic grew, administrators, clinicians, and ethicists became concerned with upholding the ethical principle of "most lives saved" by re-visiting crisis standards of care and triage protocols. Yet a colorblind, race-neutral approach to "most lives saved" is inherently inequitable because it reflects the normality and invisibility of 'whiteness' while simultaneously disregarding the burdens of 'Blackness'. As written, the crisis standards of care (CSC) adopted by States are racist policies because they contribute to a history that treats Black Americans are inherently less than. This paper will unpack the idealized fairness and equity pursued by CSC, while also considering the use of modified Sequential Organ Failure Assessment (mSOFA) as a measure of objective equality in the context of a healthcare system that is built on systemic racism and the potential dangers this can have on Black Americans with COVID-19.


Assuntos
Afro-Americanos , COVID-19/etnologia , Escores de Disfunção Orgânica , Pneumonia Viral/etnologia , Racismo/ética , Alocação de Recursos/ética , Equidade em Saúde , Disparidades nos Níveis de Saúde , Humanos , Pandemias , SARS-CoV-2 , Estados Unidos/epidemiologia
2.
Ann Intern Med ; 174(6): 786-793, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33556278

RESUMO

BACKGROUND: Racial disparities exist in outcomes after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. OBJECTIVE: To evaluate the contribution of race/ethnicity in SARS-CoV-2 testing, infection, and outcomes. DESIGN: Retrospective cohort study (1 February 2020 to 31 May 2020). SETTING: Integrated health care delivery system in Northern California. PARTICIPANTS: Adult health plan members. MEASUREMENTS: Age, sex, neighborhood deprivation index, comorbid conditions, acute physiology indices, and race/ethnicity; SARS-CoV-2 testing and incidence of positive test results; and hospitalization, illness severity, and mortality. RESULTS: Among 3 481 716 eligible members, 42.0% were White, 6.4% African American, 19.9% Hispanic, and 18.6% Asian; 13.0% were of other or unknown race. Of eligible members, 91 212 (2.6%) were tested for SARS-CoV-2 infection and 3686 had positive results (overall incidence, 105.9 per 100 000 persons; by racial group, White, 55.1; African American, 123.1; Hispanic, 219.6; Asian, 111.7; other/unknown, 79.3). African American persons had the highest unadjusted testing and mortality rates, White persons had the lowest testing rates, and those with other or unknown race had the lowest mortality rates. Compared with White persons, adjusted testing rates among non-White persons were marginally higher, but infection rates were significantly higher; adjusted odds ratios [aORs] for African American persons, Hispanic persons, Asian persons, and persons of other/unknown race were 2.01 (95% CI, 1.75 to 2.31), 3.93 (CI, 3.59 to 4.30), 2.19 (CI, 1.98 to 2.42), and 1.57 (CI, 1.38 to 1.78), respectively. Geographic analyses showed that infections clustered in areas with higher proportions of non-White persons. Compared with White persons, adjusted hospitalization rates for African American persons, Hispanic persons, Asian persons, and persons of other/unknown race were 1.47 (CI, 1.03 to 2.09), 1.42 (CI, 1.11 to 1.82), 1.47 (CI, 1.13 to 1.92), and 1.03 (CI, 0.72 to 1.46), respectively. Adjusted analyses showed no racial differences in inpatient mortality or total mortality during the study period. For testing, comorbid conditions made the greatest relative contribution to model explanatory power (77.9%); race only accounted for 8.1%. Likelihood of infection was largely due to race (80.3%). For other outcomes, age was most important; race only contributed 4.5% for hospitalization, 12.8% for admission illness severity, 2.3% for in-hospital death, and 0.4% for any death. LIMITATION: The study involved an insured population in a highly integrated health system. CONCLUSION: Race was the most important predictor of SARS-CoV-2 infection. After infection, race was associated with increased hospitalization risk but not mortality. PRIMARY FUNDING SOURCE: The Permanente Medical Group, Inc.


Assuntos
Teste para COVID-19 , COVID-19/diagnóstico , COVID-19/etnologia , Pneumonia Viral/diagnóstico , Pneumonia Viral/etnologia , APACHE , Adulto , Idoso , COVID-19/mortalidade , California/epidemiologia , Comorbidade , Prestação Integrada de Cuidados de Saúde , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/mortalidade , Pneumonia Viral/virologia , Características de Residência , Estudos Retrospectivos , Fatores de Risco , SARS-CoV-2 , Índice de Gravidade de Doença
3.
Ann Intern Med ; 174(5): 649-654, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33513035

RESUMO

BACKGROUND: Identifying occupational risk factors for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among health care workers (HCWs) can improve HCW and patient safety. OBJECTIVE: To quantify demographic, occupational, and community risk factors for SARS-CoV-2 seropositivity among HCWs in a large health care system. DESIGN: A logistic regression model was fitted to data from a cross-sectional survey conducted in April to June 2020, linking risk factors for occupational and community exposure to coronavirus disease 2019 (COVID-19) with SARS-CoV-2 seropositivity. SETTING: A large academic health care system in the Atlanta, Georgia, metropolitan area. PARTICIPANTS: Employees and medical staff members elected to participate in SARS-CoV-2 serology testing offered to all HCWs as part of a quality initiative and completed a survey on exposure to COVID-19 and use of personal protective equipment. MEASUREMENTS: Demographic risk factors for COVID-19, residential ZIP code incidence of COVID-19, occupational exposure to HCWs or patients who tested positive on polymerase chain reaction test, and use of personal protective equipment as potential risk factors for infection. The outcome was SARS-CoV-2 seropositivity. RESULTS: Adjusted SARS-CoV-2 seropositivity was estimated to be 3.8% (95% CI, 3.4% to 4.3%) (positive, n = 582) among the 10 275 HCWs (35% of the Emory Healthcare workforce) who participated in the survey. Community contact with a person known or suspected to have COVID-19 (adjusted odds ratio [aOR], 1.9 [CI, 1.4 to 2.6]; 77 positive persons [10.3%]) and community COVID-19 incidence (aOR, 1.5 [CI, 1.0 to 2.2]) increased the odds of infection. Black individuals were at high risk (aOR, 2.1 [CI, 1.7 to 2.6]; 238 positive persons [8.3%]). LIMITATIONS: Participation rates were modest and key workplace exposures, including job and infection prevention practices, changed rapidly in the early phases of the pandemic. CONCLUSION: Demographic and community risk factors, including contact with a COVID-19-positive person and Black race, are more strongly associated with SARS-CoV-2 seropositivity among HCWs than is exposure in the workplace. PRIMARY FUNDING SOURCE: Emory COVID-19 Response Collaborative.


Assuntos
COVID-19/epidemiologia , Pessoal de Saúde , Transmissão de Doença Infecciosa do Paciente para o Profissional , Doenças Profissionais/epidemiologia , Exposição Ocupacional/efeitos adversos , Pneumonia Viral/epidemiologia , Adulto , COVID-19/etnologia , Estudos Transversais , Feminino , Georgia/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Profissionais/etnologia , Pandemias , Equipamento de Proteção Individual , Pneumonia Viral/etnologia , Pneumonia Viral/virologia , Fatores de Risco , SARS-CoV-2 , Inquéritos e Questionários , Estados Unidos/epidemiologia
4.
J Pediatric Infect Dis Soc ; 10(5): 593-598, 2021 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-33301595

RESUMO

BACKGROUND: An understanding of the clinical characteristics of children with coronavirus disease 2019 in diverse communities is needed to optimize the response of healthcare providers during this pandemic. METHODS: We performed a retrospective review of all children presenting to the Texas Children's Hospital system with testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from March 10, 2020, through June 28, 2020. Demographics were recorded for all patients undergoing testing and clinical characteristics and outcomes were recorded for children with positive tests. RESULTS: Of 16 554 unique patients ≤ 21 years of age who were tested for SARS-CoV-2, 1215 (7.3%) patients tested positive. Infants under 1 year of age and patients aged 18-21 years had the highest percent of positive tests at 9.9% (230/2329) and 10.7% (79/739), respectively. Hispanic children accounted for 66% (802/1215) of positive tests, though they only represented 42.1% (6972/16 554) of all children tested for SARS-CoV-2. Of the 1215 children with a positive test, 55.7% had fever, 40.9% had cough, 39.8% had congestion or rhinorrhea, 21.9% had gastrointestinal complaints, and 15.9% were asymptomatic. Only 97 (8%) patients were hospitalized (of which 68% were Hispanic). Most of the hospitalized patients had underlying medical conditions (62/97, 63.9%), including obesity. Thirty-one hospitalized patients (31/97, 32%) required respiratory support and 9 patients (9/97, 9.3%) received SARS-CoV-2 antiviral therapy. Two patients died. CONCLUSIONS: A relatively high percentage of Hispanic children tested positive for SARS-CoV-2 and were hospitalized. Most of the children with detection of SARS-CoV-2 had uncomplicated illness courses; some children were critically ill; and 2 patients died.


Assuntos
COVID-19/epidemiologia , Pneumonia Viral/epidemiologia , Adolescente , COVID-19/etnologia , COVID-19/mortalidade , Criança , Pré-Escolar , Estado Terminal , Feminino , Hospitais Pediátricos , Humanos , Lactente , Recém-Nascido , Masculino , Pandemias , Pneumonia Viral/etnologia , Pneumonia Viral/mortalidade , Estudos Retrospectivos , SARS-CoV-2 , Texas/epidemiologia , Adulto Jovem
6.
Medicine (Baltimore) ; 99(46): e22828, 2020 Nov 13.
Artigo em Inglês | MEDLINE | ID: mdl-33181651

RESUMO

BACKGROUND: The Corona Virus Disease, 2019 (COVID-19) pandemic revealed many social disparities that already exist in countries that have social inequalities in their historical context. Studies have already been published on the epidemiological and clinical characteristics of population groups considered to be at risk where they reveal that Black people are at greater risk of becoming ill and dying from this cause. In this context, this protocol describes a systematic review that aims to analyze the association of race as the higher risk for illness and death due to COVID-19. METHODS: This protocol will be developed based on the recommendations of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA-P). For this, we will conduct searches in the PubMed, Web of Science, Scopus, Lilacs, and ScienceDirect databases in the search for cross-sectional studies. All cross-sectional studies that analyzed hospitalization and death by COVID-19 as race in its determinant will be included. The search will be carried out by 2 independent researchers who will carry out the selection of articles, then the duplicate studies will be removed and screened using the Rayyan QCRI application. To assess the risk of bias, the instrument proposed by Downs and Black will be used. Meta-analyzes and subgroup analyzes will be carried out according to included data conditions. RESULTS: Based on this review, it will be possible to carry out a high-quality synthesis of available evidence that brings race as a factor for illness and death by COVID-19 and to verify which race is most affected by this disease. CONCLUSION: The relevance of this systematic review to the current context is considered, as it has a high potential to assist in the development of public health strategies and policies that address existing racial differences.Record of systematic review: CRD42020208767.


Assuntos
Infecções por Coronavirus/etnologia , Pneumonia Viral/etnologia , Betacoronavirus , COVID-19 , Infecções por Coronavirus/mortalidade , Estudos Transversais , Humanos , Pandemias , Pneumonia Viral/mortalidade , Projetos de Pesquisa , Fatores de Risco , SARS-CoV-2
7.
Health Educ Behav ; 47(6): 845-849, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33148042

RESUMO

The COVID-19 pandemic has exposed, and intensified, health inequities faced by Latinx in the United States. Washington was one of the first U.S. states to report cases of COVID-19. Public health surveillance shows that 31% of Washington cases are Latinx, despite being only 13% of the state population. Unjust policies related to immigration, labor, housing, transportation, and education have contributed to both past and existing inequities. Approximately 20% of Latinx are uninsured, leading to delays in testing and medical care for COVID-19, and early reports indicated critical shortages in professional interpreters and multilingual telehealth options. Washington State is taking action to address some of these inequities. Applying a health equity framework, we describe key factors contributing to COVID-19-related health inequities among Latinx populations, and how Washington State has aimed to address these inequities. We draw on these experiences to make recommendations for other Latinx communities experiencing COVID-19 disparities.


Assuntos
Infecções por Coronavirus/etnologia , Disparidades em Assistência à Saúde/etnologia , Pneumonia Viral/etnologia , Betacoronavirus , COVID-19 , Barreiras de Comunicação , Política de Saúde , Acesso aos Serviços de Saúde/organização & administração , Habitação/normas , Humanos , Pandemias , SARS-CoV-2 , Tradução , Estados Unidos/epidemiologia , Washington/epidemiologia , Trabalho/estatística & dados numéricos
8.
MMWR Morb Mortal Wkly Rep ; 69(44): 1654-1659, 2020 Nov 06.
Artigo em Inglês | MEDLINE | ID: mdl-33151922

RESUMO

On June 3, 2020, a woman aged 73 years (patient A) with symptoms consistent with coronavirus disease 2019 (COVID-19) (1) was evaluated at the emergency department of the Hopi Health Care Center (HHCC, an Indian Health Services facility) and received a positive test result for SARS-CoV-2, the virus that causes COVID-19. The patient's symptoms commenced on May 27, and a sibling (patient B) of the patient experienced symptom onset the following day. On May 23, both patients had driven together and spent time in a retail store in Flagstaff, Arizona. Because of their similar exposures, symptom onset dates, and overlapping close contacts, these patients are referred to as co-index patients. The co-index patients had a total of 58 primary (i.e., direct) and secondary contacts (i.e., contacts of a primary contact); among these, 27 (47%) received positive SARS-CoV-2 test results. Four (15%) of the 27 contacts who became ill were household members of co-index patient B, 14 (52%) had attended family gatherings, one was a child who might have transmitted SARS-CoV-2 to six contacts, and eight (30%) were community members. Findings from the outbreak investigation prompted the HHCC and Hopi Tribe leadership to strengthen community education through community health representatives, public health nurses, and radio campaigns. In communities with similar extended family interaction, emphasizing safe ways to stay in touch, along with wearing a mask, frequent hand washing, and physical distancing might help limit the spread of disease.


Assuntos
Infecções por Coronavirus/etnologia , Infecções por Coronavirus/prevenção & controle , Surtos de Doenças , Índios Norte-Americanos/estatística & dados numéricos , Pandemias/prevenção & controle , Pneumonia Viral/etnologia , Pneumonia Viral/prevenção & controle , Adolescente , Adulto , Idoso , Arizona/epidemiologia , Betacoronavirus/isolamento & purificação , COVID-19 , Teste para COVID-19 , Criança , Pré-Escolar , Técnicas de Laboratório Clínico , Busca de Comunicante , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/transmissão , Feminino , Humanos , Lactente , Laboratórios , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/transmissão , SARS-CoV-2 , Adulto Jovem
10.
Artigo em Inglês | MEDLINE | ID: mdl-33153162

RESUMO

As of 18 October 2020, over 39.5 million cases of coronavirus disease 2019 (COVID-19) and 1.1 million associated deaths have been reported worldwide. It is crucial to understand the effect of social determination of health on novel COVID-19 outcomes in order to establish health justice. There is an imperative need, for policy makers at all levels, to consider socioeconomic and racial and ethnic disparities in pandemic planning. Cross-sectional analysis from COVID Boston University's Center for Antiracist Research COVID Racial Data Tracker was performed to evaluate the racial and ethnic distribution of COVID-19 outcomes relative to representation in the United States. Representation quotients (RQs) were calculated to assess for disparity using state-level data from the American Community Survey (ACS). We found that on a national level, Hispanic/Latinx, American Indian/Alaskan Native, Native Hawaiian/Pacific Islanders, and Black people had RQs > 1, indicating that these groups are over-represented in COVID-19 incidence. Dramatic racial and ethnic variances in state-level incidence and mortality RQs were also observed. This study investigates pandemic disparities and examines some factors which inform the social determination of health. These findings are key for developing effective public policy and allocating resources to effectively decrease health disparities. Protective standards, stay-at-home orders, and essential worker guidelines must be tailored to address the social determination of health in order to mitigate health injustices, as identified by COVID-19 incidence and mortality RQs.


Assuntos
Infecções por Coronavirus/etnologia , Pneumonia Viral/etnologia , Determinantes Sociais da Saúde , Betacoronavirus , COVID-19 , Infecções por Coronavirus/mortalidade , Estudos Transversais , Humanos , Pandemias , Pneumonia Viral/mortalidade , SARS-CoV-2 , Estados Unidos/epidemiologia
11.
Rev Bras Enferm ; 73(suppl 2): e20200312, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-33111778

RESUMO

OBJECTIVE: To discuss the fundamental aspects in the establishment of preventive measures to tackle covid-19 among indigenous people in view of the motivations for seeking health care in villages of the Terra Indígena Buriti, Mato Grosso do Sul, Brazil. METHODS: Theoretical-reflective study based on assumptions of the National Health System and previous ethnographic research that enabled the identification of the motivations to seek health care in Buriti villages. RESULTS: Indigenous people seek health centers for health care programs assistance, treatment of cases they cannot resolve and to chat. Such motivations were the basis for discussing the indigenization process in the confrontation of the new coronavirus pandemic in indigenous lands. FINAL CONSIDERATIONS: The motivations for seeking health care show the physical and social vulnerability of the Terena ethnicity. The effectiveness of the social isolation measure in the villages depends on the dialogue with indigenous leaders, professional engagement and intersectoral actions.


Assuntos
Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Necessidades e Demandas de Serviços de Saúde , Serviços de Saúde do Indígena , Índios Sul-Americanos/psicologia , Motivação , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Brasil/epidemiologia , Brasil/etnologia , COVID-19 , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/etnologia , Infecções por Coronavirus/psicologia , Serviços de Saúde do Indígena/organização & administração , Humanos , Índios Sul-Americanos/etnologia , Medicina Tradicional , Determinação de Necessidades de Cuidados de Saúde , Pneumonia Viral/epidemiologia , Pneumonia Viral/etnologia , Pneumonia Viral/psicologia , SARS-CoV-2 , Populações Vulneráveis
12.
PLoS One ; 15(10): e0240960, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33112892

RESUMO

BACKGROUND: Black, Asian and minority ethnic (BAME) populations are emerging as a vulnerable group in the severe acute respiratory syndrome coronavirus disease (SARS-CoV-2) pandemic. We investigated the relationship between ethnicity and health outcomes in SARS-CoV-2. METHODS AND FINDINGS: We conducted a retrospective, observational analysis of SARS-CoV-2 patients across two London teaching hospitals during March 1 -April 30, 2020. Routinely collected clinical data were extracted and analysed for 645 patients who met the study inclusion criteria. Within this hospitalised cohort, the BAME population were younger relative to the white population (61.70 years, 95% CI 59.70-63.73 versus 69.3 years, 95% CI 67.17-71.43, p<0.001). When adjusted for age, sex and comorbidity, ethnicity was not a predictor for ICU admission. The mean age at death was lower in the BAME population compared to the white population (71.44 years, 95% CI 69.90-72.90 versus, 77.40 years, 95% CI 76.1-78.70 respectively, p<0.001). When adjusted for age, sex and comorbidities, Asian patients had higher odds of death (OR 1.99: 95% CI 1.22-3.25, p<0.006). CONCLUSIONS: BAME patients were more likely to be admitted younger, and to die at a younger age with SARS-CoV-2. Within the BAME cohort, Asian patients were more likely to die but despite this, there was no difference in rates of admission to ICU. The reasons for these disparities are not fully understood and need to be addressed. Investigating ethnicity as a clinical risk factor remains a high public health priority. Studies that consider ethnicity as part of the wider socio-cultural determinant of health are urgently needed.


Assuntos
Betacoronavirus , Infecções por Coronavirus/etnologia , Pandemias , Pneumonia Viral/etnologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , /estatística & dados numéricos , COVID-19 , Criança , Pré-Escolar , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Feminino , Mortalidade Hospitalar , Hospitais de Ensino/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Tempo de Internação/estatística & dados numéricos , Londres/epidemiologia , Masculino , Pessoa de Meia-Idade , Grupos Minoritários/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Estudos Retrospectivos , SARS-CoV-2 , Atenção Secundária à Saúde/etnologia , Atenção Secundária à Saúde/estatística & dados numéricos , Fatores Socioeconômicos , Análise de Sobrevida , Resultado do Tratamento , Adulto Jovem
13.
JAMA Netw Open ; 3(10): e2026373, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-33119111

RESUMO

Importance: Policy makers have relaxed restrictions for certain nonessential industries, including construction, jeopardizing the effectiveness of social distancing measures and putting already at-risk populations at greater risk of coronavirus disease 2019 (COVID-19) infection. In Texas, Latinx populations are overly represented among construction workers, and thus have elevated rates of exposure that are compounded by prevalent high-risk comorbidities and lack of access to health care. Objective: To assess the association between construction work during the COVID-19 pandemic and hospitalization rates for construction workers and the surrounding community. Design, Setting, and Participants: This decision analytical model used a mathematical model of COVID-19 transmission, stratified by age and risk group, with construction workers modeled explicitly. The model was based on residents of the Austin-Round Rock metropolitan statistical area, with a population of 2.17 million. Based on 500 stochastic simulations for each of 15 scenarios that varied the size of the construction workforce and level of worksite transmission risk, the association between continued construction work and hospitalizations was estimated and then compared with anonymized line-list hospitalization data from central Texas through August 20, 2020. Exposures: Social distancing interventions, size of construction workforce, and level of disease transmission at construction worksites. Main Outcomes and Measures: For each scenario, the total number of COVID-19 hospitalizations and the relative risk of hospitalization among construction workers was projected and then compared with relative risks estimated from reported hospitalization data. Results: Allowing unrestricted construction work was associated with an increase of COVID-19 hospitalization rates through mid-August 2020 from 0.38 per 1000 residents to 1.5 per 1000 residents and from 0.22 per 1000 construction workers to 9.3 per 1000 construction workers. This increased risk was estimated to be offset by safety measures (such as thorough cleaning of equipment between uses, wearing of protective equipment, limits on the number of workers at a worksite, and increased health surveillance) that were associated with a 50% decrease in transmission. The observed relative risk of hospitalization among construction workers compared with other occupational categories among adults aged 18 to 64 years was 4.9 (95% CI, 3.8-6.2). Conclusions and Relevance: The findings of this study suggest that unrestricted work in high-contact industries, such as construction, is associated with a higher level of community transmission, increased risks to at-risk workers, and larger health disparities among members of racial and ethnic minority groups.


Assuntos
Indústria da Construção , Infecções por Coronavirus/etiologia , Hospitalização , Exposição Ocupacional/efeitos adversos , Pandemias , Pneumonia Viral/etiologia , Adolescente , Adulto , Betacoronavirus , COVID-19 , Comorbidade , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/etnologia , Infecções por Coronavirus/virologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Grupos Minoritários , Pneumonia Viral/epidemiologia , Pneumonia Viral/etnologia , Pneumonia Viral/virologia , Características de Residência , Fatores de Risco , SARS-CoV-2 , Segurança , Texas/epidemiologia , Local de Trabalho , Adulto Jovem
14.
PLoS Negl Trop Dis ; 14(10): e0008686, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33119616

RESUMO

As the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) pandemic continues to expand, healthcare resources globally have been spread thin. Now, the disease is rapidly spreading across South America, with deadly consequences in areas with already weakened public health systems. The Amazon region is particularly susceptible to the widespread devastation from Coronavirus disease 2019 (COVID-19) because of its immunologically fragile native Amerindian inhabitants and epidemiologic vulnerabilities. Herein, we discuss the current situation and potential impact of COVID-19 in the Amazon region and how further spread of the epidemic wave could prove devastating for many Amerindian people living in the Amazon rainforest.


Assuntos
Infecções por Coronavirus/etnologia , Índios Sul-Americanos , Pneumonia Viral/etnologia , Betacoronavirus , COVID-19 , Infecções por Coronavirus/mortalidade , Humanos , Pandemias , Pneumonia Viral/mortalidade , Floresta Úmida , SARS-CoV-2 , América do Sul/epidemiologia
15.
Int J Equity Health ; 19(1): 189, 2020 10 27.
Artigo em Inglês | MEDLINE | ID: mdl-33109197

RESUMO

There has been mounting evidence of the disproportionate involvement of black, Asian and minority ethnic (BAME) communities by the Covid-19 pandemic. In the UK, this racial disparity was brought to the fore by the fact that the first 11 doctors to die in the UK from Covid-19 were of BAME background. The mortality rate from Covid-19 among people of black African descent in English hospitals has been shown to be 3.5 times higher when compared to rates among white British people. A Public Health England report revealed that Covid-19 was more likely to be diagnosed among black ethnic groups compared to white ethnic groups with the highest mortality occurring among BAME persons and persons living in the more deprived areas. People of BAME background account for 4.5% of the English population and make up 21% of the National Health Service (NHS) workforce. The UK poverty rate among BAME populations is twice as high as for white groups. Also, people of BAME backgrounds are more likely to be engaged in frontline roles. The disproportionate involvement of BAME communities by Covid-19 in the UK illuminates perennial inequalities within the society and reaffirms the strong association between ethnicity, race, socio-economic status and health outcomes. Potential reasons for the observed differences include the overrepresentation of BAME persons in frontline roles, unequal distribution of socio-economic resources, disproportionate risks to BAME staff within the NHS workspace and high ethnic predisposition to certain diseases which have been linked to poorer outcomes with Covid-19. The ethnoracialised differences in health outcomes from Covid-19 in the UK require urgent remedial measures. We provide intersectional approaches to tackle the complex racial disparities which though not entirely new in itself, have been often systematically ignored.


Assuntos
/estatística & dados numéricos , Infecções por Coronavirus/etnologia , Infecções por Coronavirus/terapia , Disparidades nos Níveis de Saúde , Grupos Minoritários/estatística & dados numéricos , Pneumonia Viral/etnologia , Pneumonia Viral/terapia , Medicina Estatal/organização & administração , COVID-19 , Humanos , Pandemias , Reino Unido/epidemiologia , /estatística & dados numéricos
16.
JAMA Netw Open ; 3(10): e2026064, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-33104209

RESUMO

Importance: An immediate research priority is to investigate and monitor the psychological well-being among high-risk groups during the coronavirus disease 2019 (COVID-19) pandemic. Objective: To examine levels of severity of depressive symptoms over time among individuals with high risk in the UK during the COVID-19 pandemic. Design, Setting, and Participants: This cohort study is part of an ongoing large panel study of adults aged 18 years and older residing in the UK, the COVID-19 Social Study, established on March 21, 2020. Data analysis was conducted in May 2020. Exposures: Sociodemographic risk factors included belonging to the Black, Asian, and minority racial/ethnic communities, low socioeconomic position (SEP), and essential worker roles (eg, workers in health and social care, education, childcare, or key public services). Health-related and psychosocial risk factors included preexisting physical and mental health conditions, experience of psychological or physical abuse, and low social support. Main Outcomes and Measures: Depressive symptoms were measured on 7 occasions from March 21 to April 2, 2020, using the 9-item Patient Health Questionnaire (PHQ-9). Group-based depressive symptom trajectories were derived using latent growth mixture modeling. Results: The analytical sample comprised 51 417 adults aged 18 years and older (mean [SD] age, 48.8 [16.8] years; 26 276 [51.1%] women; 6145 members [12.0%] of Black, Asian, and minority racial/ethnic communities). Among these, 17 143 participants (33.3%) were in the lowest SEP quartile, and 11 342 participants (22.1%) were classified as essential workers. Three levels of severity of depressive symptoms were identified: low (30 850 participants [60.0%]), moderate (14 911 participants [29.0%]), and severe (5656 participants [11.0%]). After adjusting for covariates, experiences of physical or psychological abuse (odds ratio [OR], 13.16; 95% CI, 12.95-13.37; P < .001), preexisting mental health conditions (OR, 12.99; 95% CI, 12.87-13.11; P < .001), preexisting physical health conditions (OR, 3.41; 95% CI, 3.29-3.54; P < .001), low social support (OR, 12.72; 95% CI, 12.57-12.86; P < .001), and low SEP (OR, 5.22; 95% CI, 5.08-5.36; P < .001) were significantly associated with severe depressive symptoms. No significant association was found for race/ethnicity (OR, 1.07; 95% CI, 0.85-1.28; P = .56). Participants with essential worker roles were less likely to experience severe depressive symptoms (OR, 0.66; 95% CI, 0.53-0.80; P < .001). Similar patterns of associations were found for the group of participants with moderate depressive symptoms (abuse: OR, 5.34; 95% CI, 5.15-5.54; P < .001; mental health condition: OR, 4.24; 95% CI, 4.24-4.24; P < .001; physical health condition: OR, 1.89; 95% CI, 1.80-1.98; P < .001; low social support: OR, 4.71; 95% CI, 4.60-4.82; P < .001; low SEP: OR, 1.97; 95% CI, 1.87-2.08; P < .001). Conclusions and Relevance: In this cohort study of UK adults participating in the COVID-19 Social Study, people with psychosocial and health-related risk factors, as well as those with low SEP, were at the most risk of experiencing moderate or severe depressive symptoms during the COVID-19 pandemic.


Assuntos
Infecções por Coronavirus/psicologia , Depressão , Transtorno Depressivo , Nível de Saúde , Pandemias , Pneumonia Viral/psicologia , Índice de Gravidade de Doença , Classe Social , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus , COVID-19 , Estudos de Coortes , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/etnologia , Infecções por Coronavirus/virologia , Depressão/epidemiologia , Depressão/etiologia , Transtorno Depressivo/epidemiologia , Transtorno Depressivo/etiologia , Emprego , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , Saúde Mental , Pessoa de Meia-Idade , Pneumonia Viral/epidemiologia , Pneumonia Viral/etnologia , Pneumonia Viral/virologia , Grupos Populacionais/psicologia , Fatores de Risco , SARS-CoV-2 , Reino Unido , Adulto Jovem
17.
Artigo em Inglês | MEDLINE | ID: mdl-33121143

RESUMO

This study assessed the knowledge, attitudes and practices (KAP) towards coronavirus disease 2019 (COVID-19) among South Asians in Hong Kong and examined the factors that affect KAP towards COVID-19 in this population. This cross-sectional descriptive study recruited participants with assistance from South Asian community centres and organisations. A total of 352 participants completed questionnaires to assess their level of KAP towards COVID-19. The mean knowledge score was 5.38/10, indicating a relatively low knowledge level. The participants expressed certain misconceptions regarding the prevention of COVID-19 infection. They perceived a mild risk related to the disease, had positive attitudes regarding its prevention and often implemented recommended disease-preventive measures, such as maintaining social distance (88.1%) and wearing masks in public (94.3%). Participants who were male, had a secondary school education or lower and who perceived a lower risk of being infected and lower self-efficacy were less likely to implement preventive measures. Culturally and linguistically appropriate health education could be developed to increase the knowledge of South Asians, especially those with lower education levels, about COVID-19 and to encourage them to implement the necessary preventive measures.


Assuntos
Infecções por Coronavirus/etnologia , Coronavirus , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Pneumonia Viral/etnologia , Adulto , Betacoronavirus , COVID-19 , Infecções por Coronavirus/epidemiologia , Estudos Transversais , Hong Kong/epidemiologia , Humanos , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/epidemiologia , SARS-CoV-2 , Inquéritos e Questionários
18.
J Prim Care Community Health ; 11: 2150132720965080, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33084496

RESUMO

Hospitals and health systems suffer an over-reliance on elective surgeries to remain profitable. As a result, systems report record losses, while demand for emergency room, hospital, and intensive care beds have surged. Studies have admitted that many surgeries are unnecessary, and physician leaders admit that profit plays a role in driving such needless cost and risk. Most diseases are better managed with medications and lifestyle changes. But it pays more to replace a knee than to prevent that replacement. We must bring surgical and medical value closer in-line. Communities of color are suffering disproportionately from coronavirus. The social determinants of health that lead to higher concentrations of hypertension and diabetes can be mitigated by investment in primary care. Such investment has been proven to decrease cost and increase quality of life. However, the United States spends 50% less on primary care, than other developed countries. While showing promise, telehealth is not a panacea. It relies on continued reimbursement parity, and there remains a digital divide. Any meaningful fix will draw the ire from those who profit from such a profligate system. If we want to improve quality, access and equity, while avoiding unnecessary hospitalizations, risky surgeries, and runaway costs, we must invest in primary care.


Assuntos
Infecções por Coronavirus/etnologia , Pneumonia Viral/etnologia , Medicina Preventiva , Atenção Primária à Saúde/economia , Atenção Primária à Saúde/organização & administração , COVID-19 , Procedimentos Cirúrgicos Eletivos/economia , Acesso aos Serviços de Saúde , Disparidades nos Níveis de Saúde , Humanos , Área Carente de Assistência Médica , Pandemias , Determinantes Sociais da Saúde/etnologia , Estados Unidos/epidemiologia
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