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2.
Medwave ; 20(10): e8057, 2020 Nov 09.
Artículo en Español | MEDLINE | ID: mdl-33231573

RESUMEN

Introduction: The results of mandatory confinement have been detrimental in several respects. Nonetheless, they have resulted in reducing the number of active cases of COVID-19. Chile has begun the de-escalation and needs to know the best time to end the restrictions. Objective: We discuss the best conditions and guarantees for the end of compulsory confinement. Methods: This study is based on a trend model with prediction estimation. The data of the variables of interest were subjected to linear regression studies to determine the curve that best explained the data. The coefficient of determination, the standard deviation of y in x, and the confidence interval of the observed curve were estimated. The trend curve was chosen in accordance with the regression estimates. Outcomes: It was found that all dependent variables tended to decrease over time in a quadratic fashion, except for the new cases variable. In general, the R2 and MAPE estimates are satisfactory, except for the variable number of PCR tests per day. Conclusions: Gradual and cautious steps should be taken before ending mandatory confinement. In the current de-escalator, daily PCR tests should be increased, maintaining vigilance on indicators of incidence, prevalence, and positivity of PCR tests. Evidence suggests with some degree of confidence that mandatory confinement could be safely lifted as of August 30, 2020. Long-term preparations must be made to contain future waves of new cases.

3.
Epidemiol Infect ; 148: e270, 2020 11 04.
Artículo en Inglés | MEDLINE | ID: mdl-33143799

RESUMEN

In this study, an analysis of the Chilean public health response to mitigate the spread of COVID-19 is presented. The analysis is based on the daily transmission rate (DTR). The Chilean response has been based on dynamic quarantines, which are established, lifted or prolonged based on the percentage of infected individuals in the fundamental administrative sections, called communes. This analysis is performed at a national level, at the level of the Metropolitan Region (MR) and at the commune level in the MR according to whether the commune did or did not enter quarantine between late March and mid-May of 2020. The analysis shows a certain degree of efficacy in controlling the pandemic using the dynamic quarantine strategy. However, it also shows that apparent control has only been partially achieved to date. With this policy, the control of the DTR partially falls to 4%, where it settles, and the MR is the primary vector of infection at the country level. For this reason, we can conclude that the MR has not managed to control the disease, with variable results within its own territory.


Asunto(s)
Infecciones por Coronavirus/prevención & control , Pandemias/prevención & control , Neumonía Viral/prevención & control , Cuarentena , Betacoronavirus , Chile/epidemiología , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/transmisión , Humanos , Neumonía Viral/epidemiología , Neumonía Viral/transmisión
4.
Child Adolesc Ment Health ; 25(4): 256-257, 2020 11.
Artículo en Inglés | MEDLINE | ID: mdl-33063384

RESUMEN

Mental health in Chile has been significantly challenged by the beginning of a social crisis in October of 2019 and the COVID-19 pandemic of 2020. Despite widening of shortage of services, both the burgeoning of Telepsychiatry and a Presidential Initiative to integrate mental health to policy making and services provided by all sectors of government have mitigated the effects of this crisis.


Asunto(s)
Infecciones por Coronavirus/psicología , Salud Mental , Pandemias , Neumonía Viral/psicología , Adolescente , Servicios de Salud del Adolescente , Niño , Salud del Niño , Servicios de Salud del Niño , Preescolar , Chile/epidemiología , Planificación en Salud , Humanos , Lactante , Servicios de Salud Mental
5.
Mar Pollut Bull ; 161(Pt A): 111722, 2020 Oct 08.
Artículo en Inglés | MEDLINE | ID: mdl-33039790

RESUMEN

During the southern summer of 2020, large phytoplankton blooms were detected using satellite technology in Chile (western Patagonia), where intensive salmonid aquaculture is carried out. Some harvesting sites recorded massive fish mortalities, which were associated with the presence of the dinoflagellate species Cochlodinium sp. The bloom included other phytoplankton species, as Lepidodinium chlorophorum, which persistently changed the colour of the ocean to green. These blooms coincided with the government-managed emergency lockdown due to the COVID-19 pandemic. Local in situ sampling was slowed down. However, imagery from the Copernicus programme allowed operational monitoring. This study shows the benefits of both Sentinel-3 and Sentinel-2 satellites in terms of their spectral, spatial and temporal capabilities for improved algal bloom monitoring. These novel tools, which can foster optimal decision-making, are available for delivering early alerts in situations of natural catastrophes and blockages, such as those occurred during the global COVID-19 lockdown.

7.
Medwave ; 20(9): e8039, 2020 Oct 05.
Artículo en Español | MEDLINE | ID: mdl-33031358

RESUMEN

Introduction: SARS CoV-2 pandemic is pressing hard on the responsiveness of health systems worldwide, notably concerning the massive surge in demand for intensive care hospital beds. Aim: This study proposes a methodology to estimate the saturation moment of hospital intensive care beds (critical care beds) and determine the number of units required to compensate for this saturation. Methods: A total of 22,016 patients with diagnostic confirmation for COVID-19 caused by SARS-CoV-2 were analyzed between March 4 and May 5, 2020, nationwide. Based on information from the Chilean Ministry of Health and ministerial announcements in the media, the overall availability of critical care beds was estimated at 1,900 to 2,000. The Gompertz function was used to estimate the expected number of COVID-19 patients and to assess their exposure to the available supply of intensive care beds in various possible scenarios, taking into account the supply of total critical care beds, the average occupational index, and the demand for COVID-19 patients who would require an intensive care bed. Results: A 100% occupancy of critical care beds could be reached between May 11 and May 27. This condition could be extended for around 48 days, depending on how the expected over-demand is managed. Conclusion: A simple, easily interpretable, and applicable to all levels (nationwide, regionwide, municipalities, and hospitals) model is offered as a contribution to managing the expected demand for the coming weeks and helping reduce the adverse effects of the COVID-19 pandemic.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Capacidad de Camas en Hospitales/estadística & datos numéricos , Unidades de Cuidados Intensivos/provisión & distribución , Modelos Estadísticos , Neumonía Viral/epidemiología , Chile/epidemiología , Humanos , Pandemias
8.
J Med Internet Res ; 22(10): e22146, 2020 10 06.
Artículo en Inglés | MEDLINE | ID: mdl-32903195

RESUMEN

BACKGROUND: As the COVID-19 pandemic disrupted medical practice, telemedicine emerged as an alternative to outpatient visits. However, it is not known how patients and physicians responded to an accelerated implementation of this model of medical care. OBJECTIVE: The aim of this study is to report the system-wide accelerated implementation of telemedicine, compare patient satisfaction between telemedicine and in-person visits, and report provider perceptions. METHODS: This study was conducted at the UC Christus Health Network, a large private academic health network in Santiago, Chile. The satisfaction of patients receiving telemedicine care in March and April 2020 was compared to those receiving in-person care during the same period (concurrent control group) as well as in March and April 2019 (retrospective control group). Patient satisfaction with in-person care was measured using the Net Promoter Score (NPS) survey. Patient satisfaction with telemedicine was assessed with an online survey assessing similar domains. Providers rated their satisfaction and responded to open-ended questions assessing challenges, strategies used to address challenges, the diagnostic process, treatment, and the patient-provider relationship. RESULTS: A total of 3962 patients receiving telemedicine, 1187 patients from the concurrent control group, and 1848 patients from the retrospective control group completed the surveys. Satisfaction was very high with both telemedicine and in-person services. Overall, 263 physicians from over 41 specialties responded to the survey. During telemedicine visits, most providers felt their clinical skills were challenged (61.8%). Female providers felt more challenged than male providers (70.7% versus 50.9%, P=.002). Surgeons, obstetricians, and gynecologists felt their clinical skills were challenged the least, compared to providers from nonsurgical specialties (P<.001). Challenges related to the delivery modality, diagnostic process, and patient-provider relationship differed by provider specialty (P=.046, P<.001, and P=.02, respectively). CONCLUSIONS: Telemedicine implemented in response to the COVID-19 pandemic produced high patient and provider satisfaction. Specialty groups perceived the impact of this new mode of clinical practice differently.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Satisfacción del Paciente , Neumonía Viral/epidemiología , Telemedicina/métodos , Centros Médicos Académicos , Adolescente , Adulto , Anciano , Betacoronavirus , Niño , Preescolar , Chile/epidemiología , Femenino , Humanos , Lactante , Recién Nacido , Satisfacción en el Trabajo , Masculino , Persona de Mediana Edad , Pandemias , Investigación Cualitativa , Proyectos de Investigación , Estudios Retrospectivos , Encuestas y Cuestionarios , Telemedicina/tendencias , Adulto Joven
10.
PLoS One ; 15(9): e0239887, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32991621

RESUMEN

BACKGROUND: South America has become the epicenter of coronavirus pandemic. It seems that asymptomatic population may contribute importantly to the spread of the disease. Transmission from asymptomatic pregnant patients' needs to be characterized in larger population cohorts and symptom assessment needs to be standardized. OBJECTIVE: To assess the prevalence of SARS CoV-2 infection in an unselected obstetrical population and to describe their presentation and clinical evolution. METHODS: A cross-sectional study was designed. Medical records of pregnant women admitted at the Obstetrics & Gynecology department of Clínica Dávila for labor & delivery, between April 27th and June 7th, 2020 were reviewed. All patients were screened with RT-PCR for SARS CoV-2 at admission. After delivery, positive cases were inquired by the researchers for clinical symptoms presented before admission and clinical evolution. All neonates born from mothers with confirmed SARS CoV-2 were isolated and tested for SARS CoV-2 infection. RESULTS: A total of 586 patients were tested for SARS CoV-2 during the study period. Outcomes were obtained from 583 patients which were included in the study. Thirty-seven pregnant women had a positive test for SARS CoV-2 at admission. Cumulative prevalence of confirmed SARS CoV-2 infection was 6.35% (37/583) [CI 95%: 4.63-8.65]. From confirmed cases, 43.2% (16/37) were asymptomatic. From symptomatic patients 85.7% (18/21) had mild symptoms and evolved without complications and 14.3% (3/21) presented severe symptoms requiring admission to intensive care unit. Only 5.4% (2/37) of the neonates born to mothers with a positive test at admission had a positive RT-PCR for SARS CoV-2. CONCLUSION: In our study nearly half of pregnant patients with SARS CoV-2 were asymptomatic at the time of delivery. Universal screening, in endemic areas, is necessary for adequate patient isolation, prompt neonatal testing and targeted follow-up.


Asunto(s)
Infecciones por Coronavirus/diagnóstico , Tamizaje Masivo , Neumonía Viral/diagnóstico , Complicaciones Infecciosas del Embarazo/diagnóstico , Adulto , Infecciones Asintomáticas , Betacoronavirus , Chile/epidemiología , Técnicas de Laboratorio Clínico , Estudios Transversales , Femenino , Humanos , Recién Nacido , Pandemias , Embarazo , Complicaciones Infecciosas del Embarazo/virología , Mujeres Embarazadas , Prevalencia , Adulto Joven
11.
World Dev ; : 105208, 2020 Sep 24.
Artículo en Inglés | MEDLINE | ID: mdl-32994662

RESUMEN

Several variables and practices affect the evolution and geographic spread of COVID-19. Some of these variables pertain to policy measures such as social distancing, quarantines for specific areas, and testing availability. In this paper, I analyze the effect that lockdown and testing policies had on new contagions in Chile, especially focusing on potential heterogeneity given by population characteristics. Leveraging a natural experiment in the determination of early quarantines, I use an Augmented Synthetic Control Method to build counterfactuals for high and lower-income areas that experienced a lockdown during the first two months of the pandemic. I find substantial differences in the impact that quarantine policies had for different populations: While lockdowns were effective in containing and reducing new cases of COVID-19 in higher-income municipalities, I find no significant effect of this measure for lower-income areas. To further explain these results, I test for difference in mobility during quarantine for high and lower-income municipalities, as well as delays in test results and testing availability. These findings are consistent with previous results, showing that differences in the effectiveness of lockdowns could be partially attributed to heterogeneity in quarantine compliance in terms of mobility, as well as differential testing availability for higher and lower-income areas.

12.
MMWR Morb Mortal Wkly Rep ; 69(37): 1305-1309, 2020 Sep 18.
Artículo en Inglés | MEDLINE | ID: mdl-32941415

RESUMEN

After recognition of widespread community transmission of SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19), by mid- to late February 2020, indicators of influenza activity began to decline in the Northern Hemisphere. These changes were attributed to both artifactual changes related to declines in routine health seeking for respiratory illness as well as real changes in influenza virus circulation because of widespread implementation of measures to mitigate transmission of SARS-CoV-2. Data from clinical laboratories in the United States indicated a 61% decrease in the number of specimens submitted (from a median of 49,696 per week during September 29, 2019-February 29, 2020, to 19,537 during March 1-May 16, 2020) and a 98% decrease in influenza activity as measured by percentage of submitted specimens testing positive (from a median of 19.34% to 0.33%). Interseasonal (i.e., summer) circulation of influenza in the United States (May 17-August 8, 2020) is currently at historical lows (median = 0.20% tests positive in 2020 versus 2.35% in 2019, 1.04% in 2018, and 2.36% in 2017). Influenza data reported to the World Health Organization's (WHO's) FluNet platform from three Southern Hemisphere countries that serve as robust sentinel sites for influenza from Oceania (Australia), South America (Chile), and Southern Africa (South Africa) showed very low influenza activity during June-August 2020, the months that constitute the typical Southern Hemisphere influenza season. In countries or jurisdictions where extensive community mitigation measures are maintained (e.g., face masks, social distancing, school closures, and teleworking), those locations might have little influenza circulation during the upcoming 2020-21 Northern Hemisphere influenza season. The use of community mitigation measures for the COVID-19 pandemic, plus influenza vaccination, are likely to be effective in reducing the incidence and impact of influenza, and some of these mitigation measures could have a role in preventing influenza in future seasons. However, given the novelty of the COVID-19 pandemic and the uncertainty of continued community mitigation measures, it is important to plan for seasonal influenza circulation in the United States this fall and winter. Influenza vaccination of all persons aged ≥6 months remains the best method for influenza prevention and is especially important this season when SARS-CoV-2 and influenza virus might cocirculate (1).


Asunto(s)
Infecciones por Coronavirus/epidemiología , Gripe Humana/epidemiología , Pandemias , Neumonía Viral/epidemiología , Vigilancia de la Población , Australia/epidemiología , Chile/epidemiología , Humanos , Sudáfrica/epidemiología , Estados Unidos/epidemiología
14.
Environ Res ; 191: 109938, 2020 12.
Artículo en Inglés | MEDLINE | ID: mdl-32858479

RESUMEN

We have evaluated the spread of SARS-CoV-2 through Latin America and the Caribbean (LAC) region by means of a correlation between climate and air pollution indicators, namely, average temperature, minimum temperature, maximum temperature, rainfall, average relative humidity, wind speed, and air pollution indicators PM10, PM2.5, and NO2 with the COVID-19 daily new cases and deaths. The study focuses in the following LAC cities: Mexico City (Mexico), Santo Domingo (Dominican Republic), San Juan (Puerto Rico), Bogotá (Colombia), Guayaquil (Ecuador), Manaus (Brazil), Lima (Perú), Santiago (Chile), São Paulo (Brazil) and Buenos Aires (Argentina). The results show that average temperature, minimum temperature, and air quality were significantly associated with the spread of COVID-19 in LAC. Additionally, humidity, wind speed and rainfall showed a significant relationship with daily cases, total cases and mortality for various cities. Income inequality and poverty levels were also considered as a variable for qualitative analysis. Our findings suggest that and income inequality and poverty levels in the cities analyzed were related to the spread of COVID-19 positive and negative, respectively. These results might help decision-makers to design future strategies to tackle the spread of COVID-19 in LAC and around the world.


Asunto(s)
Contaminación del Aire , Clima , Infecciones por Coronavirus , Pandemias , Neumonía Viral , Pobreza , Argentina/epidemiología , Betacoronavirus , Brasil , Región del Caribe , Chile , Ciudades , Colombia , República Dominicana , Ecuador , Humanos , Renta , América Latina , México , Perú
15.
Int J Infect Dis ; 100: 75-81, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-32861823

RESUMEN

OBJECTIVE: To describe the clinical and epidemiological characteristics of hospitalized children with multisystem inflammatory syndrome in children (MIS-C) in Santiago, Chile. METHODS: This was an observational study of children with MIS-C (May 1 to June 24, 2020), in three pediatric hospitals in Santiago. Demographic characteristics and epidemiological data, medical history, laboratory tests, cardiology evaluations, treatment, and clinical outcomes were analyzed. RESULTS: Twenty-seven patients were admitted (median age 6, range 0-14 years). Sixteen of the 27 (59%) required intensive care unit admission; there were no deaths. Seventy-four percent had no comorbidities, and the median number of days of symptoms before admission was 4 (range 2-9 days). Gastrointestinal symptoms were the most frequent, and inflammatory markers were increased at admission. A recent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was detected in 82% of cases. The severe group showed significantly lower hemoglobin and albumin levels, decreased platelet counts, and higher d-dimer during disease evolution. Echocardiography showed abnormalities (myocardial, pericardial, or coronary) in 12 patients (46%) during their hospital stay. Anti-inflammatory treatment (immunoglobulin and/or corticosteroids) was prescribed in 24 patients. MIS-C appeared in clusters weeks after the peak of SARS-CoV-2 cases, especially in the most vulnerable areas of Santiago. CONCLUSIONS: This study describes the first series (n = 27) of children with MIS-C in a Latin American country, showing favorable clinical outcomes. Education and alerts are required for clinical teams to establish an early diagnosis and prompt treatment.

16.
Artículo en Inglés | PAHO-IRIS | ID: phr-52574

RESUMEN

[ABSTRACT]. Objectives. To report the surveillance of COVID-19 pandemic in Chile and analyse the response to public health interventions implemented from 3 March to 30 June 2020 and to assess the risks of collapse of the health care system. Methods. We analysed the effective reproductive number, underreporting of cases, burden of critical beds, case fatality ratio and number of diagnostic RT-PCR for SARS-CoV-2. Results. After an accelerated onset, the COVID-19 pandemic seemed to be relatively controlled in Chile (late April 2020), with reproductive numbers close to 1.00. However, at this time, the load of infected patients was high, with an important number of underreported cases; the diagnostic effort was still limited and heterogeneous across regions. After 1 May up to 30 June a marked exponential increase in the number of cases was observed with a peak on June 14. In this last period the occupation of intensive care unit beds increased to saturation level (89% nationally; 95% in the Metropolitan Region). Conclusions. Our findings suggest that the implemented public health interventions have been initially effective in decreasing the spread of the pandemic. Premature decisions to relax these interventions may have resulted in a rebound in cases with a rapid saturation of the health care system.


[RESUMEN]. Objetivos. Informar sobre la vigilancia de la pandemia por COVID-19 en Chile, analizar la respuesta a las intervenciones de salud pública implementadas desde el 3 de marzo hasta el 30 de junio de 2020 y evaluar los riesgos de colapso del sistema de salud. Métodos. Se analizó el número reproductivo efectivo, el subregistro de casos, la carga sobre las camas de cuidados intensivos disponibles, la tasa de letalidad y el número de pruebas diagnósticas de RT-PCR efectuadas para el SARS-CoV-2. Resultados. Tras un inicio acelerado, la pandemia por COVID-19 parecía estar relativamente controlada en Chile a finales de abril de 2020, con números reproductivos cercanos a 1,00. Sin embargo, en ese momento, la carga de pacientes infectados activos era elevada, con un número importante de casos no notificados; la capacidad diagnóstica era todavía limitada y heterogénea entre las regiones del país. Desde el 1 de mayo hasta el 30 de junio se observó un marcado incremento exponencial en el número de casos, con un pico el 14 de junio. En este último período la ocupación de camas en las unidades de cuidados intensivos aumentó hasta el nivel de saturación (89% a nivel nacional; 95% en la Región Metropolitana). Conclusiones. Nuestros hallazgos sugieren que las intervenciones de salud pública implementadas parecen haber sido efectivas inicialmente para disminuir la propagación de la pandemia. Las decisiones prematuras de relajar estas intervenciones pueden haber ocasionado un rebote en los casos con una rápida saturación del sistema de atención de salud.


Asunto(s)
Infecciones por Coronavirus , Pandemias , Salud Pública , Política de Salud , Sistemas de Salud , Chile , Infecciones por Coronavirus , Pandemias , Salud Pública , Política de Salud , Sistemas de Salud , Infecciones por Coronavirus
17.
Rev Panam Salud Publica ; 44: e99, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32821259

RESUMEN

Objectives: To report the surveillance of COVID-19 pandemic in Chile and analyse the response to public health interventions implemented from 3 March to 30 June 2020 and to assess the risks of collapse of the health care system. Methods: We analysed the effective reproductive number, underreporting of cases, burden of critical beds, case fatality ratio and number of diagnostic RT-PCR for SARS-CoV-2. Results: After an accelerated onset, the COVID-19 pandemic seemed to be relatively controlled in Chile (late April 2020), with reproductive numbers close to 1.00. However, at this time, the load of infected patients was high, with an important number of underreported cases; the diagnostic effort was still limited and heterogeneous across regions. After 1 May up to 30 June a marked exponential increase in the number of cases was observed with a peak on June 14. In this last period the occupation of intensive care unit beds increased to saturation level (89% nationally; 95% in the Metropolitan Region). Conclusions: Our findings suggest that the implemented public health interventions have been initially effective in decreasing the spread of the pandemic. Premature decisions to relax these interventions may have resulted in a rebound in cases with a rapid saturation of the health care system.

18.
Artículo en Inglés | MEDLINE | ID: mdl-32735013

RESUMEN

OBJECTIVE: Provide a synthesis of the COVID-19 policies targeting older people in Chile, stressing their short- and long-term challenges. METHOD: Critical analysis of the current legal and policy measures, based on national-level data and international experiences. RESULTS: Although several policies have been enacted to protect older people from COVID-19, these measures could have important unintended negative consequences in this group's mental and physical health, as well as financial aspects. DISCUSSION: A wider perspective is needed to include a broader definition of health-considering financial scarcity, access to health services, mental health issues, and long-term care-in the policy responses to COVID-19 targeted to older people in Chile.

20.
Artículo en Inglés | MEDLINE | ID: mdl-32731509

RESUMEN

The association between the changes in lifestyle during coronavirus disease 2019 (COVID-19) confinement and body weight have not been studied deeply. Therefore, the aim of the present study was to determine lifestyle changes, such as eating habits and physical activity (PA) patterns, caused by confinement during the COVID-19 pandemic and to analyze its association with changes in body weight. Seven hundred participants (women, n = 528 and men, n = 172) aged between 18-62 years old of the Chilean national territory participated in the study. Food habits, PA, body weight, and sociodemographic variables were measured through a survey in May and June 2020. The body weight increase presented positive association with the consumption of fried foods ≥ 3 times per week (OR; 3.36, p < 0.001), low water consumption (OR; 1.58, p = 0.03), and sedentary time ≥6 h/day (OR; 1.85, p = 0.01). Conversely, fish consumed (OR; 0.67, p = 0.03), active breaks (OR; 0.72, p = 0.04), and PA ≥ 4 times per week (OR; 0.51, p = 0.001) presented an inverse association with body weight increase. Daily alcohol consumption (OR; 4.77, p = 0.003) was associated with PA decrease. Food habits, PA, and active breaks may be protective factors for weight increase during COVID-19 confinement.


Asunto(s)
Infecciones por Coronavirus/fisiopatología , Ejercicio Físico , Conducta Alimentaria , Neumonía Viral/fisiopatología , Adolescente , Adulto , Betacoronavirus , Peso Corporal , Chile , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/virología , Ingestión de Líquidos , Femenino , Humanos , Estilo de Vida , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/epidemiología , Neumonía Viral/virología , Encuestas y Cuestionarios , Adulto Joven
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