Salud y economía: una convergencia necesaria para enfrentar la enfermedad por coronavirus (COVID-19) y retomar la senda hacia el desarrollo sostenible / Health and the economy: a convergence needed to address COVID-19 and retake the path of sustainable development in Latin America and the Caribbean

América Latina y el Caribe se ha convertido en el epicentro de la pandemia de enfermedad por coronavirus (COVID-19) y encabeza las estadísticas mundiales de casos. La pandemia ha devenido en una inédita crisis económica y social y, si no se toman medidas urgentes, podría transformarse en una crisis alimentaria, humanitaria y política. Tanto para las acciones de control de la pandemia como para las etapas de reactivación y reconstrucción, es imprescindible aumentar la inversión pública en salud hasta alcanzar los parámetros recomendados, de modo de asegurar el fortalecimiento de los sistemas de salud, ampliando y reconfigurando los servicios de salud de calidad, con un enfoque de atención primaria de salud, y abordar de manera inmediata y acelerada las necesidades de salud insatisfechas, reducir inequidades y mejorar las condiciones de acceso a servicios esenciales, incluida la protección financiera.

Latin America and the Caribbean is now the epicenter of the COVID-19 pandemic, with the highest number of cases of any region in the world. The pandemic has produced an unprecedented economic and social crisis, and it could generate a food, humanitarian, and political crisis if urgent measures are not taken. The policy options for addressing the pandemic entail consolidating national plans and achieving intersectoral consensus. The response should be structured in three nonlinear and interrelated phases­control, reactivation, and rebuilding­involving the participation of technical actors representing not only the field of health but also other social and economic areas. Measures implemented to control the pandemic as well as measures for the reactivation and rebuilding phases will require increased public investment in health until the recommended parameters are achieved. It is necessary to ensure the strengthening of health systems and the expansion and reconfiguration of quality health services with a primary health care approach and to immediately address unmet health needs, reduce inequities, and improve conditions for accessing essential services, including financial protection.

Clinical decision making in older adults with COVID-19 in developing countries: looking beyond chronological age

ABSTRACT Background: The coronavirus disease 2019 (COVID-19) has been declared a global pandemic. Older adults have been found as a vulnerable group for developing severe forms of disease and increased mortality. Objective: The objective of the study was to propose a pathway to assist the decision-making process for hospital resource allocation for older adults with COVID-19 using simple geriatric assessment-based tools. Methods: We reviewed the available literature at this point of the COVID-19 outbreak, focusing in older adult care to extract key recommendations for those health-care professionals who will be treating older adults in the hospital emergency ward (HEW) in developing countries during the COVID-19 pandemic. Results: We listed a series of easy recommendations for non-geriatrician doctors in the HEW and suggested simple tools for hospital resource allocation during critical care evaluation of older adults with COVID-19 in low- and middle-income countries. Conclusions: Age must not be used as the sole criterion for resource allocation among older adults with COVID-19. Simple and efficient tools are available to identify components of the comprehensive geriatric assessment, which could be useful to predict outcomes and provide high-quality care that would fit the particular needs of older adults in resource-limited settings amidst this global pandemic.

Determinantes sociais da saúde de mulheres imigrantes haitianas: repercussões no enfrentamento da COVID-19 / Social determinants of health of Haitian immigrant women: repercussions in facing COVID-19

Objetivos: Compreender as repercussões da COVID-19 no contexto dos determinantes sociais da saúde de mulheres imigrantes haitianas. Método: Estudo qualitativo, tipo ação-participante, fundamentado nos pressupostos de Freire, realizando-se um Círculo de Cultura Virtual, com a participação de 11 mulheres imigrantes haitianas. Foram percorridas as etapas do Itinerário de Pesquisa: Investigação Temática; Codificação e Descodificação; Desvelamento Crítico. Resultados: Nos diálogos emergiram o medo em relação à pandemia, escassos recursos econômicos, preconceito e racismo como aspectos dos determinantes sociais de saúde, que implicam na sua saúde mental das imigrantes, mas que referiram sentir-se acolhidas no Brasil. Conclusão: A partir dos determinantes sociais da saúde, apresentados pelas mulheres imigrantes haitianas no enfrentamento da pandemia mostra- se relevante a articulação entre ações de promoção da saúde, com ênfase na competência cultural, de forma a estimular o empoderamento das pessoas.

Objectives: To understand the repercussions of COVID-19 in the context of the social determinants of health of Haitian immigrant women. Method: Qualitative, participatory action study, based on Freire's assumptions, with a Virtual Culture Circle andbthe participation of eleven Haitian immigrant women. The stages of the Research Itinerary were covered: Thematic Research; Encoding and Decoding; Critical Unveiling. Results: In the dialogues, fear of the pandemic, scarce economic resources, prejudice, and racism emerged as aspects of the social determinants of health, which affect the mental health of immigrants but who mentioned feeling welcomed in Brazil. Conclusion: Based on the social determinants of health, presented by Haitian immigrant women in facing the pandemic, the collaboration between health promotion actions is relevant, with an emphasis on cultural capability, in order to stimulate the empowerment of individuals.

Fatores associados ao comportamento da população durante o isolamento social na pandemia de COVID-19 / Factors associated with people's behavior in social isolation during the COVID-19 pandemic

Resumo O artigo apresenta resultados da pesquisa de opinião realizada no Brasil sobre a percepção do isolamento social durante a pandemia de COVID-19. O questionário foi elaborado no Google Forms, disseminado por redes sociais, com questões sobre o perfil socioeconômico e fatores associados ao isolamento. Obteve-se uma amostra com 16.440 respondentes. Os dados foram analisados no software Stata 13. O convívio social foi o aspecto mais afetado entre pessoas com maior escolaridade e renda 45,8%, para pessoas de baixas renda e escolaridade, problemas financeiros provocam maior impacto 35%. Os que praticam atividade física revelaram menores níveis de estresse 13%, bem como uma maior normalidade no sono 50,3%. Pessoas que referiram residir em piores condições de habitabilidade, informaram disposição a permanecer menos tempo isoladas 73,9%. Dentre as pessoas que não estão isoladas (10,7% do total), 75,8% acredita que o isolamento social reduzirá o número de vítimas da COVID-19. Concluímos, que a percepção das pessoas quanto ao isolamento social como medida de mitigação da pandemia, varia conforme a renda, escolaridade, idade e sexo, porém a maior parte acredita que se trata da medida de controle mais indicada e estão dispostas a esperar o tempo que for necessário para contribuir com o enfrentamento à COVID-19.

Abstract This paper presents the results of an opinion poll conducted in Brazil on the perception of social isolation during the COVID-19 pandemic. The questionnaire was prepared on Google Forms, disseminated through social networks, with questions about the socioeconomic profile and factors associated with isolation. A non-probabilistic sample was obtained with 16,440 respondents. Data were analyzed using the Stata 13 software. Social interaction was the most affected aspect among people with higher education and income (45.8%), and financial problems caused a more significant impact (35%) among people with low income and education. Those who practice some physical activity showed lower levels of stress 13%, as well as greater normality in sleep 50.3%. People who reported living in worse habitability conditions reported willingness to remain isolated for less time, 73.9%. Among non-isolated people (10.7% of the total sample), 75.8% believe that social isolation will reduce the number of victims of COVID-19. We conclude, based on this sample, that the perception about social isolation as a pandemic mitigation action varies by income, education, age, and gender. However, most believe that it is the most appropriate control measure and are willing to wait as long as necessary to contribute to the fight against COVID-19.

Effect of income on the cumulative incidence of COVID-19: an ecological study / Efeito da renda sobre a incidência acumulada de COVID-19: um estudo ecológico / Efecto de la renta sobre la incidencia acumulada de COVID-19: un estudio ecológico

ABSTRACT 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.(AU)

Ensayo sobre la pandemencia: cuando los personajes y microbios de la ciencia ficción salen de la película / Essay on Pandementia: when the characters and microbes of science fiction jump off the screen and invade the planet

RESUMEN Este ensayo crítico acerca de las declaraciones sobre la técnica y la vida en el planeta COVID-19 propone una reflexión ético-filosófica de los efectos de la pandemia. Trata de entender, atribuir significados y criticar las referencias a la pandemia, especialmente en Brasil, en momentos especialmente dramáticos, debido a la sinergia entre la grave enfermedad que afecta al país y al planeta, y un gobierno que se destaca por su gigantesca incapacidad para hacer frente a la calamidad. Este texto fue escrito en el periodo de "cuarentena" brasileña, desde mediados de marzo hasta fines de abril de 2020. Es un momento en el que los hechos nos golpean y no dejan de atormentarnos, y se vive a diario bajo el terrible dominio de esta pandemia. Así, este texto se caracteriza por estar elaborado en medio de un contexto social marcado por los esfuerzos de control y atención de la salud de los afectados, a pesar del complejo marco político actual y de las profundas dificultades económicas del país.

ABSTRACT This essay intends to carry out an ethical and philosophical reflection on the effects of the emergency contingencies of the COVID-19 pandemic. With a focus on Brazil, it seeks to understand, critique, and attribute meaning to references to the pandemic, in particularly dramatic moments brought about by the synergy produced between the serious disease affecting the country and the world and a government that stands out for its remarkable unwillingness and inability to deal with this calamity. This text was written during the Brazilian "quarantine," which lasted from mid-March to late April, 2020. During this period, we were bombarded by facts that never ceased to haunt us, and lived each day under the terrible dominion of the pandemic. Therefore, this text was written in the midst of a social context marked by control efforts, with great attention directed at the health of those affected, despite the complex political framework and serious economic difficulties facing the country.