Detección y cuantificación de SARS-CoV-2 en plantas de tratamiento de aguas residuales de diferentes ciudades de Chile: hacia la implementación de una vigilancia centinela permanente / Detection and quantification of SARS-CoV-2 wastewater treatment plants from different cities in Chile; towards to a permanent sentinel surveillance

INTRODUCCIÓN: La cuantificación de SARS-CoV-2 en aguas residuales es una herramienta que permite determinar la tendencia de la circulación viral en un área geográfica determinada. OBJETIVO: Cuantificar el virus SARS-CoV-2 en 15 plantas de tratamiento de aguas residuales en diferentes ciudades de Chile para establecer una comparación con las variables de: i) casos activos por cada 100.000 habs.; ii) positividad diaria (casos nuevos); y iii) fases del plan de confinamiento. METODOLOGÍA: SARS-CoV-2 se concentró a partir de muestras de aguas residuales. Para obtener el número de genomas del virus por litro se realizó una cuantificación absoluta utilizando qRT-PCR. RESULTADOS: Entre enero y junio de 2021 se procesaron 253 muestras, siendo todas positivas para la presencia del virus. Asimismo, se logró determinar que la tasa de casos activos por cada 100.000 habs. es la variable que mejor se ajusta a las tendencias obtenidas con la cuantificación de la carga viral en las aguas residuales. CONCLUSIONES: La cuantificación de SARS-CoV-2 en las aguas residuales de manera permanente es una herramienta eficiente para determinar la tendencia del virus en un área geográfica determinada y, en conjunto con una vigilancia genómica, puede constituirse en una vigilancia centinela ideal generando alertas sobre futuros brotes.

BACKGROUND: The quantification of SARS-CoV-2 in wastewater is a tool that allows determining the trend of viral circulation in a particular geographical area. AIM: To quantify the SARS-CoV-2 virus in 15 wastewater treatment plants in different Chilean cities to establish a comparison with the variables of: i) Active cases per 100,000 inhabitants; ii) daily positivity (novel cases); and iii) phases of the lockdown strategy. METHODS: SARS-CoV-2 was concentrated from wastewater samples. To obtain the number of virus genomes per liter, absolute quantification was performed using qRT-PCR. RESULTS: Between January and June 2021, 253 samples were processed, all of which were positive for the presence of the virus. Likewise, it will be determined that the rate of active cases per 100,000 inhabitants is the variable that best fits the trends obtained with the quantification of the viral load in wastewater. CONCLUSIONS: The quantification of SARS-CoV-2 in wastewater as a continuous strategy is an efficient tool to determine the trend of the viral circulation in a delimited geographical area and, combined with genomic surveillance, it can constitute an ideal sentinel surveillance alert on future outbreaks.

Estimating the adequacy of the Philippine Health Insurance Corporation case rate for pneumonia cases admitted at the general medicine wards of the Philippine General Hospital from January to May 2013

BACKGROUND: In 2011, PhilHealth introduced the case rate payment scheme and no balance billing policy for selected diseases which will supposedly provide financial protection to patients while promoting efficiency in hospitals. There are concerns that tertiary government hospitals might end losing money as they managed mostly complicated cases.OBJECTIVE: To estimate the adequacy of the pneumonia case rates for cases admitted in the charity Medicine wards of the Philippine General Hospital.METHODS: Costing of a random sample of ward admissions for pneumonia moderate- and high-risk from January 1 to June 30, 2013 was done. Charts were retrieved to collect data on diagnostic tests, medications and mechanical ventilator use and converted to costs using price lists. Additional costs were estimated using WHO-CHOICE values. Estimated admission cost was compared to case rates to assess adequacy.RESULTS: A sample of 113 moderate-risk and 42 high-risk pneumonia cases were reviewed. For moderate-risk pneumonia, the estimated mean admission cost was PhP26,033.82 (SD: 42,987.58) with only 26.5% having costs ofPhP15,000 or lower. For high-risk pneumonia, the average was PhP33,260.65 (SD: 21,865.07) with 64.4% having expenses at PhP32,000.00 or lower.CONCLUSION: The case rate of PhilHealth seems to be adequate for the cost of high-risk pneumonia but not for moderate-risk. Studies utilizing costs and for other diseases should be performed.