Clinical characteristics and predictors of hospitalization among 7,108 ambulatory patients with positive RT-PCR for SARS-CoV-2 during the acute pandemic period.

OBJECTIVE: To describe baseline characteristics of outpatients with a positive RT-PCR for SARS-CoV-2 and to define whether "red flags" (new-onset fever, dyspnea, and chest pain) can predict clinical worsening during the isolation period. METHODS: This was an epidemiological, observational, descriptive study. Between March and September of 2020, all outpatients who tested positive for SARS-CoV-2 at a tertiary medical center located in Santiago de Chile were included. Demographic variables, comorbidities, red flags, and other symptoms were compiled using follow-up surveys at specific time points. The risk of clinical worsening (hospitalization) and adjusted hazard ratios (HRs) were calculated. RESULTS: A total of 7,108 patients were included. The median age was 38 years (range, 0-101), and 52% were men. At baseline, 77% of the patients reported having characteristic symptoms of SARS-CoV-2 infection. The most prevalent onset symptoms were headache (53%), myalgia (47%), and fever (33%). According to the follow-up surveys, the incidence of symptoms decreased during the isolation period; however, 28% of the patients still presented with symptoms on day 14. The risk of hospitalization for patients with new-onset fever and dyspnea during the follow-up period was HR = 7.43 (95% CI, 3.85-14.3, p<0.01) and HR = 5.27 (95% CI, 1.52-18.30; p < 0.01 for both), respectively. New-onset chest pain showed no association with clinical worsening. CONCLUSIONS: In this sample of outpatients with a recent diagnosis of SARS-CoV-2 infection, a survey-based monitoring of symptoms was useful to identify those at risk of clinical worsening. New-onset fever and dyspnea during the isolation period were considered as red flags associated with clinical worsening and warrants prompt medical evaluation.

Considerations regarding organizing healthcare systems for a pandemic / Algunas consideraciones sobre la organización del sistema sanitario frente a una pandemia

No hay fórmula única para enfrentar una pandemia. La diversidad de liderazgos, objetivos sanitarios, escenarios, culturas, financiamiento, y organizaciones de sistemas de salud existentes obligan a cada país a buscar sus propias estrategias. La pandemia causada por el virus SARS-CoV-2 y la tremenda cantidad de información que se ha generado a su entorno ha motivado la necesidad de evaluar la preparación de los sistemas de salud para enfrentar, responder y sobrevivir a un evento de esta naturaleza. Este artículo aporta consideraciones al respecto.

There is no "one size fits all" solution for healthcare systems when it comes to pandemics. Different and diverse scenarios with regards to financing, healthcare system structure, cultural issues and political orientation force countries to seek the most appropriate strategies for their particular case. The SARS-CoV-2 pandemic and the tremendous amount of information that is has generated pressures the need for healthcare systems to seriously evaluate how prepared they are for facing, responding and emerging from an event of this nature. This article offers considerations on the subject.

Impact of the first pandemic wave of COVID-19 on health-care workers in a private hospital / Impacto de la primera ola pandémica de COVID-19 en el personal de salud en un hospital privado

El personal de salud (PS) está más expuesto que la población general a enfermar por SARS-CoV-2, por lo que debe utilizar elementos de protección personal (EPP) en todas las atenciones. El PS de Clínica Las Condes (CLC) que requirió licencia médica (LM) por COVID-19 durante el periodo de estudio, fue evaluado por Organismo Administrador según Ley 16.744, categorizando cada caso de contacto estrecho (CE) o contagio, en común o laboral. Además, fue contactado en su totalidad por equipo de RRHH y de IAAS, para conocer estado de salud, factores de riesgo y evolución. El objetivo fue caracterizar los casos y CE de PS que tuvieron LM, relacionándolas con diferentes eventos ocurridos en la institución y la comunidad durante el periodo comprendido entre el 12 de febrero y el 31 de julio. Un 21% del PS requirió LM en el periodo y un 12,97% presentó infección confirmada por PCR. En cuanto a la distribución por sexo y edad de casos y CE, esta no difiere de la distribución observada en el total de funcionarios de CLC. Se observa que, en los casos, la mayoría corresponde a categoría intrahospitalaria, en cambio los CE, la mayor parte correspondió a comunitario. En relación con casos confirmados intrahospitalarios, destaca que el primer caso ocurrió 63 días después del primer paciente hospitalizado en CLC con diagnóstico de COVID-19, y cuando ya estaba instalada la epidemia en la Región Metropolitana (RM) de Santiago , lo que refleja la efectividad de las medidas de prevención adoptadas al interior de CLC.

Health care workers (HCW) are at higher risk to get sick from SARS-CoV-2 than general population, so they must use personal protective equipment (PPE) in all care situations. The HCW at Clinica las Condes (CLC) that required a sick leave (SL) during the study period was evaluated by the Administrative Institution according to Law 16.744, which categorized each case of close contact (CC) or confirmed case, as community-acquired (CA) or health care-associated (HCA). In addition, all of them were traced by the HR and Infection Control team, to find out health status, risk factors and evolution. The aims were to characterize the confirmed cases and CC, their association with key events that occurred in the institution and the community between February 12th and July 31th. 21%