ABSTRACT
This article presents the case of the Dominican Republic in relation to its emergency preparedness, environmental and social vulnerability framework, its response to the COVID-19 pandemic, including the policies implemented to manage it, and its prospects for the future. The Dominican Republic, being highly vulnerable to climate change and environmental risks, needs to be prepared for national emergencies, including the current pandemic. At the time of the pandemic, the country had a weak health system and weak public funding and, in this context, experienced a significant number of confirmed cases. The country’s trajectory in terms of the number of cases, mortality, and availability of beds and intensive care units for the disease is analyzed, and the experience is compared with other countries in the Americas. As of November 2021, the Dominican Republic has been able to respond adequately, maintaining one of the lowest case-fatality rates in the region and substantially controlling its number of cases in the last year, especially after the vaccination process was initiated. The control measures implemented in the country, consisting of restrictive and timely distancing policies, are noteworthy. Likewise, the country’s successful vaccination program is being followed up as part of these measures. Regardless of the good management of the pandemic by the Dominican Republic and the positive outlook for the future in economic and social areas, the need to improve the preparedness of the country’s health system, such as increasing public spending on health and investment in the first level of care, is emphasized. © 2022 Academia Nacional de Medicina. All rights reserved.
ABSTRACT
Current medical guidelines consider pregnant women with COVID-19 to be a high-risk group. Since physiological gestation downregulates the immunological response to maintain "maternal-fetal tolerance", SARS-CoV-2 infection may constitute a potentially threatening condition to both the mother and the fetus. To establish the immune profile in pregnant COVID-19+ patients, a cross-sectional study was conducted. Pregnant women with COVID-19 (P-COVID-19+; n = 15) were analyzed and compared with nonpregnant women with COVID-19 (NP-COVID-19+; n = 15) or those with physiological pregnancy (P-COVID-19-; n = 13). Serological cytokine and chemokine concentrations, leucocyte immunophenotypes, and mononuclear leucocyte responses to polyclonal stimuli were analyzed in all groups. Higher concentrations of serological TNF-α, IL-6, MIP1b and IL-4 were observed within the P-COVID-19+ group, while cytokines and chemokines secreted by peripheral leucocytes in response to LPS, IL-6 or PMA-ionomicin were similar among the groups. Immunophenotype analysis showed a lower percentage of HLA-DR+ monocytes in P-COVID-19+ than in P-COVID-19- and a higher percentage of CD39+ monocytes in P-COVID-19+ than in NP-COVID-19+. After whole blood polyclonal stimulation, similar percentages of T cells and TNF+ monocytes between groups were observed. Our results suggest that P-COVID-19+ elicits a strong inflammatory response similar to NP-COVID19+ but also displays an anti-inflammatory response that controls the ATP/adenosine balance and prevents hyperinflammatory damage in COVID-19.