Healthcare Resource Utilization and Direct Medical Costs Associated with Post COVID-19 Condition in Colombia, 2020-2021

Objectives: This study aimed to estimate the direct medical costs of patients with post COVID-19 condition in a Colombian insurance company with more than 2.5 million affiliates. Method(s): We conducted a bottom-up cost-of-illness study of adults with persistent symptoms after at least three months of hospital discharge due to COVID-19. We surveyed patients that were hospitalized between March 2020 and August 2021. We asked about healthcare resource utilization (HCRU), which included laboratories and images, medications, consults, rehospitalizations, and others, associated with post COVID-19 condition. The answers were verified using the company's outpatient and inpatient service authorization records. Costs were estimated from the third payer perspective and expressed in American dollars using an exchange rate of 1USD$=3,743COP. Result(s): We included 202 participants, 51.5% were male, mean age of 55.6 years old, 49% had a comorbidity (41.9% hypertension), and 46 patients (22.8%) required an intensive care unit. A total of 159 (78.7%) patients reported at least one symptom after discharge. Of these, 132 (65.3%) persisted with at least one symptom during the telephone survey. Seventy-five (47.2%) of the 159 patients with persistent symptoms reported HCRU. Of these, 93.3% consulted a physician (mean consultations: 2.1 SD 1.1;mean consultations with specialists: 2.4 SD 2.0), and 9.3% were re-hospitalized. The average direct medical costs of post COVID-19 condition were US$824 (95%CI 195-1,454). Costs in outpatient were US$373 (95%CI 158-588), and in inpatient, US$3,285 (95%CI -167-6,738). Conclusion(s): It is crucial to follow up and identify patients discharged from the hospital who persist with symptoms after three months since we observed a greater HCRU, including prolonged recovery therapiesCopyright © 2023

Characteristics of infections associated with health care and use of antibiotics in a COVID-19 Intensive Care Unit, in northern Peru: 20202021

Objective: To describe the frequency of HAIs and the use of antibiotics in a COVID ICU in northern Peru. Material and Methods: cross-sectional descriptive study. 85 stories were reviewed. Results: median age= 57 years, IQR (49-78);70% men;74/85 on a ventilator, median in days= 13 (IQR=7-45). HAI frequency: 28.2%: Ventilator-associated pneumonia 79.1%;26/85 had at least one culture: 22/26 bronchial secretions: 10/26 Acinetobacter baumani, 10/26 Pseudomonas Aeruginosa;8/10 of Acinetobacter and 5/10 of Pseudomonas were multidrug resistant;100% of patients received antibiotics;63% Carbapenems (36% Imipenem and 27% Meropenem) and 22% third-class cephalosporins (14% Ceftazidime and 8% Ceftriaxone);mortality: 30.6%. Of the 19 VAP, 7/19 were due to Acinetobacter Baummani and 10/19 due to Pseudomonas Aeruginosa. Of the deceased, 19% had Acinetobacter baumani and 11% had Pseudomonas Aeruginosa. Conclusion: the most frequent germs: Acinetobacter and Pseudomona, all patients received antibiotics and the most frequent was imipenem.

EPH96 Infant Immunization Coverage in a Colombian Poor Municipality in the Post-Conflict Era

Objective: Colombia has an expanded program of immunization of >22 biologics mainly for younger than 6 years old. We aimed to estimate vaccination coverage in children under 6 years old in San Jacinto (Bolivar), in a post-conflict and COVID-19 pandemic scenario. Methods: We conducted a cross-sectional survey from October to November of 2021, in a Caribbean municipality of Colombia (24,910 population) mostly affected by the armed conflict. A two-stage cluster sampling was used with a precision of 5.5% and a design effect of 2, considering a non-response rate of 20%. We collected data on immunization record cards and other basic sociodemographic information from surveys of caregivers of children. Absolute and timely-vaccine coverages adjusted by age were estimated. Data analysis was performed in Stata 13. Results: Out of 187 surveyed children, 159 (85.3%) had vaccination card. BCG (tuberculosis) vaccine had the greater coverage (99,3%), followed by Hb, pentavalent, and polio (>98%). All biologics showed absolute coverages greater than 90%, except for yellow fever (82.6%) and 5-year boosters (70% for MMR [measles, mumps, rubella] booster and 73% for polio and DPT booster). Age-appropriate timely vaccination coverages were lower than absolutes for all biologics. BCG and hepatitis B had coverages of 97% and initial doses of pentavalent, pneumococcal, polio, MMR, and first and second doses of rotavirus reported coverages greater than 91%. Second and third or booster dosages of pentavalent, polio, pneumococcal and booster of DPT, polio, and MMR had coverages between 70-80%. Lowest timely vaccination coverage were yellow fever (2.3%) and influenza (42.8% for first and 26.5% for second dosage). Conclusion: Although most vaccination coverages were greater than 90%, probably the mobility restrictions due to the pandemic severely impacted the timing of vaccination. Other plausible reasons are the timely flow of vaccines (opportunity in administration and vaccine shortages).

Homeless people and health: vulnerability and risks during the COVID-19 pandemic. Pilot study

Background: Homelessness is a complex phenomenon characterized by extreme vulnerability. The objective of the present study was to know the health status and use of the health system by homeless people (HP) in Palma de Mallorca, as well as to describe how the actual pandemic modified the needs of this population. Subjects and method: Descriptive cross-sectional study with 31 HP from Palma de Mallorca. A questionnaire that included sociodemographic profile, social support (SSQ-6), health problems, infectious diseases, mental health (PHQ-9), drug abuse (DAST-10) and basic needs (hygiene, food, safety, etc.) was administered. In addition, serology test for SARS-CoV-2, syphilis, hepatitis and HIV was performed, also their computerized medical records were reviewed. Results: The mean age was 52 +/- 8 years and 87% (27/31) were men. 48.4% had some chronic disease, 51.6% had some infectious disease and 42% had mood disorders. 96.8% of the HP used Primary Care services in 2020 versus 71% in 2019. The needs most affected by the pandemic were: hygiene (41.9%), access to public toilets (29%) and access to food (25.8%). Conclusions: HP have high rates of comorbidity. Our results suggest that the health status of HP may have worsened during the pandemic. In addition, vital needs have been affected and their vulnerability could increase.

PIN42 Molecular Testing Dynamics Is Reactive to COVID-19 Incidence: Observations from the Colombian Experience

Objectives: Testing is widely accepted as critical to fighting the COVID-19 pandemic. To understand the dynamics of tests conducted could help to assess a country response to the pandemic. In that sense, our aim was to verify if there is a relationship between pandemic dynamics and molecular tests conducted in Colombia. Methods: We retrieved publicly available data from The Colombian National Institute of Health from March 2 to December 31, 2020, on testing and outcomes related to COVID-19. Pearson correlation coefficients were calculated between molecular tests conducted per 100000 persons and death or incidence rate per 100000 people of every department of Colombia. To assess if there a cyclic relationship between the daily number of molecular tests and daily COVID-19 cases in Colombia, we executed a cointegration analysis and evaluated the hypothesis with an augmented Dickey-Fuller (ADF) test. A critical value of -3.42 for rejecting the null hypothesis at 5% was used. Results: There was a positive correlation between molecular tests conducted and COVID-19 incidence and death rate (r = 0.79, p < 0.01 and r = 0.64, p < 0.01, respectively). The cointegration (ADF) test revealed a statistically significant and closely time-dependent stochastic structure between daily COVID-19 cases and number of molecular tests (ADF, -3.50;p < 0.01). Conclusions: In Colombia, the molecular tests conducted are reactive to COVID-19 incidence and, in contrast to other scenarios, the molecular testing increase does not reduce COVID-19 incidence or mortality.