ABSTRACT
Health-care workers (HCWs) on the frontlines of the 2019 Coronavirus Disease 2019 (COVID-19) have a high risk of acquiring and dying from the disease. Brazil is a country with high morbimortality and ranks highest in general mortality from COVID-19. A large proportion of medical doctors (MDs) is dying, impacting in the workforce. As part of the research by Fiocruz on working conditions among HCWs, we have conducted this study of death among MDs. We analyzed data from Federal Council of Medicine, the only national platform with details about deaths in MDs. A broad search of other sources, including the Ministry of Health, was done, but unfortunately, the data does not exist. A total of 622 MDs died from March 2020 to March 2021: 87.6% male and 75% over age 60. The Southeast had the highest percentage (34.7%), followed by the Northeast (27.2%), and rankings by state showed Rio de Janeiro (15.8%), followed by São Paulo, Pará, Paraná and Paraíba, totalizing 50.1%. The specialties with highest mortality were gynecology (12.2%), pediatrics (10.0%), internal medicine (9.3%), general surgery (7.8%) and cardiology (7.6%). May 2020 was the month of worst mortality (16.9%) followed by July and June. A slow decline was observed until October, when Brazil begun to experience the “second wave”. The vaccination of MDs began at the end of January 2021 and has not been sufficient time to evaluate the impact on morbimortality. The results of a study of 50 professional categories are under analysis and will be published soon as well as a study of “invisible” HCWs, who do not have specific training but are essential to supporting health care system, from primary care units to high-complexity hospitals. We hope that the results of these studies will improve links among managers, those who define public policies, and union leaders, achieving better workplace and living conditions, minimizing health and socioeconomic disparities. Key messages This study is about death by COVID-19 among medical doctors in Brazil, as part of a large one on professional categories, essentials to supporting health care system, conducted by FIOCRUZ. This stdy is part of a large one on professional categories, essentials to supporting health care system, conducted by FIOCRUZ.
ABSTRACT
Background: Viscoelastic Coagulation Monitor (VCM-Entegrion, Durham, NC) is a portable, recently validated device developed to quickly evaluate the viscoelastic properties of whole blood activated by direct contact with a glass surface. We employed VCM as daily assessment of COVID-19 critically ill patients. Aim of the study was to assess whether VCM parameters were modified by heparin administration. Methods: Retrospective cohort study on COVID-19 critically ill patients who were tested with VCM during their ICU stay from March 25th to June 8th. Anticoagulation was provided either with unfractionated (UFH) or with low molecular weight (LMWH) heparin, per institutional protocol. VCM analysis was simultaneously run to standard coagulation tests Results: Thirty-six patients were included in the study for a total of 151 measurements. ECMO patients (N=4) received UFH, the remaining (except one that was heparin-free) received LMWH, for a total of 52 samples on UFH, 86 samples on LMWH, and 13 samples without any anticoagulant. The administration of UFH influenced VCM parameters towards hypocoagulability whereas LMWH did not. No flat-line tracings were observed. The correlation between VCM Clotting Time and UFH dose was moderate (Spearman's rho = 0.48, p = <0.001), the correlation between aPTT and UFH was weak (Spearman's rho = 0.35, p = 0.010). As expected, no correlation was found between VCM parameters and LMWH dose. Conclusions: VCM parameters were modified only by anticoagulant doses of UFH in a cohort of COVID-19 critically ill patients. VCM could be further evaluated as a tool for UFH anticoagulation monitoring.