Testing the predictive accuracy of COVID-19 forecasts.

We test the predictive accuracy of forecasts of the number of COVID-19 fatalities produced by several forecasting teams and collected by the United States Centers for Disease Control and Prevention for the epidemic in the United States. We find three main results. First, at the short horizon (1-week ahead) no forecasting team outperforms a simple time-series benchmark. Second, at longer horizons (3- and 4-week ahead) forecasters are more successful and sometimes outperform the benchmark. Third, one of the best performing forecasts is the Ensemble forecast, that combines all available predictions using uniform weights. In view of these results, collecting a wide range of forecasts and combining them in an ensemble forecast may be a superior approach for health authorities, rather than relying on a small number of forecasts.

Gerenciamento hospitalar no contexto da pandemia COVID-19

Objective: To describe the challenges faced by nurses in hospital management in the context of the COVID-19 pandemic. Methods: This is a descriptive, quantitative, exploratory research that used the investigative method. It was developed at Fundação Hospitalar São Sebastião, municipality of Três Corações, MG, with an online questionnaire applied to 16 nurses. The research was conducted through 07 stages respecting the precepts of Resolution 466/12 of the National Health Council. Results and Discussion: There were numerous challenges faced by nurses during the pandemic, such as overload and physical and emotional strain. They had to overcome themselves by going beyond their limits. Seeking to improve their skills every day through training, the team managed to master the subject and provide better assistance to the population. Conclusion: Amidst losses and suffering, nursing can be more valued. Working on the front lines, these true heroes now feel more prepared to act in the pandemic.;Objetivo: Describir los desafíos que enfrentan las enfermeras en la gestión hospitalaria en el contexto de la pandemia de C0VID-19. Métodos: Se trata de una investigación descriptiva, cuantitativa, exploratoria que utilizó el método investigativo. Fue desarrollado en la Fundação Hospitalar São Sebastião, municipio de Três Corações, MG, con un cuestionario online aplicado a 16 enfermeras. La investigación se realizó en 07 etapas respetando los preceptos de la Resolución 466/12 del Consejo Nacional de Salud. Resultados y Discusión: Fueron numerosos los desafíos que enfrentaron las enfermeras durante la pandemia, como la sobrecarga y el estrés físico y emocional. Tuvieron que superarse a sí mismos yendo más allá de sus límites. Buscando mejorar día a día sus habilidades a través de capacitaciones, el equipo logró dominar la asignatura y poder brindar una mejor asistencia a la población. Conclusión: En medio de pérdidas y sufrimientos, la enfermería puede ser más valorada. Trabajando en primera línea, estos verdaderos héroes ahora se sienten más preparados para actuar en la pandemia.;Objetivo: Identificar as principais barreiras no manejo da dor neonatal relatadas por estudos científicos, afim de criar subsídios para aprimoramento Objetivo: Descrever os desafios enfrentados pelos enfermeiros na gerencia hospitalar no contexto da pandemia C0VID-19. Métodos: Trata-se de uma pesquisa descritiva, quantitativa, exploratoria que utilizou o método investigativo. Foi desenvolvida na Fundação Hospitalar São Sebastião, município de Três Corações- MG, com aplicação de questionário on-line a 16 enfermeiros. A pesquisa foi conduzida através de 07 etapas respeitando os preceitos da Resolução 466/12 do Conselho Nacional de Saúde. Resultados e Discussão: Inúmeros foram os desafios enfrentados pelos enfermeiros durante a pandemia, como a sobrecarga e desgaste físico e emocional. Tiveram que se superar indo além dos seus limites. Buscando melhorar a cada dia suas habilidades através de capacitações, a equipe logrou domínio do assunto podendo prestar uma melhor assistência à população. Conclusão: Em meio a perdas e sofrimentos, a enfermagem pode ser mais valorizada. Trabalhando na linha de frente, esses verdadeiros heróis hoje se sentem mais preparados para atuar na pandemia.

The Private Sector as a Partner for SDG 6-Related Issues in Megacities: Opportunities and Challenges in Rio de Janeiro, Brazil

This article reviews recent studies that address water sustainable management opportunities and challenges in megacities around the world, with an emphasis on the case of Rio de Janeiro Metropolitan Region, one of the two megacities in Brazil. With reference to recent debates on water, megacities, and the climate crisis, as well as UN Water and Global Report Initiative documents, we focused on the implementation of the 2030 Agenda Sustainable Development Goal 6: Clean Water and Sanitation for All. The new Brazilian sanitation legal framework regulates public–private partnerships. In this context, the manuscript discusses the main question concerning water, sanitation, and hygiene that arises in the Brazilian case study: is universality possible in profit-oriented models? Through the current technical and academic literature consulted, the paper compares initiatives involving multiple stakeholder governance models that depend on private resources to implement universal access to drinking water, sanitation, and water-related extreme event controls, pointing out alternatives that can help to achieve the targets of SDG. Validation by key informants supports the synthesis of the reviewed documents, and the findings illustrate that concerted public efforts together with market mechanisms can help to overcome challenges and surpass the profit-oriented logics of private companies to achieve access to healthy and safe water, adequate sanitation, and improved hygiene, especially for vulnerable populations. This finding has transferability to other megacities in emerging countries that are facing public–private partnership debates on the provision of clean water and sanitation for all.

Testing the Predictive Accuracy of COVID-19 Forecasts (preprint)

We test the predictive accuracy of forecasts of the number of COVID-19 fatalities produced by several forecasting teams and collected by the United States Centers for Disease Control and Prevention during the first and second waves of the epidemic in the United States. We find three main results. First, at the short horizon (1-week ahead) no forecasting team outperforms a simple time-series benchmark. Second, at longer horizons (3- and 4-week ahead) forecasters are more successful and sometimes outperform the benchmark, in particular during the first wave of the epidemic. Third, one of the best performing forecasts is the Ensemble forecast, that combines all available predictions using uniform weights. In view of these results, collecting a wide range of forecasts and combining them in an ensemble forecast may be a superior approach for health authorities, rather than relying on a small number of forecasts.

Testing the Predictive Accuracy of COVID-19 Forecasts (preprint)

We test the predictive accuracy of forecasts of the number of COVID-19 fatalities produced by several forecasting teams and collected by the United States Centers for Disease Control and Prevention during the first and second waves of the epidemic in the United States. We find three main results. First, at the short horizon (1-week ahead) no forecasting team outperforms a simple time-series benchmark. Second, at longer horizons (3- and 4-week ahead) forecasters are more successful and sometimes outperform the benchmark, in particular during the first wave of the epidemic. Third, one of the best performing forecasts is the Ensemble forecast, that combines all available predictions using uniform weights. In view of these results, collecting a wide range of forecasts and combining them in an ensemble forecast may be a superior approach for health authorities, rather than relying on a small number of forecasts.

Strategies to deal with the COVID-19 pandemic

The World Health Organization declared a COVID-19 pandemic on March 11, 2020, when there were 4,293 confirmed cumulative deaths. By May 17, 2020 this number increased to 315,005. The risk of death is higher above the age of 60, but there are many deaths below 60 (for example, in Sao Paulo, 25%). Due to the lack of a vaccine or specific treatment, there are at least three types of interventions used in the first wave of this pandemic: increased alertness and hygiene (e.g. Sweden);identification and isolation of infected people and their contacts (e.g. South Korea);lockdown (e.g. Italy). These interventions are complementary. Choices of the right mix of interventions will vary from society to society and in the same society at different times. The search for a miracle drug is dangerous because it is based on the mistaken belief that any treatment option is better than "nothing". Brazilian society will not be able to maintain lockdown for a long period. Naturally, in the near future, regardless of the advice from scientists, doctors and authorities, commerce, services and schools will reopen. In order to implement any strategy aimed to control the pandemic and preserve the economy, the country needs leadership that centralizes and coordinates actions. Unfortunately, the Brazilian government is not fulfilling this role;on the contrary, it is a hindrance. This negative leadership and lack of coordination are causing many deaths and are severely damaging the lives of survivors by delaying the resuming of economic and social activities.

COVID-19 surveillance - a descriptive study on data quality issues (preprint)

Background: High-quality data is crucial for guiding decision making and practicing evidence-based healthcare, especially if previous knowledge is lacking. Nevertheless, data quality frailties have been exposed worldwide during the current COVID-19 pandemic. Focusing on a major Portuguese surveillance dataset, our study aims to assess data quality issues and suggest possible solutions. Methods: On April 27th 2020, the Portuguese Directorate-General of Health (DGS) made available a dataset (DGSApril) for researchers, upon request. On August 4th, an updated dataset (DGSAugust) was also obtained. The quality of data was assessed through analysis of data completeness and consistency between both datasets. Results: DGSAugust has not followed the data format and variables as DGSApril and a significant number of missing data and inconsistencies were found (e.g. 4,075 cases from the DGSApril were apparently not included in DGSAugust). Several variables also showed a low degree of completeness and/or changed their values from one dataset to another (e.g. the variable underlying conditions had more than half of cases showing different information between datasets). There were also significant inconsistencies between the number of cases and deaths due to COVID-19 shown in DGSAugust and by the DGS reports publicly provided daily. Conclusions: The low quality of COVID-19 surveillance datasets limits its usability to inform good decisions and perform useful research. Major improvements in surveillance datasets are therefore urgently needed - e.g. simplification of data entry processes, constant monitoring of data, and increased training and awareness of health care providers - as low data quality may lead to a deficient pandemic control.

Prototype of an affordable pressure-controlled emergency mechanical ventilator for COVID-19 (preprint)

We present a viable prototype of a simple mechanical ventilator intended as a last resort to ventilate COVID-19 patients. The prototype implements the pressure-controlled continuous mandatory ventilation mode (PC-CMV) with settable breathing rates, inspiration/expiration time ratios and FiO2 modulation. Although safe, the design aims to minimize the use of technical components and those used are common in industry, so its construction may be possible in times of logistical shortage or disruption or in areas with reduced access to technical materials and at a moderate cost, affordable to lower income countries. Most of the device can be manufactured by modest technical means and construction plans are provided.