Analyzing households' food insecurity during the COVID-19 pandemic and the role of public policies to mitigate it: evidence from Ceará, Brazil.

OBJECTIVE: To evaluate the association of conditional cash transfer policies to mitigate the food insecurity (FI) among families living in poverty during the COVID-19 pandemic in Ceará, Brazil. METHODS: An analytical cross-sectional study was carried out through telephone contact during the period of May-July 2021, during the second wave of the COVID-19 pandemic in Ceará. Families in a situation of high social and economic vulnerability participated in this study (monthly per capita income of less than US$16.50). FI was assessed using the EBIA, a Brazilian validated questionnaire. The participation of families in government programs and public policies was also investigated. Logistic regression models were used to assess the association of the several factors assessed with food insecurity. RESULTS: The prevalence of any food insecurity in this sample was 89.1% (95% Confidence interval (95% CI: 86.2 - 92.1) and of severe food insecurity, 30.3% (95% CI: 26.0 - 34.6). The Mais Infância card program, adopted as a cash transfer supplement in the state of Ceará, was significantly associated with food insecurity (OR 4.2 (95% CI: 1.7 - 10.2), with a p-value of 0.002. In addition, families affected by job losses due to the COVID-19 pandemic presented higher odds of FI. CONCLUSIONS: In this study, 89% of evaluated families presented food insecurity. Conditional cash transfer programs were associated with FI. We highlight the need for policies and interventions to reduce the impact of the COVID-19 pandemic on food insecurity. Such policies can adopt appropriate criteria for defining the participants, as well as connect the participants to an appropriate set of broader social protection measures.

Ease in Emergency Hospital Visits Due to Covid-19 Following Implementation of a Telemedicine Service in Ceará, Brazil.

Background: We assessed the impact of implementing a virtual emergency room (VER) in easing emergency room (ER) visits in patients suspected of having COVID-19. Materials and Methods: Retrospective observational cohort study conducted in May 2020 and in March 2021, during the first and second waves in Brazil. Patients could choose to either visiting ER or using the VER (implemented in March 2021). Medical records were revised for demographic and clinical data. The primary outcome was the number of visits. Results: A total of 32,822 visits were evaluated. HR was more than three times less in the VER group with <10% VER clients going to ER. The trend and volume of use of the emergency sector in the periods did not show a statistically significant difference, despite the higher number of cases in the second period. Conclusion: This telemedicine strategy led to a reduction in visits to the ER. Also, our results suggest the safety of this intervention.

Dealing with the impact of the COVID-19 pandemic on a rapid response team operation in Brazil: Quality in practice.

QUALITY PROBLEM OR ISSUE: Up to 13 July 2020, >12 million laboratory-confirmed cases of coronavirus disease of 2019 (COVID-19) infection have been reported worldwide, 1 864 681 in Brazil. We aimed to assess an intervention to deal with the impact of the COVID-19 pandemic on the operations of a rapid response team (RRT). INITIAL ASSESSMENT: An observational study with medical record review was carried out at a large tertiary care hospital in Fortaleza, a 400-bed quaternary hospital, 96 of which are intensive care unit beds. All adult patients admitted to hospital wards, treated by the RRTs during the study period, were included, and a total of 15 461 RRT calls were analyzed. CHOICE OF SOLUTION: Adequacy of workforce sizing. IMPLEMENTATION: The hospital adjusted the size of its RRTs during the period, going from two to four simultaneous on-duty medical professionals. EVALUATION: After the beginning of the pandemic, the number of treated cases in general went from an average of 30.6 daily calls to 79.2, whereas the extremely critical cases went from 3.5 to 22 on average. In percentages, the extremely critical care cases went from 10.47 to 20%, with P < 0.001. Patient mortality remained unchanged. The number of critically ill cases and the number of treated patients increased 2-fold in relation to the prepandemic period, but the effectiveness of the RRT in relation to mortality was not affected. LESSONS LEARNED: The observation of these data is important for hospital managers to adjust the size of their RRTs according to the new scenario, aiming to maintain the intervention effectiveness.