Preparedness and coping with the COVID-19 pandemic

Health disasters have affected humanity since its dawn. In other epidemics, the casualties caused number in the hundreds of thousands. The preparation for confronting the COVID-19 epidemic at the Military Hospital of Matanzas, "Dr. Mario Muñoz Monroy”, began early. In order to analyze this experience, we reflect on the results of the confrontation in 2020, based on the main aspects, the coordination with other organizations, the decisions made, structural changes and modifications of institutional processes. Consolidating scientific improvement has been a permanent pillar, along with discipline, personal and social responsibility of the members of the collective. © 2023, Editorial Ciencias Medicas. All rights reserved.

Impacts of the COVID-19 pandemic on the mother owl program of the VII health region of Pernambuco / Impactos da pandemia da COVID-19 no programa mãe coruja da VII região de saúde de Pernambuco

Resumo Objectives: to analyze the impacts caused by the COVID-19 pandemic on the Mother Owl Program of the VII Health Region of Pernambuco. Methods: descriptive, cross-sectional and quantitative study, carried out at the VII Regional Health Management, in Salgueiro-PE. Data were collected from the Mother Owl Information System, from August to November 2021, being related to women and children registered from 2019 to March 2021. Adopting a time frame for before and during the pandemic, the Student's t and chi-square tests in the analysis of continuous and categorical variables, respectively. Results: data from 581 women and 412 children were analyzed. Before the pandemic, there was a higher average number of prenatal consultations (p<0.001) and greater completeness in the children's race data (p<0.001). During the pandemic, there was a lower frequency of breastfeeding in the first hour of life (p<0.001) and of filling in the data regarding maternal education (p<0.001). In addition, no more than 7 childcare consultations were performed (p<0.001). Conclusions: the assistance of women and children was impacted, mainly with the drop in prenatal and childcare consultations, showing that COVID-19 had a negative impact on the health of people monitored by the Program and on the quality of information inserted in the system.

Resumo Objetivos: analisar os impactos causados pela pandemia da COVID-19 no Programa Mãe Coruja da VII Região de Saúde de Pernambuco. Métodos: estudo descritivo, transversal e quantitativo, realizado na VII Gerência Regional de Saúde, em Salgueiro-PE. Os dados foram coletados do Sistema de Informação Mãe Coruja, no período de agosto a novembro de 2021, sendo relacionados às mulheres e crianças cadastradas de 2019 a março de 2021. Adotando-se um marco temporal para antes e durante a pandemia, foram utilizados os testes t de Student e qui-quadrado nas análises das variáveis contínuas e categóricas, respectivamente. Resultados: foram analisados os dados de 581 mulheres e 412 crianças. Antes da pandemia constatou-se maior média de consultas de pré-natal (p<0,001) e maior completude nos dados de raça das crianças (p<0,001). Durante a pandemia ocorreu menor frequência da amamentação na primeira hora de vida (p<0,001) e do preenchimento dos dados referentes à escolaridade materna (p<0,001). Assim como, não foram realizadas mais que sete consultas de puericultura (p<0,001). Conclusões: a assistência das mulheres e crianças foi impactada, principalmente com a queda de consultas do pré-natal e da puericultura, evidenciando que a COVID-19 repercutiu negativamente na saúde das pessoas acompanhadas pelo Programa e na qualidade das informações inseridas no sistema.

Community health workers and COVID-19 in a Brazilian state capital

Community health workers (CHWs) are the main bridge between health services and the community, and therefore play a vital role in the COVID-19 response. The aim of this study was to determine the COVID-19-related health status of CHWs, their basic knowledge of the disease and the role they played in the pandemic response in 2020. A descriptive cross-sectional study was conducted with CHWs working in Campo Grande between December 2020 and January 2021. The data were collected using an electronic questionnaire. Around 40% of the sample reported at least one risk factor for COVID-19, 44% had experienced at least one COVID-19 symptom, and 76% had experienced symptoms of mental suffering during the first year of the pandemic. Mental suffering was associated with the onset of flu-like symptoms after the start of the pandemic and changes in work processes. Knowledge gaps were observed, mainly related to forms of transmission and disease prevention. In view of the uncertainty about how long this health emergency will last and the vital role CHWs play in the Brazilian Health System, health managers and society need to pay greater attention to these professionals in order to improve the effectiveness of the country's COVID-19 response. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

PERCEPTIONS OF THE PEOPLE RECRUITED ABOUT THE STRATEGIC ACTION “O BRASIL CONTA COMIGO” (BRAZIL COUNTS ON ME)

Objective: to analyze the perceptions of academics and supervisors about the strategic action “O Brasil Conta Comigo”(Brazil counts on me). Method: cross-sectional study conducted in Mato Grosso do Sul-Brazil, from December 2020 to March 2021, in two stages: 1) Exploratory (quantitative), via analysis of reports of the 33 supervisors and 90 academics convened, application of an online questionnaire;2) In-depth (qualitative), using the remote focus group technique, with convenience sampling. Descriptive and content analysis was performed. Results: the reasons for joining and remaining with the action (scholarship, internship hours, and social responsibility), the pedagogical aspects (training, evaluation, and support from educational institutions, and management), and the contributions of the action (assistance and professional training) were identified. Conclusion: the general perceptions of the recruits are positive. Pedagogical aspects related to the evaluation of academics and support from higher education institutions should be reviewed, for more assertive actions in times of health crisis. © 2022, Universidade Federal do Parana. All rights reserved.

Impact of the Suspension of Elective Surgeries for Adolescent Idiopathic Scoliosis during the COVID-19 Pandemic.

Objectives This study evaluated the radiographic progressions of scoliotic curves higher than 40° in patients with adolescent idiopathic scoliosis (AIS). These subjects waited for the surgical procedure while elective surgeries were on hold during the COVID-19 pandemic. In addition to radiographic progressions, this study described the quality of life of these patients. Methods This study is a retrospective cohort assessing 29 AIS patients with surgical indications registered in the Brazilian public healthcare service. We compared the scoliotic radiographic measurements in two moments: at the beginning of the interruption of elective surgeries due to the COVID-19 pandemic and when these procedures resumed. Results When comparing the radiographic measurements before and after the suspension of assessments for elective surgeries, we observed a significant increase in main curve angles ( p < 0.001), with variations ranging from 0 to 68° and a median value of 10°. In secondary curves, we observed an increase in angles from the proximal thoracic ( p < 0.001) and lumbar ( p = 0.001) regions. However, the increase in the main thoracic region was not significant ( p = 0.317). Conclusion The suspension of elective surgeries for AIS resulted in a significant increase in the radiographic values of patients' spine deformities. This increase harmed the quality of life of these subjects and their families.

Unveiling conflicting strategies in the Brazilian response to COVID-19: A cross-sectional study using the Functional Resonance Analysis Method.

By the time the present study was completed, Brazil had been the second epicenter of COVID-19. In addition, the actions taken to respond to the pandemic in Brazil were the subject of extensive debate, since some diverged from recommendations from health authorities and scientists. Since then, the resulting political and social turmoil showed conflicting strategies to tackle the pandemic in Brazil, with visible consequences in the numbers of casualties, but also with effects on the resilience of the overall health system. Thus, this article explores the actions taken in Brazil to cope with the pandemic from a systems analysis perspective. The structure of the domain was analyzed using Work Domain Analysis, and the activated functions were analyzed using the Functional Resonance Analysis Method, identifying the variability resulting from the conflicting strategies carried out and the consequences to the capacity of the Brazilian health system to respond resiliently to the pandemic. Results of the study show that functions that overlapped the operation of the overall system were introduced, causing the health system to operate under conflicting objectives, in which functions were created to restrict the outcomes of each other during the entire COVID-19 crisis.

COVID-19 and zoonoses in Brazil: Environmental scan of one health preparedness and response.

The emergence of the COVID-19 pandemic reinforced the central role of the One Health (OH) approach, as a multisectoral and multidisciplinary perspective, to tackle health threats at the human-animal-environment interface. This study assessed Brazilian preparedness and response to COVID-19 and zoonoses with a focus on the OH approach and equity dimensions. We conducted an environmental scan using a protocol developed as part of a multi-country study. The article selection process resulted in 45 documents: 79 files and 112 references on OH; 41 files and 81 references on equity. The OH and equity aspects are poorly represented in the official documents regarding the COVID-19 response, either at the federal and state levels. Brazil has a governance infrastructure that allows for the response to infectious diseases, including zoonoses, as well as the fight against antimicrobial resistance through the OH approach. However, the response to the pandemic did not fully utilize the resources of the Brazilian state, due to the lack of central coordination and articulation among the sectors involved. Brazil is considered an area of high risk for emergence of zoonoses mainly due to climate change, large-scale deforestation and urbanization, high wildlife biodiversity, wide dry frontier, and poor control of wild animals' traffic. Therefore, encouraging existing mechanisms for collaboration across sectors and disciplines, with the inclusion of vulnerable populations, is required for making a multisectoral OH approach successful in the country.

Impact of COVID-19 mitigation strategies on asthma hospitalizations in Brazil.

Background: In 2020, a unique social experience was provided by the pandemic of coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2. Interventions to tackle the pandemic may affect the burden of other respiratory diseases. Objective: This study aims to assess the impact of the COVID-19 mitigation strategies on hospitalizations for asthma in children aged between 1 and 14 years, adults aged between 20 and 59 years, and elderly older than 60 years. Methods: Data from hospital admissions for asthma were obtained from the Department of Informatics of Brazilian Public Health System database in the period between January 2016 and December 2020 and analyzed by age groups. To evaluate the effect of containment measures on the incidence of asthma and respiratory system diseases (total), the absolute reduction and relative reduction were calculated by analyzing the subsets from 2016 to 2019 versus 2020. Results: There was a significant reduction in the average incidence of hospitalizations in 2020, with numbers ranging from -59% (incidence rate ratio, 0.41 [0.37-0.45]) for age 1 to 14 years (prepandemic 1,393.2/100,000 vs pandemic 574.9/100.000), -37% (incidence rate ratio, 0.63 [0.49-0.80]) for age 20 to 59 years (prepandemic 160.2/100,000 vs pandemic 101.1/100,000), and -60% (incidence rate ratio, 0.40 [0.33-0.47]) for older than 60 years (prepandemic 460.6/100,000 vs pandemic 185.3/100,000). Conclusions: Ashtma hospitalizations decreased in 2020, especially in the pediatric group and the older group during the COVID-19 pandemic, which may be associated with the reduction in the incidence of many respiratory viral infections.

Public health training in physical education curricula: a current portrait / A formação em saúde coletiva nos currículos de educação física: um retrato atual / La formación en salud colectiva en los currículos de educación física: un retrato actual

Resumo Este estudo apresenta uma análise nacional da formação superior em Saúde Coletiva nos cursos de graduação em Educação Física de instituições de ensino superior públicas. Foi realizada uma análise documental das estruturas curriculares, ementas e programas de disciplinas ofertadas por essas universidades, avaliando os conteúdos, a inserção prática no Sistema Único de Saúde (SUS) e a carga horária em Saúde Coletiva. Ao todo, 173 currículos ativos e regulares de graduação de 87 instituições públicas foram analisados, e observaram-se defasagens na formação em saúde: quando obrigatórias, as disciplinas de Saúde Coletiva se apresentam como componentes isolados; predominam conteúdos ligados às ciências biológicas; apresentam limitada carga horária e falta inserção e diálogo com os serviços de saúde do SUS. Identificaram-se algumas propostas curriculares que avançam na formação em saúde, mas ainda de maneira muito tímida, especialmente frente à urgência que a nova realidade decorrente da pandemia de covid-19 exige dos cursos de saúde.

Resumen Este estudio presenta un análisis nacional de la educación superior en Salud Colectiva en los cursos de grado en Educación Física de instituciones de enseñanza superior públicas. Se realizó un análisis documental de las estructuras curriculares, contenidos y programas de disciplinas ofrecidos por esas universidades, evaluando los contenidos, la inserción práctica en el Sistema Único de Salud (SUS) y la carga horaria en Salud Colectiva. En total, se analizaron 173 currículos de grado activos y regulares de 87 instituciones públicas, y se observaron lagunas en la formación en salud: cuando son obligatorias, las disciplinas de Salud Colectiva se presentan como componentes aislados; predominan los contenidos relacionados con las ciencias biológicas; tienen una carga horaria limitada y carecen de inserción y diálogo con los servicios de salud del SUS. Se han identificado algunas propuestas curriculares que avanzan en la formación en salud, pero aún de manera muy tímida, especialmente ante la urgencia que la nueva realidad derivada de la pandemia de COVID-19 demanda a los cursos de salud.

Abstract This study presents a national analysis of Public Health training in the undergraduate Physical Education degree programs of public universities. A document analysis of the curricular structures, syllabus and programs of disciplines offered by these universities was carried out, evaluating the content, the practical immersion in the SUS and the workload in Public Health. A sum of 173 active and regular undergraduate curricula from 87 public institutions were analyzed and some gaps in health education were identified: when mandatory, Public Health disciplines are presented as isolated components; there is a predomination of content related to the biological sciences; there is a limited course load and there is a lack of immersion and dialogue with health services of the SUS. Some curricular configurations were identified as presenting advancements in health education, but still in a very timid manner, especially in view of the urgency that the reality resulting from the COVID-19 pandemic demands from health education programs.

Public health training in physical education curricula: a current portrait / A formação em saúde coletiva nos currículos de educação física: um retrato atual / La formación en salud colectiva en los currículos de educación física: un retrato actual

Resumo Este estudo apresenta uma análise nacional da formação superior em Saúde Coletiva nos cursos de graduação em Educação Física de instituições de ensino superior públicas. Foi realizada uma análise documental das estruturas curriculares, ementas e programas de disciplinas ofertadas por essas universidades, avaliando os conteúdos, a inserção prática no Sistema Único de Saúde (SUS) e a carga horária em Saúde Coletiva. Ao todo, 173 currículos ativos e regulares de graduação de 87 instituições públicas foram analisados, e observaram-se defasagens na formação em saúde: quando obrigatórias, as disciplinas de Saúde Coletiva se apresentam como componentes isolados; predominam conteúdos ligados às ciências biológicas; apresentam limitada carga horária e falta inserção e diálogo com os serviços de saúde do SUS. Identificaram-se algumas propostas curriculares que avançam na formação em saúde, mas ainda de maneira muito tímida, especialmente frente à urgência que a nova realidade decorrente da pandemia de covid-19 exige dos cursos de saúde.

Resumen Este estudio presenta un análisis nacional de la educación superior en Salud Colectiva en los cursos de grado en Educación Física de instituciones de enseñanza superior públicas. Se realizó un análisis documental de las estructuras curriculares, contenidos y programas de disciplinas ofrecidos por esas universidades, evaluando los contenidos, la inserción práctica en el Sistema Único de Salud (SUS) y la carga horaria en Salud Colectiva. En total, se analizaron 173 currículos de grado activos y regulares de 87 instituciones públicas, y se observaron lagunas en la formación en salud: cuando son obligatorias, las disciplinas de Salud Colectiva se presentan como componentes aislados; predominan los contenidos relacionados con las ciencias biológicas; tienen una carga horaria limitada y carecen de inserción y diálogo con los servicios de salud del SUS. Se han identificado algunas propuestas curriculares que avanzan en la formación en salud, pero aún de manera muy tímida, especialmente ante la urgencia que la nueva realidad derivada de la pandemia de COVID-19 demanda a los cursos de salud.

Abstract This study presents a national analysis of Public Health training in the undergraduate Physical Education degree programs of public universities. A document analysis of the curricular structures, syllabus and programs of disciplines offered by these universities was carried out, evaluating the content, the practical immersion in the SUS and the workload in Public Health. A sum of 173 active and regular undergraduate curricula from 87 public institutions were analyzed and some gaps in health education were identified: when mandatory, Public Health disciplines are presented as isolated components; there is a predomination of content related to the biological sciences; there is a limited course load and there is a lack of immersion and dialogue with health services of the SUS. Some curricular configurations were identified as presenting advancements in health education, but still in a very timid manner, especially in view of the urgency that the reality resulting from the COVID-19 pandemic demands from health education programs.

COVID-19 as the leading cause of hospital deaths in the Brazilian public health system in 2020.

OBJECTIVES: To describe the profile of hospital deaths in Brazil according to cause of admission during the pre-pandemic (2019) and pandemic periods (2020). METHODS: Descriptive study based on individual-level records of all hospital admissions with death outcomes reimbursed by the Brazilian National Health System in 2019 and 2020. RESULTS: The number of hospital deaths increased by 16.7% in 2020 compared with 2019 (522,686 vs 609,755). Coronavirus disease 2019 (COVID-19) was associated with 19.5% (118,879) of all hospital deaths in 2020, surpassing diseases of the circulatory system (15.4%, 93,735) and diseases of the respiratory system (14.9%, 91,035). CONCLUSIONS: COVID-19 was the main cause of death in public hospitals in Brazil in 2020.

Description of e-Health Initiatives to Reduce Chronic Non-Communicable Disease Burden on Brazilian Health System.

Chronic non-communicable diseases (NCD) account for 72% of the causes of death in Brazil. In 2013, 54 million Brazilians reported having at least one NCD. The implementation of e-Health in the Unified Health System (SUS) could fill gaps in access to health in primary health care (PHC). OBJECTIVE: to demonstrate telehealth strategies carried out within the scope of the Institutional Development Support Program of the Unified Health System (PROADI-SUS) and developed by Hospital Alemão Oswaldo Cruz, between 2018 and 2021, on evaluation, supply, and problem-solving capacity for patients with NCDs. METHODOLOGY: a prospective and descriptive study of three projects in the telehealth areas, using document analysis. The Brasil Redes project used availability, implementation, and cost-effectiveness analysis, TELEconsulta Diabetes is a randomized clinical trial, and Regula Mais Brasil is focused on the waiting list for regulation of specialties. All those strategies were developed within the scope of the SUS. RESULTS: 161 patients were attended by endocrinology teleconsultation in one project and another two research projects, one evaluating Brazil's Telehealth Network Program, and another evaluating effectiveness and safety of teleconsultation in patients with diabetes mellitus referred from primary care to specialized care in SUS. Despite the discrepancy in the provision of telehealth services in the country, there was an increase in access to specialized care on the three projects and especially on the Regula Mais Brasil Collaborative project; we observed a reduction on waiting time and favored distance education processes. CONCLUSION: the three projects offered subsidies for decision-making by the Ministry of Health in e-Health and two developed technologies that could be incorporated into SUS.

[Work and subjectivity: reflections on experiences dealing with COVID-19 in the Brazilian Unified Health System]. / Trabajo y subjetividad: reflexiones a partir de la experiencia de enfrentar el COVID-19 en el Sistema Único de Salud de Brasil.

This article presents a critical analysis of the relationship between work and subjectivity, based on reflections regarding experiences of dealing with the SARS-CoV-2 (COVID-19) epidemic in the Unified Health System (SUS) in Sao Paulo, Brazil. In order to do so, context is first provided regarding Brazilian policy and the SUS, drawing attention to different modes of health policy formulation. The ways in which the challenges of the pandemic were dealt with in the SUS are then presented, through an examination of material from panel discussions held with healthcare workers - which are publicly available on Youtube - regarding what they have lived through during the pandemic and the political conflicts they have encountered, as well as their lived experiences with the primary level of care, with mental health, and with social movements. This material is analyzed vis-à-vis conceptual elements that seek to expand upon notions of healthcare work, policies and practices in health care, and subjectification processes, shedding light on lessons that have emerged and on future challenges.

Este artículo busca problematizar la relación trabajo y subjetividad a partir de una reflexión sobre experiencias y modos de enfrentar la epidemia de SARS-Cov 2 (COVID-19) en el Sistema Único de Salud (SUS) de San Pablo, Brasil. Para eso se realiza una contextualización de la política brasileña y del SUS, rescatando los modos de hacer política en salud. Luego, se presentan los modos de enfrentar la pandemia en el SUS sobre la base de diversas rondas de conversaciones con las y los trabajadores de la salud acerca de lo vivido en la pandemia y su enfrentamiento político, sobre vivencias en el primer nivel de atención, en salud mental, y con los movimientos sociales, cuyo registro está disponible en Youtube. Sobre estos registros, se analizan elementos conceptuales que procuran ampliar las nociones en torno al trabajo en salud, las políticas, las prácticas en salud y los procesos de subjetivación, destacando aprendizajes y retos hacia el futuro.

Homeopathy for Covid-19 in Primary Care: A structured summary of a study protocol for a randomized controlled trial.

OBJECTIVES: To investigate the effectiveness and safety of homeopathic medicine Natrum muriaticum (LM2) for mild cases of COVID-19 in Primary Health Care. TRIAL DESIGN: A randomized, two-armed (1:1), parallel, placebo-controlled, double-blind, clinical trial is being performed to test the following hypotheses: H0: homeopathic medicines = placebo (null hypothesis) vs. H1: homeopathic medicines ≠ placebo (alternative hypothesis) for mild cases of COVID-19 in Primary Care. PARTICIPANTS: Setting: Primary Care of São Carlos - São Paulo - Brazil. One hundred participants aged 18 years or older, with Influenza-like symptoms and a positive RT-PCR for SARS-CoV-2. Willingness to give informed consent and to comply with the study procedures is also required. Exclusion criterium: severe acute respiratory syndrome. INTERVENTION AND COMPARATOR: Homeopathy: 1 globule of Natrum muriaticum LM2 diluted in 20 mL of alcohol 30% and dispensed in a 30 ml bottle. Placebo: 20 mL of alcohol 30% dispensed in a 30 ml bottle. Posology: one drop taken orally every 4 hours (6 doses/day) while there is fever, cough, tiredness, or pain (headache, sore throat, muscle aches, chest pain, etc.) followed by one drop every 6 hours (4 doses/day) until the fourteenth day of use. The bottle of study medication should be submitted to 10 vigorous shakes (succussions) before each dose. Posology may be changed by telemedicine, with no break in blinding. Study medication should be maintained during home isolation. According to the Primary Care protocol, the home isolation period lasts until the 10th day after the appearance of the first symptom, or up to 72 hours without symptoms. MAIN OUTCOMES: The primary endpoint will be time to recovery, defined as the number of days elapsed before all COVID-19 Influenza-like symptoms are recorded as mild or absent during home isolation period. Secondary measures are recovery time for each COVID-19 symptom; score of the scale created for the study (COVID-Simile Scale); medicines used during follow-up; number of days of follow-up; number of visits to emergency services; number of hospitalizations; other symptoms and Adverse Events during home isolation period. RANDOMISATION: The study Statistician generated a block randomization list, using a 1:1 ratio of the two groups (denoted as A and B) and a web-based tool ( http://www.random.org/lists ). BLINDING (MASKING): The clinical investigators, the statistician, the Primary Care teams, the study collaborators, and the participants will remain blinded from the identity of the two treatment groups until the end of the study. NUMBERS TO BE RANDOMISED (SAMPLE SIZE): One hundred participants are planned to be randomized (1:1) to placebo (50) or homeopathy (50). TRIAL STATUS: Protocol version/date May 21, 2020. Recruitment is ongoing. First participant was recruited/included on June 29,2020. Due to recruitment adaptations to Primary Care changes, the authors anticipate the trial will finish recruiting on April 10, 2021. TRIAL REGISTRATION: COVID-Simile Study was registered at the University Hospital Medical Information Network (UMIN - https://www.umin.ac.jp/ctr/index.htm ) on June 1st, 2020, and the trial start date was June 15, 2020. Unique ID: UMIN000040602. FULL PROTOCOL: The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol.

Frontline Nursing Care: The COVID-19 Pandemic and the Brazilian Health System.

Emerging and reemerging infectious diseases are constant challenges for global public health. After the World Health Organization declared COVID-19 a pandemic on March 11, 2020, the spread of SARS-CoV-2 has been the focus of attention for scientists, governments and populations worldwide. In Brazil, the first case of COVID-19 was identified on February 26 2020, being the first country in Latin America to have affected patients. Almost four months later, more than one million confirmed cases of COVID-19 have been identified in the country, and the virus has spread across all 27 states and is responsible for at least 48,954 deaths until June 19, 2020. In addition, a global outbreak requires the active participation of the nursing workforce in clinical care, education, and sharing of accurate information of public health and policies. This year is particularly important for Nursing, as 2020 is the international year for Nursing and Midwifery Professionals. Nursing professionals corresponds to more than half of the health workforce in the country, being crucial in implementing public health policies and programs. Nurses and frontline health care workers have a critical role in the COVID-19 prevention and response, not only by providing direct assistance to patients and communities, but also in the implementation of health promotion and prevention strategies. Hence, we provide a reflection on the strengths and weaknesses of how the nursing profession is engaged with the COVID-19 response in Brazil.