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Rev Bras Enferm ; 73(suppl 2): e20200244, 2020.
Artículo en Inglés, Portugués | MEDLINE | ID: covidwho-788927


OBJECTIVE: To analyze information on resource allocation in the context of the COVID-19 pandemic, published in indexed scientific journals, from December 2019 to March 2020. METHODS: This is an integrative literature review, which took place in March 2020. All databases were investigated and studies were found only in MEDLINE. After applying the established criteria, six articles were selected. RESULTS: It was evident that the allocation of resources is carried out as the demands emerge. The fragility in presenting scientific-methodological evidence that can guide decision makers for assertive allocation of available resources is highlighted. The results showed that studies on this subject are incipient and need to be expanded. FINAL CONSIDERATIONS: The need for health organizations and area authorities to be better prepared for the proper use of available resources, with allocation based on scientific evidence and maximization of resources is indicated.

Betacoronavirus , Infecciones por Coronavirus/epidemiología , Prestación de Atención de Salud , Neumonía Viral/epidemiología , Asignación de Recursos/métodos , Humanos , Pandemias , Política Pública
Am J Transplant ; 20(9): 2332-2336, 2020 09.
Artículo en Inglés | MEDLINE | ID: covidwho-760098


The novel coronavirus disease 2019 (COVID-19) is impacting transplant programs around the world, and, as the center of the pandemic shifts to the United States, we have to prepare to make decisions about which patients to transplant during times of constrained resources. In this paper, we discuss how to transition from the traditional justice versus utility consideration in organ allocation to a more nuanced allocation scheme based on ethical values that drive decisions in times of absolute scarcity. We recognize that many decisions are made based on the practical limitations that transplant programs face, especially at the extremes. As programs make the transition from a standard approach to a resource-constrained approach to transplantation, we utilize a framework for ethical decisions in settings of absolutely scarce resources to help guide programs in deciding which patients to transplant, which donors to accept, how to minimize risk, and how to ensure the best utilization of transplant team members.

Betacoronavirus , Infecciones por Coronavirus/epidemiología , Asignación de Recursos para la Atención de Salud/organización & administración , Recursos en Salud/estadística & datos numéricos , Trasplante de Órganos/estadística & datos numéricos , Neumonía Viral/epidemiología , Asignación de Recursos/métodos , Humanos , Pandemias , Selección de Paciente
Nat Commun ; 11(1): 4049, 2020 08 13.
Artículo en Inglés | MEDLINE | ID: covidwho-720833


The ongoing novel coronavirus disease (COVID-19) pandemic has already infected millions worldwide and, with no vaccine available, interventions to mitigate transmission are urgently needed. While there is broad agreement that travel restrictions and social distancing are beneficial in limiting spread, recommendations around face mask use are inconsistent. Here, we use mathematical modeling to examine the epidemiological impact of face masks, considering resource limitations and a range of supply and demand dynamics. Even with a limited protective effect, face masks can reduce total infections and deaths, and can delay the peak time of the epidemic. However, random distribution of masks is generally suboptimal; prioritized coverage of the elderly improves outcomes, while retaining resources for detected cases provides further mitigation under a range of scenarios. Face mask use, particularly for a pathogen with relatively common asymptomatic carriage, is an effective intervention strategy, while optimized distribution is important when resources are limited.

Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/prevención & control , Máscaras/provisión & distribución , Pandemias/prevención & control , Neumonía Viral/epidemiología , Neumonía Viral/prevención & control , Asignación de Recursos/métodos , Factores de Edad , Anciano , Betacoronavirus/aislamiento & purificación , Infecciones por Coronavirus/transmisión , Infecciones por Coronavirus/virología , Humanos , Máscaras/estadística & datos numéricos , Modelos Teóricos , Morbilidad , Neumonía Viral/transmisión , Neumonía Viral/virología , Factores de Riesgo , Distancia Social
Med Intensiva ; 44(6): 363-370, 2020.
Artículo en Inglés, Español | MEDLINE | ID: covidwho-706806


In January 2020, the Chinese authorities identified a new virus of the Coronaviridae family as the cause of several cases of pneumonia of unknown aetiology. The outbreak was initially confined to Wuhan City, but then spread outside Chinese borders. On 31 January 2020, the first case was declared in Spain. On 11 March 2020, The World Health Organization (WHO) declared the coronavirus outbreak a pandemic. On 16 March 2020, there were 139 countries affected. In this situation, the Scientific Societies SEMICYUC and SEEIUC have decided to draw up this Contingency Plan to guide the response of the Intensive Care Services. The objectives of this plan are to estimate the magnitude of the problem and identify the necessary human and material resources. This is to provide the Spanish Intensive Medicine Services with a tool to programme optimal response strategies.

Betacoronavirus , Infecciones por Coronavirus/terapia , Cuidados Críticos/organización & administración , Evaluación de Necesidades/organización & administración , Neumonía Viral/terapia , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/prevención & control , Cuidados Críticos/normas , Infección Hospitalaria/prevención & control , Recursos en Salud/organización & administración , Humanos , Difusión de la Información/métodos , Unidades de Cuidados Intensivos/organización & administración , Evaluación de Necesidades/estadística & datos numéricos , Pandemias/prevención & control , Admisión del Paciente/normas , Equipo de Protección Personal/normas , Admisión y Programación de Personal , Neumonía Viral/epidemiología , Neumonía Viral/prevención & control , Asignación de Recursos/métodos , Asignación de Recursos/organización & administración , Programas Informáticos , España/epidemiología , Desarrollo de Personal/organización & administración
Pediatrics ; 146(1)2020 07.
Artículo en Inglés | MEDLINE | ID: covidwho-203500


The coronavirus disease 2019 pandemic has affected nearly every aspect of medicine and raises numerous moral dilemmas for clinicians. Foremost of these quandaries is how to delineate and implement crisis standards of care and, specifically, how to consider how health care resources should be distributed in times of shortage. We review basic principles of disaster planning and resource stewardship with ethical relevance for this and future public health crises, explore the role of illness severity scoring systems and their limitations and potential contribution to health disparities, and consider the role for exceptionally resource-intensive interventions. We also review the philosophical and practical underpinnings of crisis standards of care and describe historical approaches to scarce resource allocation to offer analysis and guidance for pediatric clinicians. Particular attention is given to the impact on children of this endeavor. Although few children have required hospitalization for symptomatic infection, children nonetheless have the potential to be profoundly affected by the strain on the health care system imposed by the pandemic and should be considered prospectively in resource allocation frameworks.

Betacoronavirus , Pandemias/ética , Pediatría/ética , Asignación de Recursos/ética , Niño , Infecciones por Coronavirus/terapia , Prestación de Atención de Salud/ética , Prestación de Atención de Salud/métodos , Humanos , Pediatría/métodos , Neumonía Viral/terapia , Asignación de Recursos/métodos
Eur Heart J Acute Cardiovasc Care ; 9(3): 248-252, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: covidwho-141767


The current outbreak of SARS-CoV-2 has and continues to put huge pressure on intensive care units (ICUs) worldwide. Many patients with COVID-19 require some form of respiratory support and often have prolonged ICU stays, which results in a critical shortage of ICU beds. It is therefore not always physically possible to treat all the patients who require intensive care, raising major ethical dilemmas related to which patients should benefit from the limited resources and which should not. Here we consider some of the approaches to the acute shortages seen during this and other epidemics, including some guidelines for triaging ICU admissions and treatments.

Betacoronavirus/aislamiento & purificación , Infecciones por Coronavirus/epidemiología , Recursos en Salud/organización & administración , Unidades de Cuidados Intensivos/organización & administración , Neumonía Viral/epidemiología , Triaje/ética , Lechos/provisión & distribución , Enfermedad Catastrófica/epidemiología , Enfermedad Catastrófica/enfermería , Toma de Decisiones Clínicas/ética , Comunicación , Ética Médica/educación , Recursos en Salud/provisión & distribución , Humanos , Unidades de Cuidados Intensivos/provisión & distribución , Pandemias , Asignación de Recursos/ética , Asignación de Recursos/métodos , Índice de Severidad de la Enfermedad , Triaje/organización & administración