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1.
Emerg Infect Dis ; 27(4)2021 04.
Artículo en Inglés | MEDLINE | ID: covidwho-1146720

RESUMEN

We analyzed feasibility of pooling saliva samples for severe acute respiratory syndrome coronavirus 2 testing and found that sensitivity decreased according to pool size: 5 samples/pool, 7.4% reduction; 10 samples/pool, 11.1%; and 20 samples/pool, 14.8%. When virus prevalence is >2.6%, pools of 5 require fewer tests; when <0.6%, pools of 20 support screening strategies.


Asunto(s)
/métodos , Saliva/virología , Manejo de Especímenes/métodos , /diagnóstico , Creación de Capacidad/métodos , Asignación de Recursos para la Atención de Salud , Humanos , Límite de Detección , Asignación de Recursos/métodos , Sensibilidad y Especificidad , Estados Unidos
2.
JAMA Netw Open ; 4(3): e214149, 2021 03 01.
Artículo en Inglés | MEDLINE | ID: covidwho-1141277

RESUMEN

Importance: Significant concern has been raised that crisis standards of care policies aimed at guiding resource allocation may be biased against people based on race/ethnicity. Objective: To evaluate whether unanticipated disparities by race or ethnicity arise from a single institution's resource allocation policy. Design, Setting, and Participants: This cohort study included adults (aged ≥18 years) who were cared for on a coronavirus disease 2019 (COVID-19) ward or in a monitored unit requiring invasive or noninvasive ventilation or high-flow nasal cannula between May 26 and July 14, 2020, at 2 academic hospitals in Miami, Florida. Exposures: Race (ie, White, Black, Asian, multiracial) and ethnicity (ie, non-Hispanic, Hispanic). Main Outcomes and Measures: The primary outcome was based on a resource allocation priority score (range, 1-8, with 1 indicating highest and 8 indicating lowest priority) that was assigned daily based on both estimated short-term (using Sequential Organ Failure Assessment score) and longer-term (using comorbidities) mortality. There were 2 coprimary outcomes: maximum and minimum score for each patient over all eligible patient-days. Standard summary statistics were used to describe the cohort, and multivariable Poisson regression was used to identify associations of race and ethnicity with each outcome. Results: The cohort consisted of 5613 patient-days of data from 1127 patients (median [interquartile range {IQR}] age, 62.7 [51.7-73.7]; 607 [53.9%] men). Of these, 711 (63.1%) were White patients, 323 (28.7%) were Black patients, 8 (0.7%) were Asian patients, and 31 (2.8%) were multiracial patients; 480 (42.6%) were non-Hispanic patients, and 611 (54.2%) were Hispanic patients. The median (IQR) maximum priority score for the cohort was 3 (1-4); the median (IQR) minimum score was 2 (1-3). After adjustment, there was no association of race with maximum priority score using White patients as the reference group (Black patients: incidence rate ratio [IRR], 1.00; 95% CI, 0.89-1.12; Asian patients: IRR, 0.95; 95% CI. 0.62-1.45; multiracial patients: IRR, 0.93; 95% CI, 0.72-1.19) or of ethnicity using non-Hispanic patients as the reference group (Hispanic patients: IRR, 0.98; 95% CI, 0.88-1.10); similarly, no association was found with minimum score for race, again with White patients as the reference group (Black patients: IRR, 1.01; 95% CI, 0.90-1.14; Asian patients: IRR, 0.96; 95% CI, 0.62-1.49; multiracial patients: IRR, 0.81; 95% CI, 0.61-1.07) or ethnicity, again with non-Hispanic patients as the reference group (Hispanic patients: IRR, 1.00; 95% CI, 0.89-1.13). Conclusions and Relevance: In this cohort study of adult patients admitted to a COVID-19 unit at 2 US hospitals, there was no association of race or ethnicity with the priority score underpinning the resource allocation policy. Despite this finding, any policy to guide altered standards of care during a crisis should be monitored to ensure equitable distribution of resources.


Asunto(s)
Asignación de Recursos para la Atención de Salud , Disparidades en Atención de Salud/etnología , Hospitalización/estadística & datos numéricos , Asignación de Recursos , Nivel de Atención/estadística & datos numéricos , /etnología , Estudios de Cohortes , Grupos Étnicos , Femenino , Florida/epidemiología , Asignación de Recursos para la Atención de Salud/métodos , Asignación de Recursos para la Atención de Salud/organización & administración , Necesidades y Demandas de Servicios de Salud , Humanos , Masculino , Persona de Mediana Edad , Mortalidad/etnología , Asignación de Recursos/métodos , Asignación de Recursos/organización & administración
3.
Ciênc. Saúde Colet ; 26(3): 1001-1012, mar. 2021. tab, graf
Artículo en Portugués | LILACS (Américas) | ID: covidwho-1138611

RESUMEN

Resumo A resposta americana à pandemia envolve um proeminente volume de recursos federais, em especial destinados ao desenvolvimento e aquisição de produtos no uso interno, como diagnósticos ou vacinas. As justificativas para esse desembolso se baseiam em mecanismos de investimentos e aspectos históricos. Assim, a construção social do nacionalismo na formação na sociedade americana prejudica o acesso a tecnologias em saúde. A revisão desses aspectos demonstra como os Estados Unidos (EUA) garantiram compra de grande quantitativo de produtos em potencial, inclusive assegurando excessiva produção local. Essa política externa unilateral tem influenciado outros países ou blocos regionais e prejudicado a cooperação e a solidariedade global com impacto na saúde coletiva de diversas nações.


Abstract The American response to the pandemic involves a prominent volume of federal resources, especially for developing and acquiring products for internal use, such as diagnostics or vaccines. Investment mechanisms and historical aspects justify this expenditure. Thus, the social construction of nationalism in American society hinders access to health technologies. The review of such aspects shows how the United States (U.S.) secured a large number of potential products, ensuring excessive local production. This unilateral foreign policy has influenced other countries or regional blocs and undermined global cooperation and solidarity, affecting the collective health of several nations.


Asunto(s)
Humanos , Salud Global , Infecciones por Coronavirus/epidemiología , Pandemias , Cooperación Internacional , Sistemas Políticos , Estados Unidos/epidemiología , United States Dept. of Health and Human Services/economía , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/terapia , Costos y Análisis de Costo , Asignación de Recursos/economía , Asignación de Recursos/métodos , Países en Desarrollo , Difusión de Innovaciones , Economía , Recursos en Salud/economía , Recursos en Salud/provisión & distribución , Accesibilidad a los Servicios de Salud
4.
Int J Qual Health Care ; 33(1)2021 Mar 16.
Artículo en Inglés | MEDLINE | ID: covidwho-1119021

RESUMEN

BACKGROUND: COVID-19 pandemic has had a major impact globally, with older people living in aged care homes suffering high death rates. OBJECTIVES: We aimed to compare the impact of initial government policies on this vulnerable older population between the UK and Australia during the first wave of attack. METHODS: We searched websites of governments in the UK and Australia and media outlets. We examined the key policies including the national lockdown dates and the distribution of some important resources (personal protective equipment and testing) and the effects of these initial policies on the mortality rates in the aged care homes during the first wave of attack of COVID-19. RESULTS: We found that both countries had prioritized resources to hospitals over aged care homes during the first wave of attack. Both countries had lower priority for aged care residents in hospitals (e.g. discharging without testing for COVID-19 or discouraging admissions). However, deaths in aged care homes were 270 times higher in the UK than in Australia as on 7 May 2020 (despite UK having a population only 2.5 times larger than Australia). The lower fatality rate in Australia may have been due to the earlier lockdown strategy when the total daily cases were low in Australia (118) compared to the UK (over 1000), as well as the better community viral testing regime in Australia. CONCLUSION: In conclusion, the public health policy in Australia aimed towards earlier intervention with earlier national lockdown and more viral testing to prevent new cases. This primary prevention could have resulted in more lives being saved. In contrast, the initial policy in the UK focussed mainly on protecting resources for hospitals, and there was a delay in national lockdown intervention and lower viral testing rate, resulting in more lives lost in the aged care sector.


Asunto(s)
/prevención & control , Política de Salud , Hogares para Ancianos/organización & administración , Australia/epidemiología , Inglaterra/epidemiología , Hospitalización/estadística & datos numéricos , Humanos , Asignación de Recursos/métodos , Asignación de Recursos/organización & administración , Reino Unido/epidemiología
6.
Swiss Med Wkly ; 150: w20445, 2020 12 14.
Artículo en Inglés | MEDLINE | ID: covidwho-979196

RESUMEN

The systematic identification of infected individuals is critical for the containment of the COVID-19 pandemic. Currently, the spread of the disease is mostly quantified by the reported numbers of infections, hospitalisations, recoveries and deaths; these quantities inform epidemiology models that provide forecasts for the spread of the epidemic and guide policy making. The veracity of these forecasts depends on the discrepancy between the numbers of reported, and unreported yet infectious, individuals. We combine Bayesian experimental design with an epidemiology model and propose a methodology for the optimal allocation of limited testing resources in space and time, which maximises the information gain for such unreported infections. The proposed approach is applicable at the onset and spread of the epidemic and can forewarn of a possible recurrence of the disease after relaxation of interventions. We examine its application in Switzerland; the open source software is, however, readily adaptable to countries around the world. We find that following the proposed methodology can lead to vastly less uncertain predictions for the spread of the disease, thus improving estimates of the effective reproduction number and the future number of unreported infections. This information can provide timely and systematic guidance for the effective identification of infectious individuals and for decision-making regarding lockdown measures and the distribution of vaccines.


Asunto(s)
/métodos , Control de Enfermedades Transmisibles/métodos , Monitoreo Epidemiológico , Política de Salud , Asignación de Recursos/métodos , Teorema de Bayes , /prevención & control , Servicios de Diagnóstico/provisión & distribución , Predicción , Humanos , Distribución Aleatoria , Suiza/epidemiología
8.
Rev Bras Enferm ; 73(suppl 2): e20200244, 2020.
Artículo en Inglés, Portugués | MEDLINE | ID: covidwho-788927

RESUMEN

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.


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

RESUMEN

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.


Asunto(s)
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
12.
Nat Commun ; 11(1): 4049, 2020 08 13.
Artículo en Inglés | MEDLINE | ID: covidwho-720833

RESUMEN

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.


Asunto(s)
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
13.
Med Intensiva ; 44(6): 363-370, 2020.
Artículo en Inglés, Español | MEDLINE | ID: covidwho-706806

RESUMEN

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.


Asunto(s)
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
19.
Pediatrics ; 146(1)2020 07.
Artículo en Inglés | MEDLINE | ID: covidwho-203500

RESUMEN

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.


Asunto(s)
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
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