Critical Care Requirements Under Uncontrolled Transmission of SARS-CoV-2

2021 ◽  
pp. e1-e4
Author(s):  
Gonzalo Martínez-Alés ◽  
Arce Domingo-Relloso ◽  
José R. Arribas ◽  
Manuel Quintana-Díaz ◽  
Miguel A. Hernán
Keyword(s):  
Public Health ◽  
Critical Care ◽  
Control Strategies ◽  
Health Care Systems ◽  
The Elderly ◽  
Large Hospital ◽  
Protection Measures ◽  
Care Systems ◽  
Bed Capacity ◽  
Care Requirements

Objectives. To estimate the critical care bed capacity that would be required to admit all critical COVID-19 cases in a setting of unchecked SARS-CoV-2 transmission, both with and without elderly-specific protection measures. Methods. Using electronic health records of all 2432 COVID-19 patients hospitalized in a large hospital in Madrid, Spain, between February 28 and April 23, 2020, we estimated the number of critical care beds needed to admit all critical care patients. To mimic a hypothetical intervention that halves SARS-CoV-2 infections among the elderly, we randomly excluded 50% of patients aged 65 years and older. Results. Critical care requirements peaked at 49 beds per 100 000 on April 1—2 weeks after the start of a national lockdown. After randomly excluding 50% of elderly patients, the estimated peak was 39 beds per 100 000. Conclusions. Under unchecked SARS-CoV-2 transmission, peak critical care requirements in Madrid were at least fivefold higher than prepandemic capacity. Under a hypothetical intervention that halves infections among the elderly, critical care peak requirements would have exceeded the prepandemic capacity of most high-income countries. Public Health Implications. Pandemic control strategies that rely exclusively on protecting the elderly are likely to overwhelm health care systems. (Am J Public Health. Published online ahead of print March 18, 2021: e1–e4. https://doi.org/10.2105/AJPH.2020.306151 )

scholarly journals The impact of chronic disease and disability on the elderly

1999 ◽  
Vol 55 (3) ◽  
pp. 9-14
Author(s):  
C. J. Eales
Keyword(s):  
Health Care ◽  
Chronic Disease ◽  
Chronic Diseases ◽  
Health Care Systems ◽  
The Elderly ◽  
Therapeutic Interventions ◽  
Elderly Persons ◽  
Care Systems ◽  
And Function ◽  
The Impact

Health care systems for elderly people should aim to delay the onset of illness, reducing the final period of infirmity and illness to the shortest possible time. The most effective way to achieve this is by health education and preventative medicine to maintain mobility and function. Changes in life style even in late life may result in improved health, effectively decreasing the incidence of chronic diseases associated with advancing age. This paper presents the problems experienced by elderly persons with chronic diseases and disabilities with indications for meaningful therapeutic interventions.

scholarly journals COVID-19: Rethinking the Lockdown Groupthink

2021 ◽  
Vol 9 ◽  
Author(s):  
Ari R. Joffe
Keyword(s):  
Public Health ◽  
High Risk ◽  
Cost Benefit Analysis ◽  
Health Care Systems ◽  
Herd Immunity ◽  
Cost Benefit ◽  
Risk Groups ◽  
School Closures ◽  
Trade Offs ◽  
Care Systems

The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has caused the Coronavirus Disease 2019 (COVID-19) worldwide pandemic in 2020. In response, most countries in the world implemented lockdowns, restricting their population's movements, work, education, gatherings, and general activities in attempt to “flatten the curve” of COVID-19 cases. The public health goal of lockdowns was to save the population from COVID-19 cases and deaths, and to prevent overwhelming health care systems with COVID-19 patients. In this narrative review I explain why I changed my mind about supporting lockdowns. The initial modeling predictions induced fear and crowd-effects (i.e., groupthink). Over time, important information emerged relevant to the modeling, including the lower infection fatality rate (median 0.23%), clarification of high-risk groups (specifically, those 70 years of age and older), lower herd immunity thresholds (likely 20–40% population immunity), and the difficult exit strategies. In addition, information emerged on significant collateral damage due to the response to the pandemic, adversely affecting many millions of people with poverty, food insecurity, loneliness, unemployment, school closures, and interrupted healthcare. Raw numbers of COVID-19 cases and deaths were difficult to interpret, and may be tempered by information placing the number of COVID-19 deaths in proper context and perspective relative to background rates. Considering this information, a cost-benefit analysis of the response to COVID-19 finds that lockdowns are far more harmful to public health (at least 5–10 times so in terms of wellbeing years) than COVID-19 can be. Controversies and objections about the main points made are considered and addressed. Progress in the response to COVID-19 depends on considering the trade-offs discussed here that determine the wellbeing of populations. I close with some suggestions for moving forward, including focused protection of those truly at high risk, opening of schools, and building back better with a economy.

scholarly journals Learning from health care in other countries: the prospect of comparative research

2015 ◽  
Vol 14 (1) ◽  
pp. 8-12 ◽  
Author(s):  
Edwin Van Teijlingen ◽  
Cecilia Benoit ◽  
Ivy Bourgeault ◽  
Raymond DeVries ◽  
Jane Sandall ◽  
...  
Keyword(s):  
Public Health ◽  
Health Care ◽  
Comparative Research ◽  
Cultural Context ◽  
Health Care Systems ◽  
Cultural Factors ◽  
Reproductive Health Care ◽  
Care Systems ◽  
Cross National ◽  
The Way

It is widely accepted that policy-makers (in Nepal and elsewhere) can learn valuable lessons from the way other countries run their health and social services. We highlight some of the specific contributions the discipline of sociology can make to cross-national comparative research in the public health field. Sociologists call attention to often unnoticed social and cultural factors that influence the way national reproductive health care systems are created and operated. In this paper we address questions such as: ‘Why do these health services appear to be operating successfully in one country, but not another?’; ‘What is it in one country that makes a particular public health intervention successful and how is the cultural context different in a neighbouring country?’ The key examples in this paper focus on maternity care and sex education in the Netherlands and the UK, as examples to highlight the power of cross-national research. Our key messages are: a) Cross-national comparative research can help us to understand the design and running of health services in one country, say Nepal, by learning from a comparison with other countries, for example Sri Lanka or India. b) Cultural factors unique to a country affect the way that reproductive health care systems operate. c) Therefore,we need to understand why and how services work in a certain cultural context before we start trying to implement them in another cultural context.

scholarly journals Application of Health-Care Networking in COVID-19: A Brief Report

2020 ◽  
pp. 1-5
Author(s):  
Punidha Kaliaperumal ◽  
Tamorish Kole ◽  
Neha Chugh
Keyword(s):  
Public Health ◽  
Health Care ◽  
Health Care Systems ◽  
Public Health Care ◽  
Current Crisis ◽  
Delivery Of Care ◽  
Public Health Emergencies ◽  
Northern India ◽  
Care Systems ◽  
Private And Public

ABSTRACT Health-care systems all over the world are stretched out and being reconfigured to deal with the coronavirus disease 2019 (COVID-19) pandemic. Some countries have flattened the curve, some are still fighting to survive it, and others are embracing the second wave. Globally, there is an urgent need to increase the resilience, capacity, and capability of health-care systems to deal with the current crisis and improve upon the future responses. The epidemiological burden of COVID-19 has led to rapid exhaustion of local response resources and massive disruption to the delivery of care in many countries. Health-care networking and liaison are essential component in disaster management and public health emergencies. It aims to provide logistical support between hospitals; financial support through local or regional governmental and nongovernmental agencies for response; manpower and mechanism for coordination and to implement policies, procedures, and technologies in the event of such crisis. This brief report describes how 4 independent private hospitals in northern India had adopted the principles of health-care networking, pooled their resources, and scaled up 1 of the partner hospitals as Dedicated COVID-19 Hospital (DCH) to treat moderate to severe category of COVID-19 patients. It brings out the importance of a unique coalition between private and public health-care system.

Regional critical care delivery systems

2016 ◽  
Author(s):  
Theodore J. Iwashyna ◽  
Colin R. Cooke
Keyword(s):  
Critical Care ◽  
Systems Of Care ◽  
Care Delivery ◽  
Health Care Systems ◽  
Cost Effective ◽  
Design Decisions ◽  
Regional Systems ◽  
Regional System ◽  
Care Systems ◽  
Regionalization Of Care

A regional system of critical care is one in which hospitals are acknowledged to vary in their care of critically-ill patients, and procedures exist to systematically refer patients to a subset of those hospitals. Given scarcity in health care systems, regional systems of care are an attempt to rationalize differentiation among hospitals. There are several examples that suggest regionalization of care can result in cost-effective improvements in patient outcomes. Yet there are also numerous examples of regional systems of care that offer few benefits to patients, or that fail to actually concentrate patients despite the grand plans of their designers. This chapter suggests several key design decisions that can be used to help improve the effectiveness of regional system of care. Addressing all these issues may offer dramatic benefits for patients.

scholarly journals Health equality, social justice and the poverty of autonomy

2017 ◽  
Vol 12 (4) ◽  
pp. 411-433 ◽  
Author(s):  
Christopher Newdick
Keyword(s):  
Public Health ◽  
Health Care ◽  
Health Care Systems ◽  
Public Health Care ◽  
Public Health Policies ◽  
Public Health Systems ◽  
Care Systems ◽  
Health Equality ◽  
The Cost ◽  
Lifestyle Diseases

AbstractHow does the concept of autonomy assist public responses to ‘lifestyle’ diseases? Autonomy is fundamental to bioethics, but its emphasis on self-determination and individuality hardly supports public health policies to eat and drink less and take more exercise. Autonomy rejects a ‘nanny’ state. Yet, the cost of non-communicable diseases is increasing to individuals personally and to public health systems generally. Health care systems are under mounting and unsustainable pressure. What is the proper responsibility of individuals, governments and corporate interests working within a global trading environment? When public health care resources are unlikely to increase, we cannot afford to be so diffident to the cost of avoidable diseases.

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