scholarly journals Restructuring of Healthcare System in Italy during COVID-19

Author(s):  
Ziad Sabaa-Ayoun

The rise of the novel coronavirus disease 2019 (COVID-19) caused unprecedented public health responses worldwide. To prevent hospitals from oversaturating, nations are restructuring their healthcare systems to prioritize limited resources and care for the treatment of COVID-19-infected patients. The Italian healthcare system, for example, converted numerous hospital services to Intensive Care Units, redeployed physicians to short-staffed centers, and centralized medical services to a small number of hospitals to meet the pandemic’s demands. While this restructuring served the nation’s short-term healthcare needs, it impeded access to care for non-COVID-19 patients suffering from acute or chronic non-communicable diseases, such as strokes. These patients are at increased risk of long-term disability and poorer adherence to management plans and have an increased likelihood of disease recurrence. This commentary discusses the ethical dilemma surrounding the necessary healthcare restructuring and unintended impairment of care to non-infected patients. It also explores the need for national public health officials to reassess strategies employed during the pandemic and their need to focus on creating ethical frameworks for maximizing equitable care.

Author(s):  
Shenae Samuels ◽  
Jianli Niu ◽  
Candice Sareli ◽  
Paula Eckardt

AbstractThe novel coronavirus disease 2019 (COVID-19) continues to be a major public health concern. The aim of this study was to describe the presenting characteristics, epidemiology and predictors of outcomes among confirmed COVID-19 cases seen at a large community healthcare system which serves the epicenter and diverse region of Florida. We conducted a retrospective analysis of individuals with lab-confirmed SARS-CoV-2 infection who were seen, from March 2, 2020 to May 31, 2020, at Memorial Healthcare System in South Florida. Data was extracted from a COVID-19 registry of patients with lab-confirmed SARS-CoV-2 infection. Univariate and backward stepwise multivariate logistic regression models were used to determine predictors of key study outcomes. There were a total of 1692 confirmed COVID-19 patients included in this study. Increasing age was found to be a significant predictor of hospitalization, 30-day readmission and death. Having a temperature of 38 °C or more and increasing comorbidity score were also associated with an increased risk of hospitalization. Significant predictors of ICU admission included having a saturated oxygen level less than 90%, hypertension, dementia, rheumatologic disease, having a respiratory rate greater than 24 breaths per minute. Being of Hispanic ethnicity and immunosuppressant utilization greatly increased the risk of 30-day readmission. Having an oxygen saturation less than 90% and an underlying neurological disorder were associated with an increased likelihood of death. Results show that a patient’s demographic, underlying condition and vitals at triage may increase or reduce their risk of hospitalization, ICU admission, 30-day readmission or death.


2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Megi Gogishvili ◽  
Karen R. Flórez ◽  
Sergio A. Costa ◽  
Terry T.-K. Huang

Abstract Background Immigrants are disproportionally impacted by HIV infection in Europe and in Spain. Immigrants are also identified as a vulnerable population during economic crises. Various socioeconomic barriers hinder HIV-positive immigrants from accessing healthcare services in the host country. As a result of the 2008 financial crisis, Spain has implemented multiple austerity measures, one of which was the enactments of Royal Decree Law (RDL) 16/2012 and Royal Decree (RD) 1192/2012 which abolished universal healthcare coverage. In this context, this study examined: 1) Participants’ mixed experiences in accessing health care after the enactment of 2012 RDL and RD, and 2) Distress felt by the participants and their experiences as HIV-positive immigrants living in Spain. Methods Participants were recruited through a nongovernmental organization (NGO) during routine visits at the center. A total of 12 participants were interviewed to reach data saturation. Participants were HIV-positive immigrants living in Spain for 1 or more years, allowing for substantial experience with navigating the healthcare system. Thematic analysis was performed to identify common themes in participants’ experiences living as HIV-positive individuals in Spain and in accessing healthcare. Results Four primary themes were identified. The primary systemic barrier to accessing health care encountered by participants was the inability to fulfill the requirement of having proof of registration in an Autonomous Community for the required time period, thus not being able to apply for a public health insurance card and utilize free care services. Participants identified a positive impact of third party (NGO, social worker, friend/family member) guidance on their experience of applying for a public health insurance card. Participants expressed experiencing emotional or physical (eg, side effects of medication) distress in adapting to life as HIV-positive individuals. Participants also identified experiencing discrimination while living as HIV-positive immigrants in Spain. Conclusions HIV-positive immigrants are underserved in Spain. They encounter systemic barriers while accessing healthcare services, and experience fear and/or discrimination. The study underscores the role of NGOs in helping HIV-positive immigrants navigate the healthcare system. More research is needed on comprehensive approaches to address healthcare needs of HIV-positive immigrants in Spain.


2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Bridget J. Kelly ◽  
Brian G. Southwell ◽  
Lauren A. McCormack ◽  
Carla M. Bann ◽  
Pia D. M. MacDonald ◽  
...  

Abstract Background As COVID-19 vaccine distribution efforts continue, public health workers can strategize about vaccine promotion in an effort to increase willingness among those who may be hesitant. Methods In April 2020, we surveyed a national probability sample of 2279 U.S. adults using an online panel recruited through address-based sampling. Households received a computer and internet access if needed to participate in the panel. Participants were invited via e-mail and answered online survey questions about their willingness to get a novel coronavirus vaccine when one became available. The survey was completed in English and Spanish. We report weighted percentages. Results Most respondents were willing to get the vaccine for themselves (75%) or their children (73%). Notably, Black respondents were less willing than White respondents (47% vs. 79%, p < 0.001), while Hispanic respondents were more willing than White respondents (80% vs. 75%, p < 0.003). Females were less likely than makes (72% vs. 79%, p < 0.001). Those without insurance were less willing than the insured (47% vs. 78%, p < 0.001). Willingness to vaccinate was higher for those age 65 and older than for some younger age groups (85% for those 65 and older vs. 75% for those 50–64, p < 0.017; 72% for those 35–49, p < 0.002; 70% for those 25–34, p = NS and 75% for ages 18–24, p = NS), but other groups at increased risk because of underlying medical conditions or morbid obesity were not more willing to get vaccinated than their lower risk counterparts. Conclusions Most Americans were willing to get a COVID-19 vaccine, but several vulnerable populations reported low willingness. Public health efforts should address these gaps as national implementation efforts continue.


2021 ◽  
Vol 42 (6) ◽  
pp. 425-437
Author(s):  
Safiya Amaran ◽  
Ahmad Zulfahmi Mohd Kamaruzaman ◽  
Nurul Yaqeen Mohd Esa ◽  
Zaharah Sulaiman

The year 2020 saw the emergence of a novel coronavirus—the severe acute respiratory syndrome coronavirus 2— which has led to an unprecedented pandemic that has shaken the entire world. The pandemic has been a new experience for Malaysia, especially during the implementation of large-scale public health and social measures called the Movement Control Order (MCO). This paper seeks to describe the experiences of the Malaysian healthcare system thus far in combatting the pandemic. The Malaysian healthcare system comprises two main arms: public health and medicine. The public health arm focuses on early disease detection, contact tracing, quarantines, the MCO, and risk stratification strategies in the community. The medical arm focuses on the clinical management of coronavirus disease 2019 (COVID-19) patients; it encompasses laboratory services, the devising of clinical setting adjustments, and hospital management for COVID-19 and non-COVID-19 patients. Malaysia experienced intense emotions at the beginning of the pandemic, with great uncertainty regarding the pandemic’s outcome, as the world saw a frighteningly high COVID-19 mortality. As of writing (May 30, 2020), Malaysia has passed the peak of its second wave of infections. The experience thus far has helped in preparing the country’s healthcare system to be vigilant and more prepared for future COVID-19 waves. To date, the pandemic has changed many aspects of Malaysia’s life, and people are still learning to adapt to new norms in their lives.


2020 ◽  
Author(s):  
Brittany Shoots-Reinhard ◽  
Mason Shihab

In response to COVID-19, Ohio, along with many other states, enacted a stay-at-home order in March to limit the spread of the pandemic. Crashes appear to have fallen as people stayed home, but fatal crashes did not. We investigated whether increases in speeding, alcohol use, or drug use could have taken place to offset the reduction in traffic. In addition, we examined whether support for President Trump would relate to both stay-at-home compliance and rates of crashes. Stay-at-home compliance predicted lower overall crash rate, particularly for less severe crashes, but not for fatal crashes. We did not find evidence that speeding or drug-related crashes increased during the stay-at-home order, but percentage of speed-related crashes was higher in areas with greater stay-at-home compliance. Alcohol-related crashes were involved in a greater proportion of crashes during the shutdown, and as they are more severe, may explain why fatal crashes did not fall. Support for President Trump was related to lower stay-at-home compliance and increased percentage of alcohol-related crashes controlling for median income, rurality, and Appalachian region. The combination of rejection of recommendations from public health officials and increased rates of alcohol-related crashes may put a particular burden on Republicans.


2020 ◽  
Vol 185 (11-12) ◽  
pp. e2158-e2161 ◽  
Author(s):  
Jonathan D Kline ◽  
Andrew E Donovan

Abstract For healthcare providers, specifically military and federal public health personnel, prompt and accurate diagnosis and isolation of SARS-CoV-2 novel coronavirus patients provide a two-fold benefit: (1) directing appropriate treatment to the infected patient as early as possible in the progression of the disease to increase survival rates and minimize the devastating sequelae following recovery and remission of symptoms; (2) provide critical information requirements that enable commanders and public health officials to best synchronize policy, regulations, and troop movement restrictions while best allocating scarce resources in the delicate balance of risk mitigation versus mission readiness. Simple personal protective measures and robust testing and quarantine procedures, instituted and enforced aggressively by senior leaders, physicians, and healthcare professionals at all levels are an essential aspect of the battle against the COVID-19 pandemic that will determine the success or failure of the overall effort. As consideration, the authors respectfully submit this vignette of the first confirmed positive COVID-19 case presenting to the Emergency Department at Winn Army Community Hospital, Fort Stewart, Georgia.


2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
◽  

Abstract COVID19 challenges every dimension of public health systems, from research and health care treatment to public communication, coercive mechanisms such as quarantine, and respect for individual rights. This round table has 3 key objectives: To understand patterns in responses across countries, and in particular the different ways that authoritarian and democratic regimes responded;To identify comparative lessons for understanding the European experience from other high-income health systems;To draw conclusions about the politics of effective public health intervention and likely lessons of COVID19. Burris will present on how although initial control efforts took the form of travel restrictions, quarantine and isolation, sustained human-to-human community transmission of COVID-19 in the United States pushed authorities to move from these traditional tools to the challenge of promoting social distancing behavior and managing a surge in demand for health care. These challenges posed new and urgent questions of practical regulation and distributive justice as underlying social disparities created differing levels of vulnerability. This presentation reviews the first six months of the response in the US from a legal and social justice standpoint, focusing on issues of equity. Fafard will analyze the communications role of senior public health officials during the COVID-19 outbreak in five countries; their public messaging across a range of media platforms, including how they deal with misinformation; and the extent to which members of the public receive, understand, and trust this messaging. Kavanagh will discuss how relative democratic and autocratic political institutions have influenced early responses to the novel coronavirus outbreak. Using evidence from process tracing in China, Iran, the United States, South Korea, and Italy, this presentation evaluates the hypothesis advanced or implied by many global public health officials that authoritarian governments have an advantage in disease response Peralta will discuss how severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) epidemic highlighted the heterogeneity in the measured used for containment and mitigation by governments. Where authoritarian states, that theoretically have more policy options for containment and mitigation, have an advantage in an epidemic event remains unclear. This presentation will compare measures taken by governments and health authorities in five selected authoritarian states and five democracies and evaluate the capacity of epidemic containment. Willison will highlight how political elites in the United States define public health threats; how partisanship and party competition define public health responses, including expenditure and coordination; and how party and media elites draw on established tensions in American politics to frame outbreaks in ways advantageous to the parties. Key messages We will focus on similarities and differences in responses to COVID-19 around the world, highlight effective measures, and reflect on lessons learned in the first few months of this novel coronavirus. We will draw attention to issues of human rights and health equity among government responses. Panelists: Scott Burris Temple University, Philadelphia, USA Contact: [email protected] Patrick Fafard University of Ottawa, Ottawa, Canada Contact: [email protected] Matthew Kavanaugh Global Health Policy & Governance Initiative at the O'Neill Institute for National and Global Health, Washington DC, USA Contact: [email protected] André Peralta-Santos University of Washington, Seattle, USA Contact: [email protected] Charley Willison University of Washington, Seattle, USA Contact: [email protected]


Author(s):  
MR Alexander ◽  
CT Schoeder ◽  
JA Brown ◽  
CD Smart ◽  
C Moth ◽  
...  

AbstractIn only a few months, the novel coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused a global pandemic, leaving physicians, scientists, and public health officials racing to understand, treat, and contain this zoonotic disease. SARS-CoV-2 has made the leap from animals to humans, but little is known about variations in species susceptibility that could identify potential reservoir species, animal models, and the risk to pets, wildlife, and livestock. While there is evidence that certain species, such as cats, are susceptible, the vast majority of animal species, including those in close contact with humans, have unknown susceptibility. Hence, methods to predict their infection risk are urgently needed. SARS-CoV-2 spike protein binding to angiotensin converting enzyme 2 (ACE2) is critical for viral cell entry and infection. Here we identified key ACE2 residues that distinguish susceptible from resistant species using in-depth sequence and structural analyses of ACE2 and its binding to SARS-CoV-2. Our findings have important implications for identification of ACE2 and SARS-CoV-2 residues for therapeutic targeting and identification of animal species with increased susceptibility for infection on which to focus research and protection measures for environmental and public health.


Author(s):  
Wai-Kit Ming ◽  
Jian Huang ◽  
Casper J. P. Zhang

AbstractA novel coronavirus pneumonia initially identified in Wuhan, China and provisionally named 2019-nCoV has surged in the public. In anticipation of substantial burdens on healthcare system following this human-to-human spread, we aim to scrutinise the currently available information and evaluate the burden of healthcare systems during this outbreak in Wuhan. We applied a modified SIR model to project the actual number of infected cases and the specific burdens on isolation wards and intensive care units, given the scenarios of different diagnosis rates as well as different public health intervention efficacy. Our estimates suggest the actual number of infected cases could be much higher than the reported, with estimated 26,701 cases (as of 28th January 2020) assuming 50% diagnosis rate if no public health interventions were implemented. The estimated burdens on healthcare system could be largely reduced if at least 70% efficacy of public health intervention is achieved.


2020 ◽  
pp. 1-6
Author(s):  
Robert Skopec ◽  

As the novel coronavirus first emerged in China late last year, more than a dozen U.S. researchers, doctors, and public health officials were working at the World Health Organization’s Geneva headquarters. President Trump has accused the United Nations’ health agency of not clearly communicating early on how big a threat the COVID-19 coronavirus pandemic was, in an attempt to protect China. Last week, he said the U.S. will halt funding to the WHO and conduct a review “to assess the WHO’s role in severely mismanaging and covering up the spread of the coronavirus.


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