A Unidade Básica de Saúde Fluvial constitui um novo modelo concebido para viabilizar cuidados básicos em saúde, visando a cobertura universal para populações ribeirinhas da Amazônia e Pantanal. O estudo tem como objetivo descrever o processo de planejamento e execução das atividades dessa unidade de saúde flutuante e a gestão do cuidado diferenciada nesse novo modelo de atenção à saúde preconizada pela Política Nacional de Atenção Básica. Trata-se de um estudo exploratório-descritivo sobre o processo de gestão do cuidado por meio de uma abordagem cartográfica, com observação participante e entrevista em duas viagens ao município de Borba no Estado do Amazonas. Destaca-se a relevância da política que dialoga com as características do território, entendendo o rio como caminho que o serviço de saúde deve utilizar para promoção da equidade, em especial para população ribeirinha da Amazônia.

Abstract

Background Almost 200,000 deaths from COVID-19 were reported in Brazil in 2020. The case fatality rate of a new infectious disease can vary by different risk factors and over time. We analysed the trends and associated factors of COVID-19 case fatality rates in Brazilian public hospital admissions during the first wave of the pandemic. Methods A retrospective cohort of all COVID-19-related admissions between epidemiological weeks 10–40 in the Brazilian Public Health System (SUS) was delimited from available reimbursement records. Smoothing time series and survival analyses were conducted to evaluate the trends of hospital case fatality rates (CFR) and the probability of death according to factors such as sex, age, ethnicity, comorbidities, length of stay and ICU use. Results With 398,063 admissions and 86,452 (21.7%) deaths, the overall age-standardized hospital CFR trend decreased throughout the period, varying from 31.8% (95%CI: 31.2 to 32.5%) in week 10 to 18.2% (95%CI: 17.6 to 18.8%) in week 40. This decreasing trend was observed in all sex, age, ethnic groups, length of stay and ICU admissions. Consistently, later admission (from July to September) was an independent protective factor. Patients 80+ year old had a hazard ratio of 8.18 (95% CI: 7.51 to 8.91). Ethnicity, comorbidities, and ICU need were also associated with the death risk. Although also decreasing, the CFR was always around 40–50% in people who needed an ICU admission. Conclusions The overall hospital CFR of COVID-19 has decreased in Brazilian public hospitals during the first wave of the pandemic in 2020. Nevertheless, during the entire period, the CFR was still very high, suggesting the need for improving COVID-19 hospital care in Brazil.

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This article proposes an analysis of the fiscal austerity measures of the Brazilian government and its unfolding in the public health system. It has examined the post-impeachment period of the president of Brazil and the changes of the social policies conduct in opposition to the principle of equity and universality in health with impacts on Brazilian sovereignty. It was a scientific essay on the perspective of the Unified Health System (SUS) and the policy development based on fiscal austerity that is taking place in the Brazilian political scenario, seeking to articulate a diagnosis of the impact of these actions on the structure of the country and the health rights. In this way, we conclude that the SUS is in imminent danger and that austerity policies in Brazil have denied the social gains achieved from previous governments, contributing to the discussion on health systems in the context of the neoliberal economic pressure and its impacts on lifestyles and access to the health services of the Brazilian people.

Cenário do atendimento aos agravos provocados por acidentes e violência contra idosos na rede SUS de Manaus (AM, Brasil)Scenario of the service to damage provoked by accidents and violence against elderly at SUS in Manaus (AM, Brazil)

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