Emerging from the COVID-19 pandemic: the numbers and lessons that will stay with us forever

Degani-Costa, Luiza Helena; Rolla, Fabiana; Oliveira, Raphael Augusto Gomes; Schettino, Guilherme de Paula Pinto; Cordioli, Ricardo Luiz; Hohmann, Fabio Barlem; Campos, Niklas Söderberg; Alencar, Roger Monteiro; Ferraz, Leonardo José Rolim; Piza, Felipe Maia de Toledo

doi:10.31744/einstein_journal/2021ed6207

Cited by 2 publications

(3 citation statements)

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“…These included changes in processes, infrastructure, medical and human resources which had to be put in place at a record amount of time. As such, non-COVID patients were transferred in order to avoid in-hospital contamination, the number of ward and ICU beds were significantly increased, and more healthcare professionals were hired( 9 ). Palliative care teams comprised of specialized physicians in hospital 1 and a multidisciplinary team in hospital 2 were also expanded, but pre-pandemic eligibility criteria and treatment protocols were maintained.…”

Section: Methodsmentioning

confidence: 99%

Palliative care in Hospitalized Middle-Aged and Older Adults With COVID-19

Almeida

Avelino‐Silva

Silva³

et al. 2022

Journal of Pain and Symptom Management

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Background : As COVID-19 overwhelms health systems worldwide, palliative care strategies may ensure rational use of resources while safeguarding patient comfort and dignity. Aim : To describe palliative care practices in hospitalized middle-aged and older adults in two of the largest COVID-19 treatment centers in Sao Paulo, Brazil. Design : Retrospective cohort Setting/participants : Eligible patients were those aged 50 years or older hospitalized between March and May 2020 with a laboratory confirmation of SARS-CoV-2 infection. Palliative care implementation was defined as present if medical notes indicated a decision to limit escalation of life support measures, or when opioids or sedatives were prescribed for palliative management of symptoms. Results : We included 1162 participants (57% male, median 65 years). Overall, 21% were frail and 54% were treated in intensive care units, but only 17% received palliative care. Stepwise logistic regression demonstrated that age ≥80 years, dementia, history of stroke or cancer, frailty, having a PaO 2 /FiO 2 <200 or a C-reactive protein ≥150mg/dl at admission predicted palliative care implementation. Patients placed under palliative care stayed longer (13 vs.11 days) and were more likely to die in hospital (86 vs.27%). They also spent more days in ICU and received vasoactive drugs, hemodialysis, and invasive ventilation more frequently. Conclusions : one in five middle-aged and older adults hospitalized with COVID-19 received palliative care in our cohort. Patients who were very old, multimorbid, frail, and had severe COVID-19 were more likely to receive palliative care. However, it was often delayed until advanced and invasive life support measures had already been implemented.

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Section: Methodsmentioning

confidence: 99%

Palliative care in Hospitalized Middle-Aged and Older Adults With COVID-19

Almeida

Avelino‐Silva

Silva³

et al. 2022

Journal of Pain and Symptom Management

Self Cite

View full text Add to dashboard Cite

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“…Indeed, there are dramatic differences between the Brazilian public and supplementary/private healthcare systems, with the latter historically presenting (i) a higher number of hospital beds per number of beneficiaries; (ii) a proportionately larger human resource contingency; (iii) a much lower bureaucratic burden pertaining to the acquisition of supplies; and (iv) a higher operational efficiency. In fact, the operational expertise of several large players in the supplementary health system was paramount during the pandemic, and even benefited the public system by strengthening public-private partnerships [ 2 ]. Hence, the swift response implemented in the supplementary system (eg.…”

Section: Discussionmentioning

confidence: 99%

“…In Brazil, the first case of SARS-CoV-2 was confirmed in February 2020 [2]. At the time, the lack of knowledge about the disease, combined with limited resources (e.g., personal protection equipment (PPE), supplementary oxygen, and mechanical ventilators), and the lack of coordinated public health policies generated significant barriers to the maintenance/functionality of the healthcare system [3][4][5].…”

Section: Introductionmentioning

confidence: 99%

Impact of COVID-19 pandemic on surgical activity in the Brazilian private healthcare system

Degani Costa,

Yepes Pereira,

Queiros Castro

et al. 2023

PLoS ONE

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Introduction Surgical volume was drastically reduced in many countries due to challenges imposed by the COVID-19 pandemic. Objectives We sought to estimate the number of cancelled surgical and diagnostic procedures within the Brazilian private healthcare system between 2020 and 2021 over the course of the COVID-19 pandemic, and to project the procedural backlog generated for specific elective and time-sensitive surgeries, and diagnostic procedures. Methods Data were systematically extracted from the Brazilian national regulatory agency for the private healthcare system and included (i) quarterly and annual surgical and diagnostic volume, and (ii) the number of private health insurance beneficiaries between January 2016 and June 2021. Based on pre-pandemic data we estimated the expected number of surgical and diagnostic procedures that failed to be performed between 2020 and 2021. Results The average quarterly surgical and diagnostic procedures declined by 29.5% in 2020 and by 21.5% in 2021 compared to 2019. In 2020, such reduction reflected a lower number of diagnostic procedures under anesthesia (-35.1%), as well as elective (-14.7%), time-sensitive (-18.8%), and urgent (-4.6%) surgeries. In the first half of 2021, though the surgical and diagnostic procedures increased compared to 2020, they remained significantly below their historical average. The estimated backlogs were 134.385,64 for total surgical procedures, 2.634,64 for bariatric surgery and arthroplasty revision (elective surgeries), 2.845,61 for oncologic (time-sensitive) surgeries, and 304.193,99 for diagnostic procedures, requiring 1.7, 15.9, and 6.8 years, respectively, to make up for such backlogs. Conclusion There was a major decline on the number of surgical and diagnostic procedures due to the COVID-19 pandemic. Despite a slight recovery of elective surgeries throughout the pandemic, many time-sensitive surgeries and diagnostic procedures were cancelled, with potential medium- to long-term consequences to patients and the system as a whole.

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Emerging from the COVID-19 pandemic: the numbers and lessons that will stay with us forever

Cited by 2 publications

References 4 publications

Palliative care in Hospitalized Middle-Aged and Older Adults With COVID-19

Palliative care in Hospitalized Middle-Aged and Older Adults With COVID-19

Impact of COVID-19 pandemic on surgical activity in the Brazilian private healthcare system

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