Analysis of case fatality rate of SARS-CoV-2 infection in the Spanish Autonomous Communities between March and May 2020

Objective The Spanish health system is made up of seventeen regional health systems. Through the official reporting systems, some inconsistencies and differences in case fatality rates between Autonomous Communities (CC.AA.) have been observed. Therefore the objective of this paper is to compare COVID-19 case fatality rates across the Spanish CC.AA. Material and methods Observational descriptive study. The COVID-19 case fatality rate (CFR) was estimated according to the official records (CFR-PCR+), the daily mortality monitory system (MoMo) record (CFR-Mo), and the seroprevalence study ENE-COVID-19 (Estudio Nacional de sero Epidemiologia Covid-19) according to sex, age group and CC.AA. between March and June 2020. The main objective is to detect whether there are any differences in CFR between Spanish Regions using two different register systems, i. e., the official register of the Ministry of Health and the MoMo. Results Overall, the CFR-Mo was higher than the CFR-PCR+, 1.59% vs 0.98%. The differences in case fatality rate between both methods were significantly higher in Castilla La Mancha, Castilla y León, Cataluña, and Madrid. The difference between both methods was higher in persons over 74 years of age (CFR-PCR+ 7.5% vs 13.0% for the CFR-Mo) but without statistical significance. There was no correlation of the estimated prevalence of infection with CFR-PCR+, but there was with CFR-Mo (R2 = 0.33). Andalucía presented a SCFR below 1 with both methods, and Asturias had a SCFR higher than 1. Cataluña and Castilla La Mancha presented a SCFR greater than 1 in any scenario of SARS-CoV-2 infection calculated with SCFR-Mo. Conclusions The PCR+ case fatality rate underestimates the case fatality rate of the SARS-CoV- 2 virus pandemic. It is therefore preferable to consider the MoMo case fatality rate. Significant differences have been observed in the information and registration systems and in the severity of the pandemic between the Spanish CC.AA. Although the infection prevalence correlates with case fatality rate, other factors such as age, comorbidities, and the policies adopted to address the pandemic can explain the differences observed between CC.AA.

Dealing with COVID-19 Epidemic in Italy: Responses from Regional Organizational Models during the First Phase of the Epidemic

As the COVID-19 outbreak traveled through various Italian regions, all national and local administrations issued measures to counter the spread of the contagion and organize healthcare. The Italian healthcare system is, indeed, a decentralized system with 21 regional health systems (RHSs), with different models of healthcare service delivery and organization. This study investigates whether a different organization of RHSs would have led to different management of the COVID-19 epidemic, and evaluates the effect of different approaches in epidemic management on the COVID-19 epidemiological trend. A set of indicators is identified by conducting an online synchronous Focus Group, involving an experts panel. A Pearson’s correlation test was performed on the values assumed by the historical series of indicators investigate correlations among the trends represented by the indicators or between them and external factors. The comparison between the experiences of the different Italian regions, regarding the management of the epidemic, has helped to confirm and emphasize the importance of a community-based approach in health care—integrated with the hospital’s functions for the care of complex conditions and the need for specialized assistance.

SCENARIO APPROACH TO BUILDING PREDICTIVE MODELS FOR THE DEVELOPMENT OF REGIONAL HEALTH SYSTEMS

The article is devoted to the problems of scenario modeling in relation to solving a number of problems of managing the health care system of the Perm Territory, which in recent years has attracted attention by the development of a number of promising pro-jects to develop this industry, to expand the availability of medical services and to im-prove the level of medical care for the popu-lation. Since any good-quality project must be directly linked not only to the future peri-ods of its implementation, but also be scien-tifically justified in terms of insuring all kinds of risks and threats that will stand in the way of the successful completion of the project, recently all kinds of projects, programs and plans are often developed are created using the so-called scenario approach. Several options for the development of events with this approach are offered to the appropriate circle of leaders or the power structure for the subsequent adoption of an appropriate management decision. The authors of the article consider the main provisions and principles of the scenario ap-proach using the example of the develop-ment of the health care system of a particu-lar subject of the federation, which makes the material proposed for consideration very relevant. The authors also define, as they see it, the main result of improving the indus-try in the form of a target and a national goal - the expected (upcoming) life expectancy of the population of the study area. This socio-economic indicator, which has all the signs of fatefulness, is considered by the authors to be a priority analytical indicator of the lev-el and quality of an effective life of a Russian. The latter determines the purpose of this study. The authors consider the construction of dy-namic multivariate models of industry devel-opment options for a period of up to three years to be an efficient tool for analyzing and forecasting this indicator, which is presented in the article in the form of five simultaneous equations of multiple regressions. The re-sults of this construction are continued by discussion, and the article ends with conclu-sions.

Competitiveness of Regional Health Systems and Specific Medical Organizations in the Context of the Coronovirus Pandemic

Research background: As the experience of a number of countries whose health systems were considered effective has shown, the pandemic has caused multiple disruptions, system overloads, and in some cases complete collapse. The negative experience made us think about what characteristics of the system and each specific medical organization are determining, and which parameters contributed to the increase of problems in the system, and which ones ensured the ability of the medical cluster or organizations to successfully function in the complex conditions of the pandemic. Consequently, mechanisms for evaluating medical institutions and clusters that would be able to monitor the health system in a normal situation and monitor its readiness for peak loads are coming to the fore. Purpose of the article: This article is intended to identify the key factors for ensuring the competitiveness of regional medical clusters and develop a methodology for assessing the level of competitiveness of institutions in the context of a pandemic. Methods: The methodology of evaluation is built based on modified matrices of competitiveness based on the matrix of strategic mechanisms. Findings & Value added: The article analyses the successful strategic practices of medical market leaders for other players and maintaining the effectiveness of the healthcare system even during global pandemics. As the scientific increment can be considered the results of analysis of mechanisms for evaluating medical institutions and clusters that could monitor the health care system in a normal situation and monitor its readiness for peak loads.

A network model of Italy shows that intermittent regional strategies can alleviate the COVID-19 epidemic

The COVID-19 epidemic hit Italy particularly hard, yielding the implementation of strict national lockdown rules. Previous modelling studies at the national level overlooked the fact that Italy is divided into administrative regions which can independently oversee their own share of the Italian National Health Service. Here, we show that heterogeneity between regions is essential to understand the spread of the epidemic and to design effective strategies to control the disease. We model Italy as a network of regions and parameterize the model of each region on real data spanning over two months from the initial outbreak. We confirm the effectiveness at the regional level of the national lockdown strategy and propose coordinated regional interventions to prevent future national lockdowns, while avoiding saturation of the regional health systems and mitigating impact on costs. Our study and methodology can be easily extended to other levels of granularity to support policy- and decision-makers.

SARS-CoV-2 pandemic in Italy: ethical and organizational considerations

The current SARS-CoV-2 pandemic is still raging in Italy. The country is currently plagued by a huge burden of virus relatedcases and deaths. So far, the disease has highlighted a number of problems, some in common with other Countries and others peculiar to Italy which has suffered from a mortality rate higher than that observed in China and in most Countries in the world. The causes must be sought not only in the average age of the population (one of the oldest in the world), but also in the inconsistencies of the regional health systems (into which the National Health System is divided) and their delayed response, at least in some areas. Ethical issues emerged from the beginning, ranging from restrictions on freedom of movements and restrictions on personal privacy due to the lockdown, further to the dilemma for healthcare professionals to select people for ICU hospitalization in a shortage of beds in Intensive Care Unit (ICU). Organizational problems also emerged, although an official 2007 document from the Ministry of Health had planned not only what measures had to be taken during an epidemic caused by respiratory viruses, but also what had to be done in the inter-epidemic period (including the establishment of DPIs stocks and ventilators), vast areas of Italy were totally unprepared to cope with the disease, as a line of that document was not implemented. Since organizational problems can worsen (and even cause) ethical dilemmas, every effort should be made in the near future to prepare the health system to respond to a similar emergency in a joint, coherent, and homogeneous way across the Country, as planned in the 2007 document. In this perspective, Pulmonary Units and specialists can play a fundamental role in coping with the disease not only in hospitals, as intermediate care units, but also at a territorial level in an integrated network with GPs.

COVID-19 heightens US-China rivalry in South-east Asia

Subject Impact of COVID-19 crisis on US-China rivalry in South-east Asia. Significance Washington’s preoccupation with handling the COVID-19 crisis has undermined the operational readiness of US armed forces in the Indo-Pacific. China has capitalised on this situation by pushing its claims in the South China Sea. Impacts South-east Asian economies will be hit hard as US-China trade tensions rise and foreign investment falls. Infrastructure projects in the region that are part of China’s Belt and Road Initiative will face delays and cancellations. Medical assistance from the United States, China and elsewhere will barely ease the strain on regional health systems caused by COVID-19.

Nefrologia Interventistica: una disciplina in evoluzione. L’esperienza di due centri italiani a confronto

We describe the multidisciplinary work of nephrological realities belonging to two different Regional Health Systems, Lombardia and Lazio. The interventional nephrologist is a specialist in nephrology with ultra-specialist know-how for vascular access for dialysis. He is the coordinator of a team of vascular accesses and applies a team work with the other interventional nephrologists, with the vascular surgeon and the interventional radiologist, with whom he decides the diagnostic-therapeutic procedure to perform the best possible vascular access for that individual patient.

Estimation of SARS-CoV-2 Infection Prevalence in Santa Clara County

SummaryTo reliably estimate the demand on regional health systems and perform public health planning, it is necessary to have a good estimate of the prevalence of infection with SARS-CoV-2 (the virus that causes COVID-19) in the population. In the absence of wide-spread testing, we provide one approach to infer prevalence based on the assumption that the fraction of true infections needing hospitalization is fixed and that all hospitalized cases of COVID-19 in Santa Clara are identified.Our goal is to estimate the prevalence of SARS-CoV-2 infections, i.e. the true number of people currently infected with the virus, divided by the total population size.Our analysis suggests that as of March 17, 2020, there are 6,500 infections (0.34% of the population) of SARS-CoV-2 in Santa Clara County. Based on adjusting the parameters of our model to be optimistic (respectively pessimistic), the number of infections would be 1,400 (resp. 26,000), corresponding to a prevalence of 0.08% (resp. 1.36%). If the shelter-in-place led to R0 < 1, we would expect the number of infections to remain about constant for the next few weeks. However, even if this were true, we expect to continue to see an increase in hospitalized cases of COVID-19 in the short term due to the fact that infection of SARS-CoV-2 on March 17th can lead to hospitalizations up to 14 days later.