Hospital contingency in coping with COVID-19 in Brazil: governmental problems and alternatives

Santos, Thadeu Borges Souza; Andrade, Laise Rezende de; Vieira, Silvana Lima; Duarte, Joseane Aparecida; Martins, Juliete Sales; Rosado, Lilian Barbosa; Oliveira, Juliana dos Santos; Pinto, Isabela Cardoso de Matos

doi:10.1590/1413-81232021264.43472020

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FREE THEMES • Ciênc. saúde coletiva 26 (4) • Apr 2021 • https://doi.org/10.1590/1413-81232021264.43472020 copy

Hospital contingency in coping with COVID-19 in Brazil: governmental problems and alternatives

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

This paper analyzes the government’s strategic agenda for coping with COVID-19 in Brazil, focusing on hospital care. Twenty-eight Contingency Plans were analyzed in full, one national, 26 at state level, and one from the Federal District. The Public Policy Cycle’s theoretical framework was used, specifically governmental pre-decision and decision to face the pandemic. The evidence revealed convergences between the national and state levels concerning proposals for reorienting care flow, detecting cases, and indicating referral hospitals. However, the state agendas revealed weaknesses in acquiring mechanical ventilation devices, sizing human resources, and regionalizing hospital care. Moreover, few states have established a method for calculating back-end beds, mainly regarding the outlook of opening hospitals of reference or contracting additional ICU beds. We can conclude that the heterogeneous actions explained in the plans show the complex process of coping with COVID-19 in Brazil with its regional inequalities, weaknesses in the state health systems, and reduced coordination by the Ministry of Health.

Key words
Coronavirus; Unified Health Systems; Hospitals; Hospital Bed Capacity; Contingency Plans

Containment Stage

Mitigation Stage

. Identify and prevent virus spread;
. Conduct surveillance actions;
. Check stock and purchase Personal Protective Equipment (PPE);
. Orient home quarantine to suspected cases;
. Record information for surveillance;
. Alert the entire SUS health care network;
. Prepare responses in the care network;
. Define urgent and emergency care network;
. Sensitize health professionals to detect suspected cases, adequate patient management, and PPE use;
. Develop and divulge State Contingency Plans containing the organization of the hospital care network

. Avoid the occurrence of severe cases and deaths;
. Recommend restrictive isolation and home quarantine measures for suspected and confirmed mild cases;
. Provide hospital care for severe cases;
. Expand hospital beds when there is a risk of exceeding the hospital's response capacity to care for severe cases;
. Emergency contracting of ICU beds.

Percentage of State Priorities		Brazilian Regions										Brazil
National Priorities	State Priorities	North		Northeast		Southeast		Midwest		South		Brazil
National Priorities	State Priorities	n	%	n	%	n	%	n	%	n	%	n	%
1. Covid-19 care network systematization	1. Establish a network and regulation flow for severe cases	7	100	9	100	4	100	4	100	3	100	27	100
	2. Ensure regular inter-hospital transportation	2	28.57	5	55.55	2	50	3	75	2	66.33	14	51.85
	3. Perform counter-referral of patients	5	71.42	1	11.11	0	0	1	25	2	66.33	9	33.33
	4. Sort the network with complexity and regionalization levels	1	14.28	2	22.22	2	50	1	25	1	33.33	7	25.92
	5. Indicate referral hospitals and reserve beds for contingencies	6	85.71	7	77.77	3	75	3	75	1	33.33	20	74.07
2. Covid-19 urgent care network definition	6. Provide a Pre-Hospital Care Network	0	0	3	33.33	1	25	2	50	2	66.33	8	29.62
2. Covid-19 urgent care network definition	7. Implement the reception of cases with risk classification	1	14.28	2	22.22	2	50	1	25	0	0	6	22.22
3. Orientation of hospital care to Covid-19 cases	8. Guide clinical management	7	100	9	100	4	100	4	100	3	100	27	100
	9. Estimate the need for HRH	1	12.48	3	33.33	1	25	0	0	0	0	5	18.51
	10. Support the Hospital Epidemiological Surveillance Centers	4	57.14	2	22.22	0	0	0	0	0	0	6	22.22
4. Hospital care for severe Covid-19 cases	11. Secure equipment, laboratory supplies, and PPE	7	100	9	100	4	100	4	100	3	100	27	100
	12. Guarantee the stock of medicines	4	71.42	4	44.44	0	0	4	100	3	100	15	55.55
	13. Purchase mechanical ventilation devices	0	0	0	0	0	0	0	0	0	0	0	0
5. Increased hospital bed capacity	14. Establish the calculation of bed availability	1	14.28	1	11.11	1	25	1	25	0	0	4	14.81
	15. Determine the Emergency Plan or the opening of campaign hospital units	1	14.28	3	33.33	2	50	1	25	1	33.33	8	29.62
	16. Articulate inter-federative support in a situation of overcrowding in the state network	1	14.28	2	22.22	0	0	0	0	1	33.33	4	14.81
6. Emergency contracting of Covid-19 ICU beds	17. Contract private ICU back-end beds for severe COVID-19 cases	0	0	0	0	0	0	0	0	0	0	0	0

Priorities		FU by Regions
National	State	North							Northeast									Southeast				Midwest				South			N
National	State	AC	AM	AP	PA	RO	RR	TO	AL	BA	CE	MA	PB	PE	PI	RN	SE	ES	MG	RJ	SP	GO	MT	MS	DF	PR	RS	SC	N
Covid-19 care network systematization	Establish a network and regulation flow for severe cases																												27
	Ensure regular inter-hospital transportation																												14
	Perform counter-referral of patients																												09
	Sort the network with complexity and regionalization levels																												07
	Indicate referral hospitals and reserve beds for contingencies																												20
Covid-19 urgent care network definition	Provide a Pre-Hospital Care Network																												08
Covid-19 urgent care network definition	Implement the reception of cases with risk classification																												05
Orientation of hospital care to Covid-19 cases	Guide clinical management																												27
	Estimate the need for HRH																												05
	Support the Hospital Epidemiological Surveillance Centers																												06
Hospital care for severe Covid-19 cases	Secure equipment, laboratory supplies, and PPE																												27
	Guarantee the stock of medicines																												15
	Purchase mechanical ventilation devices																												00
Increased hospital bed capacity	Establish the calculation of bed availability																												04
	Determine the Emergency Plan or the opening of campaign hospital units																												08
	Articulate inter-federative support in a situation of overcrowding in the state network																												04
Emergency contracting of Covid-19 ICU beds	Contract private ICU back-end beds for severe COVID-19 cases																												00
Sub-total of considered actions		10	8	8	6	3	5	8	4	11	4	7	8	9	5	6	7	4	11	6	5	12	7	5	5	7	4	10
Sub-total of considered actions not considered		7	9	9	11	14	12	9	13	6	13	10	9	8	12	11	10	13	6	11	12	5	10	12	12	9	13	7
Total actions		17	17	17	17	17	17	17	17	17	17	17	17	17	17	17	17	17	17	17	17	17	17	17	17	17	17	17

ABRASCO - Associação Brasileira de Saúde Coletiva Av. Brasil, 4036 - sala 700 Manguinhos, 21040-361 Rio de Janeiro RJ - Brazil, Tel.: +55 21 3882-9153 / 3882-9151 - Rio de Janeiro - RJ - Brazil
E-mail: cienciasaudecoletiva@fiocruz.br

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[1] Collaborations

TBS Santos, LR Andrade, SL Vieira, JA Duarte, JS Martins, LB Rosado, JS Oliveira and ICM Pinto conceived the methodological design of the manuscript, produced data, participated in the analysis and interpretation of results, discussed conclusions, and approved the final version of the manuscript.