| Significant correlation between the mitigation strategies and the percentage of confirmed tests for COVID-19 (p = 0.029; r = 0.34) |
Organization of the network of services at the municipal level |
The municipalities adapted their physical and organizational structures. There was a national and regional misalignment. The regional level was considered after the state assumed the role of guiding coping guidelines. In the municipalities, there was an expansion of teams, the creation of new patient care flows and protocols |
In the beginning, each municipality acted individually. One made a decree, the other did it differently. Therefore, after the State protocol was established, everyone followed the same pattern more or less [...] (E6).
Following the municipal law for hiring professionals [...], our staff has increased a lot [...]. The structure created for the COVID outpatient clinic was one of the best things (E3, E7, E8, E12, E14, E15).
[...] in the construction of the contingency plan, our committee involved various segments of the municipality, from the Civil Police to the Public Ministry (E5, E14).
[...] strategy of going to the patient’s home for testing, monitoring, including indigenous areas (E3, E5, E7, E13, E14). |
| Significant correlation between the rate of confirmed cases and deaths (p = 0.002; r = 0.47) |
Challenges of municipal management in coping with the pandemic |
The municipalities faced political and economic pressures, difficulties in complying with sanitary and epidemiological protocols, in addition to the shortage of tests. In addition, there were flows with low effectiveness in the response time of the results. Such obstacles may have contributed to the negative outcomes of high hospitalization and death rates |
We were not able to hold people back during the election period (E1, E5, E8).
The government was under a lot of pressure from businesses, bars and restaurants and this entire group of businessmen were against closures (E3, E4, E6, E8, E9, E14).
As Secretary of Health, I had the full support of the mayor to make decisions. However, he, like me, as political managers, we were concerned about not massacring our trade, but it was very difficult to consider the economy and health in the pandemic (E4).
In the region, our municipality was the one where most died due to COVID [...]. The lockdown was instituted [...]. We also had difficulties here with religious services, the churches did not want to cease their activities [...], or saying that the deaths generated financial resources, which did not exist [...]. We had a large reduction in cases and deaths in the end. After we hired specific professionals for COVID care, we reduced the cases by almost 100% (E8).
We had some problems with the refrigerator [...]. The PHC physician would leave, and the occupational physician there would ask him or her to return. Until, on a certain day, we had a meeting and, there, they started to respect what the primary care physician said (E3).
The CRP tests were sent to LACEN at the time. We even had exams that took 27 days to get the results (E9) |
| Inverse and significant correlation between the testing rate and mortality (p = 0.038; r = -0.32) |
Regional coordination and expansion of COVID-19 testing |
Regarding regional coordination, the main coping measure, testing, was expanded. Thus, with the autonomy to test and obtain the results in a timely manner, the municipalities that appropriated this tool were able to break the chain of transmissibility of the virus to comfortable levels |
The advent of the university laboratory had a great impact on our region. From there, for us, it was a leap, not only because of the quality of the test but also the logistics. With a lab very close by, we were able to administer the tests and receive the results quickly (E3, E6, E9, E14).
We appreciated the university laboratory. It was there that things started to gear up regarding the tests and the quick results… and there were changes in the protocols[....] Asymptomatic respiratory patients, those in contact with positive or suspected individuals, were tested (E2, E3).
We knew that it was necessary to identify all contacts of people with COVID-19, or as many people as we could, who had contact with positive people, and test and isolate those who were positive (E3) |
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