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JOURNAL CLUB JULIO

 

 

En los últimos tres meses, el impacto de la pandemia COVID-19 ha transformado nuestra vida personal y profesional.  Nuestra  practica Urológica diaria, se ha modificado drásticamente,  requiriendo una  re- adaptación total, con implementación de protocolos y medidas que se han venido optimizando  en base a la situación de cada país, regulado por la  implementación de los distintos  recursos  provenientes de los Sistemas de Salud y Gobierno.

Como parte de un esfuerzo colaborativo internacional, la Confederación Americana de Urología y la Sociedade Brasileira de Urologia (SBU) han realizado un suplemento especial “SARS-COVID-19 in Urology  joint supplement of SBU and CAU” International Braz J Urology Vol. 46, Suppl. I July, 2020, con el objetivo de proporcionar una revisión  general del Impacto de la pandemia en el desarrollo de las diferentes áreas de la Urología, el cual contiene un total de 27 manuscritos realizados por Urólogos proveniente de Francia, Italia, España, Iran Alemania, Argentina, Uruguay, Brazil, Peru, Bolivia, Panama y USA.

Por tal motivo el Journal Club correspondiente al mes de Julio  se ha titulado “The social, economic and sanitary impact of COVID-19 Pandemic” 

Esperamos sea de utilidad para todos

Dra. Ana María Autrán Gómez
Directora Oficina de Investigación CAU

Dr. Luciano Favorito
Unidad de Pesquisa Urogenital
Univ. do Est do Rio de Janeiro- UERJ
Editor in Chief of International Braz. J Urol

The Social Economic and Sanitary Impact of COVID-19 Outbreak 
 International Braz.  J Urol. Vol. 46, Supplement I, July, 2020

In the last 3 months, nearly a third of the world’s population has changed their lifestyle. At this time of writing (July 15)  the COVID-19 pandemic has left a total of  13.349.795 confirmed cases, with more than 579.335  deaths worldwide, spreading to more than 188 countries (1). The pandemic has hit each of the different social strata, the population has had to re-adapt to the circumstances, absolutely all of us have changed the way we face the day to day.

Asia, Europe and recently Latin America have been involved in this catastrophe, where the delay in the implementation of health policies by governments has aggravated the problem.  

Currently, Brazil, one of the main countries and economic force in Latin America, occupies the second place in the world with a total of 1.926.824  confirmed cases and 74.133 deaths (1).    

The COVID-19 pandemic represents a sanitary, social and economic challenge at a global level, since the City of Wuhan in China declared it´s lockdown on January 23th 2020, about a third of the world’s population has had to follow the same policies of restriction and isolation at home, imposed by governments, to reduce the spread of the disease and to avoid the collapse of  health systems, measures that today are not entirely clear, as they have been implemented as “emergencies”.  This is the result of a lack of adequate epidemiological strategies, focused on the impact of the dissemination of the disease, with the application of tests to the population, tests that we do not currently have.  Lockdown measures have led to the cessation of industrial and commercial production in most sectors, with job reductions and layoffs.  Recently an editorial in the newspaper The Economist (2) revealed that approximately the cessation of economic activity produced by the lockdown and reduction of movement, will lead a total of 420,000,000 people to absolute poverty with incomes of less than USA $1.90 a day.  If we look at first world countries, the United States (USA) has reported a gradual increase of 3.5% in unemployment in February versus 14.7% in April 2020.

The COVID-19 is without a doubt one of many pandemics that humanity has had to face throughout history. Never before has the fear of death been so pronounce, because we were reminded daily that people were dying in alarming numbers of around 100 deaths per minute and 150,000 deaths per day.      This fear of loss, coupled with social distancing, lockdown, economic instability and uncertainty, will result in a strong psychosocial impact that will have to be addressed (3).        

Regarding to international Health Systems, the impact on the cessation of development and stabilization in the coming months is enormous.    It is estimated that England, by prioritizing care for COVID-19 patients and reducing care for cancer patients, within 6 months, will lose 40% of the quality of life gained in the last 5 years.   The World Health Organization warns that if, as a result of the health impact of the pandemic, vaccination programs are paralyzed, arround 140 children in Africa will die from each death caused by COVID-19. Just three months into lockdown, 10 months of discontinuation of Tuberculosis  treatment in Third World countries will follow, equivalent to approximately 1,4,000,000 deaths between 2020-2025.    

Therefore, health systems require an adequate cost-benefit balance between the health policies and economic resources established in each country to face the pandemic, which must be directed on the basis of social risk groups, development dynamics, developmental heterogeneity and resources.  

In most countries, the contingency and reaction plans established by the government have been misdirected, at the wrong time, implementing urgent measures, most of them with little effectiveness, we have faced a shortage of resources, lack of medical equipment, exhaustion with psychological burn out, infections of health care workers, how many of us have not suffered the disease and have seen so many colleagues infected?.  Only in Spain the latest publication of the Spanish Ministry of Health (4) (June 12th 2020), has reported a total of 51.849   infected health care workers.

Regarding the management of assistance protocols and triage, they have been constantly modified in each centre, in each province, trying to adapt to the resources and assistance demands of each country.

Without a doubt, all these experiences have enriched our knowledge, survival and management of the COVID-19 pandemic in each of our countries.  

The volume of publications and scientific articles that have been written and made available is impressive. The medical community worldwide has joined efforts to be able to transmit quickly and effectively a large number of constant information from the different medical specialties.    The social networks have been overturned with the diffusion of information, which on some occasions, we could call misinformation.

In this context, urology, without a doubt, has not been the exception as since the end of March 2020, different International Urological Societies, have added their efforts to be able to establish recommendations, which have allowed us to optimize and prioritize patients´ care being implemented, in most Urology services. We have learned that patient care can continue, through the introduction of Telemedicine, that medical education is feasible and that we can share knowledge and with residents to continue their training.

 At this time, we have shared academic sessions with our colleagues and friends around the world thus discovering these new tools of communication and development. We have also learned that we can grow among all, expanding our network of scientific collaboration, all these leaves us the COVID-19 Pandemic 

As part of an international collaborative effort, the American Confederation of Urology (CAU) and Sociedade Brasileira de Urologia (SBU) performs this special edition, which aims to provide a screenshot impact of the COVID-19 Pandemic on Urology, within each different area of development It´s contains a total of 27 manuscripts performed by expert urologists from France, Italy, Spain, Iran, Germany, Argentina, Uruguay, Brazil, Mexico, Peru, Bolivia, Panama, the USA. The information that it contains, is reported until May 8th 2020.

Finally, I would like to thank each colleague participating in this project for the effort and valuable academic contribution,  hoping that this crisis we are going through will allow us to grow as people and professionals.  “Every crisis has a solution and a learning process, this only depends on us” 

http://intbrazjurol.com.br/pdf/vol46S1/Suppl_1_2020.pdf

Dra. Ana María Autrán Gómez                                           Dr. Luciano Favorito

Director of Research Office CAU                                  Editor in Chief  Int .Braz.J.Urol

                                                        

References

1.- The Johns Hopkins Center for Health Security (JHCHS) | Homepage [Internet]. [cited 2020 July 15]. https://www.centerforhealthsecurity.org/

2.- The Economist [Internet]. [cited 2020 May 24] https://www.economist.com

3.- Brooks S, Webster R, Smith L, Woodland L, Wessely S, Greenberg N et al. The Psychological Impact of Quarantine and How to Reduce It: Rapid Review of the Evidence. SSRN Electronic Journal. 2020; 395:912-20.

4.- Ministerio de Salud de España  [Internet]. [cited 2020 June 12] https://www.mscbs.gob.es