RESUMO
BACKGROUND: Mexican state governments' actions are essential to control the COVID-19 pandemic within the country. However, the type, rigor and pace of implementation of public policies have varied considerably between states. Little is known about the subnational (state) variation policy response to the COVID-19 pandemic in Mexico. MATERIAL AND METHODS: We collected daily information on public policies designed to inform the public, as well as to promote distancing, and mask use. The policies analyzed were: School Closure, Workplace Closure, Cancellation of Public Events, Restrictions on Gatherings, Stay at Home Order, Public Transit Suspensions, Information Campaigns, Internal Travel Controls, International Travel Controls, Use of Face Masks We use these data to create a composite index to evaluate the adoption of these policies in the 32 states. We then assess the timeliness and rigor of the policies across the country, from the date of the first case, February 27, 2020. RESULTS: The national average in the index during the 143 days of the pandemic was 41.1 out of a possible 100 points on our index. Nuevo León achieved the highest performance (50.4); San Luis Potosí the lowest (34.1). The differential between the highest versus the lowest performance was 47.4%. CONCLUSIONS: The study identifies variability and heterogeneity in how and when Mexican states implemented policies to contain COVID-19. We demonstrate the absence of a uniform national response and widely varying stringency of state responses. We also show how these responses are not based on testing and do not reflect the local burden of disease. National health system stewardship and a coordinated, timely, rigorous response to the pandemic did not occur in Mexico but is desirable to contain COVID-19.
Assuntos
COVID-19/epidemiologia , COVID-19/prevenção & controle , Regulamentação Governamental , Política de Saúde/legislação & jurisprudência , Pandemias , Distanciamento Físico , SARS-CoV-2/patogenicidade , COVID-19/transmissão , Humanos , Máscaras/provisão & distribuição , México/epidemiologia , Quarentena/legislação & jurisprudência , Quarentena/organização & administração , ViagemAssuntos
Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Aplicação da Lei , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Quarentena/psicologia , Suicídio Consumado/psicologia , COVID-19 , Colômbia , Humanos , Masculino , Pessoa de Meia-Idade , Quarentena/legislação & jurisprudência , SARS-CoV-2RESUMO
La declaratoria del estado de emergencia, a causa de la pandemia de la covid-19, exige un análisis de la vigencia de las relaciones contractuales y cómo estas pueden verse afectadas por eventos extraordinarios, imprevisibles e irresistibles que impidan el cumplimiento de las prestaciones, así como aquellos casos en los que la alteración de las circunstancias puede llevar a que una de las partes exija al juez recomponga el contenido de la prestación pactada o la resolución del contrato.
The declaration of a state of emergency due to the covid-19 pandemic requires an analysis of the validity of the contractual relations and how these may be affected by extraordinary, unforeseeable and irresistible events that prevent the performance of the services, as well as those cases in which the alteration of circumstances may lead one of the parties to demand that the judge recompose the content of the agreed service or terminate the contract.
A declaração de estado de emergência, devido à pandemia da covid-19, exige uma análise da vigência das relações contratuais e como estas podem ser afetadas por eventos extraordinários, imprevisíveis e irresistíveis que impeçam o cumprimento das prestações, assim como aqueles casos em que a alteração das circunstâncias podem levar a que uma das partes exija que o juiz recomponha o conteúdo da prestação acordada ou a rescisão do contrato.
Assuntos
Quarentena/legislação & jurisprudência , Infecções por Coronavirus , Atenção à Saúde/legislação & jurisprudência , Contratos/legislação & jurisprudência , Pandemias/legislação & jurisprudência , Peru , Pneumonia Viral , Quarentena/ética , Responsabilidade Contratual , Atenção à Saúde/ética , Contratos/ética , Pandemias/ética , BetacoronavirusAssuntos
Humanos , Masculino , Pneumonia Viral/prevenção & controle , Quarentena/psicologia , Infecções por Coronavirus/prevenção & controle , Aplicação da Lei , Pandemias/prevenção & controle , Betacoronavirus , Suicídio Consumado/psicologia , Quarentena/legislação & jurisprudência , Colômbia , SARS-CoV-2 , COVID-19 , Pessoa de Meia-IdadeRESUMO
OBJECTIVE: We present a model for the 2009 influenza epidemic in Mexico to describe the observed pattern of the epidemic from March through the end of August (before the onset of the expected winter epidemic) in terms of the reproduction number and social isolation measures. MATERIAL AND METHODS: The model uses a system of ordinary differential equations. Computer simulations are performed to optimize trajectories as a function of parameters. RESULTS: We report on the theoretical consequences of social isolation using published estimates of the basic reproduction number. The comparison with actual data provides a reasonable good fit. CONCLUSIONS: The pattern of the epidemic outbreak in Mexico is characterized by two peaks resulting from the application of very drastic social isolation measures and other prophylactic measures that lasted for about two weeks. Our model is capable of reproducing the observed pattern.
Assuntos
Simulação por Computador , Vírus da Influenza A Subtipo H1N1 , Influenza Humana/epidemiologia , Modelos Teóricos , Isolamento de Pacientes , Quarentena , Surtos de Doenças/prevenção & controle , Surtos de Doenças/estatística & dados numéricos , Suscetibilidade a Doenças , Humanos , Imunidade Inata , Influenza Humana/prevenção & controle , Influenza Humana/virologia , México/epidemiologia , Isolamento de Pacientes/legislação & jurisprudência , Quarentena/legislação & jurisprudência , Estações do Ano , Fatores de Tempo , ViagemRESUMO
OBJECTIVE: We present a model for the 2009 influenza epidemic in Mexico to describe the observed pattern of the epidemic from March through the end of August (before the onset of the expected winter epidemic) in terms of the reproduction number and social isolation measures. MATERIAL AND METHODS: The model uses a system of ordinary differential equations. Computer simulations are performed to optimize trajectories as a function of parameters. RESULTS: We report on the theoretical consequences of social isolation using published estimates of the basic reproduction number. The comparison with actual data provides a reasonable good fit. CONCLUSIONS: The pattern of the epidemic outbreak in Mexico is characterized by two peaks resulting from the application of very drastic social isolation measures and other prophylactic measures that lasted for about two weeks. Our model is capable of reproducing the observed pattern.
OBJETIVO: Se presenta un modelo de la epidemia de influenza en México en 2009 para describir el patrón observado desde marzo hasta finales de agosto (antes del inicio de la epidemia invernal), en términos del número reproductivo y las medidas de aislamiento social. MATERIAL Y MÉTODOS: El modelo es un sistema de ecuaciones diferenciales ordinarias. Se realizaron simulaciones computacionales para la optimización de trayectorias como función de los parámetros. RESULTADOS: Se exploran las consecuencias de esta última medida combinada con los valores estimados en la literatura médica del número reproductivo básico. CONCLUSIONES: El patrón de la epidemia mexicana de influenza es bimodal debido a la aplicación del aislamiento social y otras medidas profilácticas que duró aproximadamente dos semanas. Este modelo es capaz de reproducir el patrón observado.
Assuntos
Humanos , Simulação por Computador , Vírus da Influenza A Subtipo H1N1 , Influenza Humana/epidemiologia , Modelos Teóricos , Isolamento de Pacientes , Quarentena , Surtos de Doenças/prevenção & controle , Surtos de Doenças/estatística & dados numéricos , Suscetibilidade a Doenças , Imunidade Inata , Influenza Humana/prevenção & controle , Influenza Humana/virologia , México/epidemiologia , Isolamento de Pacientes/legislação & jurisprudência , Quarentena/legislação & jurisprudência , Estações do Ano , Fatores de Tempo , ViagemRESUMO
The segregation of leprosy patients, a practice introduced early in the 20th century, was maintained in Japan after World War II. It locked in the viability of subsequent policy choices, and patients' isolation was sustained long after it was proven to be scientifically unnecessary. For leprologists and leprosarium directors, there was little opportunity to conceptualize and test the epidemiological validity and effectiveness of outpatient services as alternatives to the existing policy, since most of the patients were already hospitalized. Since leprosy was no longer a threat to the general public, bureaucratic officials, as well as legislators, lacked strong incentives to reformulate the overall policy. Within the Ministry of Health and Welfare, daily tasks were largely transferred to the section for leprosarium management, and the search for other options lost importance. For patients, long institutionalization elevated their dependency on life in leprosaria. These conditions must be emphasized as policy legacies, the results of past policies, since they posed obstacles to effective policy innovation in accordance with changing scientific knowledge. To make policies reflective of scientific knowledge, it is essential to understand and foresee the effect of policy legacy, when introducing and appraising public health policies.
Assuntos
Humanos , História do Século XIX , História do Século XX , Atitude Frente a Saúde , Hanseníase/história , Hanseníase/prevenção & controle , Isolamento de Pacientes/história , Isolamento de Pacientes/legislação & jurisprudência , Política , Política de Saúde/história , Política de Saúde/legislação & jurisprudência , Preconceito , Quarentena/história , Quarentena/legislação & jurisprudênciaAssuntos
Hanseníase , Governo Local , Serviços Preventivos de Saúde , Saúde Pública , Saneamento , Problemas Sociais , Fatores Socioeconômicos , Costa Rica/etnologia , Família/etnologia , Família/psicologia , História do Século XVIII , História do Século XIX , Hospitais Públicos/economia , Hospitais Públicos/história , Hospitais Públicos/legislação & jurisprudência , Humanos , Hospitais de Dermatologia Sanitária de Patologia Tropical/economia , Hospitais de Dermatologia Sanitária de Patologia Tropical/história , Hospitais de Dermatologia Sanitária de Patologia Tropical/legislação & jurisprudência , Hanseníase/economia , Hanseníase/etnologia , Hanseníase/história , Hanseníase/psicologia , Grupos Populacionais/educação , Grupos Populacionais/etnologia , Grupos Populacionais/história , Grupos Populacionais/legislação & jurisprudência , Grupos Populacionais/psicologia , Serviços Preventivos de Saúde/economia , Serviços Preventivos de Saúde/história , Serviços Preventivos de Saúde/legislação & jurisprudência , Saúde Pública/economia , Saúde Pública/educação , Saúde Pública/história , Saúde Pública/legislação & jurisprudência , Quarentena/economia , Quarentena/história , Quarentena/legislação & jurisprudência , Quarentena/psicologia , Saneamento/economia , Saneamento/história , Saneamento/legislação & jurisprudência , Comportamento Social , Mudança Social/história , Problemas Sociais/economia , Problemas Sociais/etnologia , Problemas Sociais/história , Problemas Sociais/legislação & jurisprudência , Problemas Sociais/psicologiaRESUMO
PIP: Cuba has initiated a program to control Acquired Immune Deficiency Syndrome (AIDS) that is designed to limit the spread of infection with the human immunodeficiency virus (HIV) by implementing compulsory elements of the public health tradition. Widespread screening for HIV infection began 3 years ago, and persons identified as infected have been sent to a sanatorium located in a Havana suburb. The program also reflects concern over the marked increase in prevalence of sexually transmitted diseases. Educational effects in Cuba stress that AIDS is not a disease exclusively of homosexuals and can affect any individual. Condoms are recommended for protection. In contrast to virtually every other nation, Cuba has not made education the key focus of its anti-AIDS strategy. Education is relegated to a marginal role. Key to the policy is identifying infected individuals and bringing them under medical control. Cuba's HIV surveillance program has been carried out with use of an enzyme-linked immunosorbent assay (ELISA), Western blot assay, and antigen tests that have been developed domestically. The director of the Cuban AIDS Investigations Laboratory reports that nearly 3 million Cubans have been tested. It is estimated that among the 7 low-infection groups tested in Cuba, between 21 and 53 persons may have been inaccurately considered positive as a result of testing. Cuban authorities have expressed much interest in obtaining commercially available HIV screening kits -- both ELISA and Western blot assays -- as a standard against which to measure their own test. Despite the inevitability of continued viral transmission, Cuba's policy of a modified quarantine certainly will limit the toll of HIV infection markedly yet comes at a great price. For other nations, the imperatives of prevention, however important, are not the only values to be considered in the battle against AIDS.^ieng