Covid-19: aspectos da doença, do tratamento medicamentoso e seu manejo no SUS

Abstract

There are still gaps in the literature regarding the variables that interfere in the prevention, control and treatment of the disease caused by coronavirus 2019 (COVID-19), as well as the resolubility of the public health network in managing the disease. Thus, the aim of the study was to analyze the epidemiological and clinical aspects of COVID-19 in Alfenas-MG, the relationship between drug treatment and morbidity and mortality and its management in the Unified Health System (SUS). The research was organized into five stages (A, B, C, D and E). In stage A, a cross-sectional study was carried out with COVID-19 cases in order to characterize those affected by the disease and identify the predictors of hospitalization. In stage B, a crosssectional study was carried out with data from the medical records of COVID-19 patients admitted to the municipality's referral hospital, in order to identify the determinants of morbidity and mortality. In stage C, a descriptive study was carried out with the patients included in stage B who were discharged from hospital, in order to understand the therapeutic itinerary and the resolubility of the public health network. In stage D, a descriptive study was carried out with the pharmacological prescriptions of stage B patients, with the aim of analyzing the direct costs of pharmacotherapy applied to COVID-19. In stage E, a systematic review was carried out to assess the effectiveness and safety of sotrovimab in the treatment of COVID-19. The data was analyzed using descriptive and inferential statistics, with a significance level of 5%. The study was approved by the UNIFAL-MG Research Ethics Committee. The results of stage A showed that COVID-19 mainly affected people who were female (55%), aged between 19 and 59 (67.8%), single (48.6%), white (60.7%), had completed high school (35%) and had an income of up to three minimum wages (61.4%). The determinants of hospitalization included: white race/color, older age group, lower monthly income and level of schooling (p<0.001); occurrence of chronic diseases, smoking and medication use (P<0.05). In stage B, there was an association between hospital mortality and the permanence of alterations in lactic acid, D-dimer and C-reactive protein tests (P<0.05). In addition, drugs such as enoxaparin, dexamethasone, ivermectin, acetylcysteine, chloroquine and clarithromycin were correlated with death (P<0.05). In stage C, 75.8% of the interviewees sought medical help between 1 and 5 days of symptoms, and the hospital emergency room was the first place most of them sought care (85.5%). In addition, inadequate conduct was observed in terms of following COVID-19 management protocols and flowcharts. Stage D showed that the average daily cost of pharmacological treatment per patient was around 44% of the amount provided by the SUS for hospital management of COVID-19. Antibacterials and anticoagulants consumed the majority (68%) of drug therapy costs. In the systematic review (stage E), there was no significant difference between the sotrovimab and control groups in terms of the use of invasive mechanical ventilation and mortality. However, it was observed that sotrovimab can be effective in reducing hospitalization rates compared to control (IV = -1.57; 95% CI: -2.41-0.73; p=0.99). The study showed that different COVID-19 outcomes can be influenced by social, economic and educational aspects, clinical factors and lifestyle habits. However, therapeutic interventions also impacted hospitalizations and deaths. The evidence of the use of sotrovimab has partly refuted the hypothesis that the drug can bring benefits in the treatment of the disease in relation to control. Furthermore, the visualization of failures in management raises the possibility of inferring other damages to health, in addition to unnecessary expenses, reinforcing the need to optimize preventive actions and management of COVID-19.