Proteger os trabalhadores da saúde contra o SARS-CoV-2
Resumo
A COVID-19 é uma séria ameaça à capacidade de resposta dos serviços de saúde. Neste contexto espera-se que os trabalhadores de saúde (TdS) laborem longas horas, sob grande pressão profissional, familiar e emocional, com recursos muitas vezes inadequados, enquanto aceitam os perigos inerentes à atividade, à proximidade com pessoas infeciosas, aos perigos inseparáveis dos ambientes de trabalho. O impacto na pandemia reflete-se nos TdS enquanto indivíduos, mas também afeta as suas famílias, quer relativamente ao menor tempo disponível quer ao nível da saúde mental. Fatores como a quantidade, o custo, a disponibilidade bem como a falta de hábito no uso de equipamentos de proteção individual (EPI) condicionam a sua utilização pelos TdS. A utilização de EPI não é proteção suficiente se não for acompanhada da adoção de outras medidas de controlo de infeção, como a higienização das mãos e distanciamento físico entre funcionários em todas as situações. Deve também ser dada prioridade à testagem de TdS. A pandemia desafia os sistemas de saúde a uma adaptação dinâmica na gestão dos recursos existentes, com um especial enfoque nos sistemas de informação. Os serviços digitalizados ou de telemedicina podem potencialmente reduzir o contato com o paciente e, portanto, os riscos de infeção por SARS- CoV-2. Na perspetiva de uma vacina contra o SARS-CoV-2 para breve, os TdS deverão estar entre os grupos prioritários para a receber. Os TdS são dos recursos mais importantes de um país, pelo que há que cuidar destes profissionais em todos os aspetos nas organizações de saúde, para que os TdS estejam em melhores condições de responder às exigências desta pandemia e outras que eventualmente irão ocorrer no futuro. A pandemia não reconhece fronteiras. Devendo ser abordada de forma a fortalecer uma colaboração internacional que possibilite a solidariedade e a partilha equitativa de recursos.
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Referências
World Health Organization. Rapid hospital readiness checklist: harmonized
health service capacity assessments in the context of the COVID-19 pandemic:
interim guidance, 25 June 2020. World Health Organization. 2020. Consultado a
09.2020 em: https://apps.who.int/iris/handle/10665/332779.
United Nations. United Nations Comprehensive Response to COVID-19 Saving
Lives, Protecting Societies, Recovering Better. New York; United Nation;
September 2020. Consultado a 17.09.2020 em: https://unsdg.un.org/resources/
united-nations-comprehensive-response-covid-19-saving-lives-protecting-
-societies
Chan EYY, Goabt N, Kim JH, et al. Informal home care providers: the forgotten
health-care workers during the COVID-19 pandemic. Lancet. 2020; 395:
-1959. doi:10.1016/S0140-6736(20)31254-X
Chersich MF, Gray G, Fairlie L, et al. COVID-19 in Africa: care and protection
for frontline healthcare workers. Globalization and Health. 2020; 16: 46. doi.
org/10.1186/s12992-020-00574-3
Kang L, Li Y, Hu S, et al. The mental health of medical workers in Wuhan, China
dealing with the 2019 novel coronavirus. Lancet Psychiatry. 2020; 7(3): e14.
doi:10.1016/S2215-0366(20)30047-X
Rose C. Am I Part of the cure or Am I part of the disease? Keeping coronavirus
out when a doctor comes home. N Engl J Med. 2020; 382:1684-1685.
doi:10.1056/NEJMp2004768.
Schwartz J, King C-C, Yen M-Y. Protecting health care workers during the COVID-
coronavirus outbreak-Lessons from Taiwan’s SARS response. Clin Infect
Dis. 2020;71 (15): 858-860. doi: 10.1093/cid/ciaa255
Bielicki JA, Duval X, Gobat N, et al. Monitoring approaches for health-care
workers during the COVID-19 pandemic. Lancet Infectious Diseases. 2020; doi.
org/10.1016/S1473-3099(20)30458-8.
Nguyen LH, Drew DA, Graham MS, et al. Risk of COVID-19 among front-line
health-care workers and the general community: a prospective cohort study.
Lancet Public Health. 2020; 5: e475–83. doi.org/10.1016/S2468-2667(20)-
-X
Brasil. Ministério da Saúde. Boletim Epidemiológico Especial no. 30. Consultado
a 17.09.2020 em: https://www.saude.gov.br/images/pdf/2020/September/
/Boletim-epidemiologico-COVID-30.pdf.
Ruiu ML. Mismanagement of Covid-19: Lessons Learned from Italy. Journal
of Risk Research Routledge. 2020: 1–14. doi:10.1080/13669877.2020.17587
Zawiah M, Al-Ashwal FY, Saeed RM, et al. Assessment of Healthcare System
Capabilities and Preparedness in Yemen to Confront the Novel Coronavirus
(COVID-19) Outbreak: A Perspective of Healthcare Workers. Front. Public
Health. 2020; 8: 419. doi:10.3389/fpubh.2020.00419
Adam JG, Walls RM. Supporting the Health Care Workforce During the COVID-
Global Epidemic. JAMA. 2020; 323 (15): 1439-1440. doi:10.1001/
jama.2020.3972
Sim MR. The COVID-19 pandemic: major risks to healthcare and other workers
on the front line. Occup Environ Med. 2020;77:281–282. doi:10.1136/
oemed-2020-106567
Wilson N, Baker M, Crampton P, et al. The potential impact of the next influenza
pandemic10. on a national primary care medical workforce. Hum Resour
Health. 2005; 3(1): 7. doi:10.1186/1478-4491-3-7
Chen L, Hangvaravongchai P. HIV/AIDS and Human Resources -Editorial.
Bulletin of the World Health Organization. 2005, 83 (4): 243-244.
Dieleman M, Bwete V, Maniple E et al. ‘I believe that the staff have reduced
their closeness to patients’: an exploratory study on the impact of HIV/AIDS on
staff in four rural hospitals in Uganda. BMC Health Serv Res. 2007; 7: 205. doi.
org/10.1186/1472-6963-7-205
Ulrich C M. Ebola is causing moral distress among African healthcare workers.
BMJ. 2014; 349: g6672. doi:10.1136/bmj.g6672
McMahon SA, Ho LS, Brown H, et al. Healthcare providers on the frontlines:
a qualitative investigation of the social and emotional impact of delivering health
services during Sierra Leone’s Ebola epidemic. Health Policy Plan. 2016; 31(9):
–1239. doi: 10.1093/heapol/czw055
McMahon SA, Ho LS, Scott K, et al. “We and the nurses are now working
with one voice”: How community leaders and health committee members describe
their role in Sierra Leone’s Ebola response. BMC Health Serv Res. 2017;
(1): 495. doi.org/10.1186/s12913-017-2414-x
Selvaraj SA, Lee KE, Harrell M, et al. Infection Rates and Risk Factors for
Infection Among Health Workers During Ebola and Marburg Virus Outbreaks: A
Systematic Review. The Journal of Infectious Diseases. 2018; 218 (suppl 5): 15:
S679–S689. doi.org/10.1093/infdis/jiy435
Kapiriri, L., Ross, A. The Politics of Disease Epidemics: a Comparative Analysis
of the SARS, Zika, and Ebola Outbreaks. Glob Soc Welf 7, 33–45 (2020). doi.
org/10.1007/s40609-018-0123-y
Karlsson U, Fraenkel C-J. Complete protection from COVID-19 is possible
for health workers. All they need is the right protective equipment. BMJ.
;370:m2641 doi.org/10.1136/bmj.m2641
Health & Care Professions Council. How we will continue to regulate in light
of novel coronavirus. Joint statement from Chief Executives of statutory regulators
of health and care professionals.03.03.2020. Consultado a 17.09.2020 em:
https://www.hcpc-uk.org/registrants/updates/2020/how-we-will-continue-
-to-regulate-in-light-of-novel-coronavirus/
Ordem dos Médicos. Ministra da Saúde responde a pedido do bastonário e
vai acautelar situações em que os dois pais são médicos ou das profissões prioritárias
nesta fase crítica. Comunicado. 15.03.2020. Consultado a 17.09.2020 em:
https://ordemdosmedicos.pt/ministra-da-saude-responde-a-pedido-do-bastonario-
e-vai-acautelar-situacoes-em-que-os-dois-pais-sao-medicos-ou-das-profissoes-
prioritarias-nesta-fase-critica/
Ordem dos Médicos. Falta de equipamentos de proteção para profissionais
estão a ser calcanhar de Aquiles no combate ao novo coronavírus. Nota de Imprensa.
03.2020. Consultado a 17.09.2020 em: https://ordemdosmedicos.
pt/wp-content/uploads/2020/03/2020.03.17_NI-Falta-de-equipamentos-de-
-protec%CC%A7a%CC%83o-para-profissionais-esta%CC%83o-a-ser-calcanhar-
de-Aquiles-no-combate-ao-novo-coronavi%CC%81rus.pdf
Ferrinho P, Sidat M, Leiras G, et al. Principalism in public health decision
making in the context of the COVID-19 pandemic. Int J Health Plann Mgmt.
;1–4. doi: 10.1002/hpm.3015
Public Services International. Public Health, Once and for All! Concept
Note. 19.03.2020. Consultado a 17.09.2020 em https://publicservices.international/
resources/news/public-health-br-once-and-for-all-?id=10648〈=en
Gorry C. Global Collaboration in Times of COVID-19: Cuba’s Emergency
Medical Contingent. MEDICC Rev. 2020;22(2):64-66.
Ferrinho P, Biscaia A, Fronteira I, et al. Patterns of perceptions of workplace
violence in the Portuguese health care sector. Human Resources for Health.
; 1(1): 11. doi:10.1186/1478-4491-1-11
Patrício SR, Sidat, M, Ferrinho P. Violência Contra os Trabalhadores da Saúde
no Local de Trabalho na Cidade de Lichinga, Província de Niassa, Moçambique
entre março e maio de 2019. Anais do IHMT. 2020. Aceite para publicação.
ILO/ICN/WHO/PSI Joint Programme on Workplace Violence in the Health
Sector. Framework guidelines for addressing workplace violence in the health
sector / Joint Programme on Workplace Violence in the Health Sector. Geneva :
International Labour Organization. 2002. Consultado a 17.09.202 em: https://
apps.who.int/iris/handle/10665/42617
Declaration By The Health Care in Danger Community of Concern About
the Current Situation of Violence Against Health Care. Consultado a 17.09.202
em: https://healthcareindanger.org/wp-content/uploads/2020/05/Declaration_
HCiD_Current_Situation_against_HC_PDF1-002.pdf
Grover S, Singh P, Sahoo S, Mehra A. Stigma related to COVID-19 infection:
Are the Health Care Workers stigmatizing their own colleagues? [published
online ahead of print, 2020 Aug 27]. Asian J Psychiatr. 2020;53:102381.
doi:10.1016/j.ajp.2020.102381
Do Duy C, Nong VM, Van AN, et al. COVID-19 related stigma and its association
with mental health of health-care workers after quarantined in Vietnam
[published online ahead of print, 2020 Jul 23]. Psychiatry Clin Neurosci.
;10.1111/pcn.13120. doi:10.1111/pcn.13120
Lempel H, Epstein JM, Hammond RA. Economic Cost and Health Care Workforce
Effects of School Closures in the U.S. PLoS Curr. 2009; 1: RRN1051.
doi:10.1371/currents.RRN1051
Di Tella M, Romeo A, Benfante A, Castelli L. Mental health of healthcare
workers during the COVID-19 pandemic in Italy. J Eval Clin Pract. 2020; 1– 5.
https://doi.org/10.1111/jep.13444
Keubo FRN, Mboua PC, Tadongfack TD, et al. Psychological distress among
healthcare professionals of the three COVID-19 most affected Regions in Cameroon:
prevalence and associated factors. Annales Médico-psychologiques,
revue psychiatrique. 2020; journal pre-proof, doi:https://doi.org/10.1016/j.
amp.2020.08.012
Ying Y, Ruan L, Kong F et al. Mental health status among family members of
health care workers in Ningbo, China, during the coronavirus disease 2019 (COVID-
outbreak: a cross-sectional study. BMC Psychiatry. 2020; 20(1): 379.
doi: 10.1186/s12888-020-02784-w
Yildirim TT, Atas O, Asafov A, et al. Psychological Status of Healthcare Workers
during the Covid-19 Pandemic. Journal of the College of Physicians and
Surgeons--pakistan : JCPSP. 2020; 30(6): 26-31. doi:10.29271/jcpsp.2020.
supp1.s26
Pozzan E, Cattaneo U. Women health workers: Working relentlessly in hospitals
and at home, ILO news story, 7 Apr. 2020. Consultado a 17.09.202 em: https://
www.ilo.org/global/about-the-ilo/newsroom/news/WCMS_741060/
lang--en/index.htm
Klompas M, Morris CA, Sinclair J, Pearson M, Shenoy ES. Universal Masking
in Hospitals inlick the Covid-19 Era. N Engl J Med. 2020; 382;21: e63(1-3).
doi:10.1056/NEJMp2006372
Nagesh S, Chakraborty S. Saving the frontline health workforce amidst the
COVID-19 crisis: Challenges and recommendations. Journal of Global Health.
; 10 (1): 1-4. doi:10.7189/jogh-10-010345
Rosenbaum L. The Untold Toll — The pandemic’s effects on patients without
Covid-19. N Engl J Med. 2020;382:2368-71. doi:10.1056/NEJMms2009984
Van Damme W, Van Lerberghe W. Epidemics and fear. Tropical Medicine
and International Health. 2000; 5 (8): 511–514. doi.org/10.1046/j.
-3156.2000.00599.x
Mykytyn PP. COVID-19 and Its Impacts on Managing Information Systems. Information
Systems Management. 2020; doi: 10.1080/10580530.2020.1818900
Baumgart DC. Digital advantage in the COVID-19 response: perspective
from Canada’s largest integrated digitalized healthcare system. npj Digit. Med.
; 3, 114. https://doi.org/10.1038/s41746-020-00326-y
Whitelaw S, Mamas MA, Topol E, Van Spall HGC. Applications of digital technology
in COVID-19 pandemic planning and response. Lancet Digital Health.
; 2: e435–440. doi.org/10.1016/S2589-7500(20)30142-4
Peine A, Paffenholz P, Martin L, et al. Telemedicine in Germany During the
COVID-19 Pandemic: Multi-Professional National Survey. J Med Internet Res
;22(8):e19745. doi: 10.2196/19745
Shann F. The non- specific effects of vaccines. Arch. Dis. Child. 2010; 95:
–667. doi: 10.1136/adc.2009.157537
Belizário JE. Trained innate immunity, COVID-19 therapeutic dilemma, and fake science. Clinics. 2020; 75: e2124. doi.org/10.6061/clinics/2020/e2124.3.
Benn CS, Netea MG, Selin LK, Aaby P. A small jab – a big effect: nonspecific
immunomodulation by vaccines. Trends in Immunology. 2013; 34 (9): 431-439.
doi:10.1016/j.it.2013.04.004
Higgins JPT, Soares-Weiser K, López-López JA, et al. Association of BCG,
DTP, and measles containing vaccines with childhood mortality: systematic review.
BMJ. 2016;355:i5170. doi.org/10.1136/bmj.i5170
Miller A, Reandelar MJ, Fasciglione K, et al. Correlation between universal
BCG vaccination policy and reduced morbidity and mortality for COVID-
: an epidemiological study. medRxiv 2020; 28 March 2020. doi:
1101/2020.03.24.20042937.
Klinger D, Blass I, Rappoport N, Linial M. Significantly Improved COVID-19
Outcomes in Countries with Higher BCG Vaccination Coverage: a Multivariable
Analysis. Vaccines. 2020, 8, 378; doi:10.3390/vaccines8030378
Salman S, Salem ML. Routine childhood immunization may protect
against COVID-19. Med. Hypotheses. 2020, 140, 109689. doi: 10.1016/j.
mehy.2020.109689
Redelman-Sidi G. Could BCG be used to protect against COVID-19? Nat Ver
Urol. (2020) 17:316–7. doi: 10.1038/s41585-020-0325-9
O’Neill LAJ, Netea MG. BCG- induced trained immunity: can it offer protection
against COVID-19? Nature Reviews Immunology.2020; 20: 336-337.
doi: 10.1038/s41577-020-0337-y
Namkoong H, Horita N, Ebina-Shibuya R. Concern over a COVID-19-related
BCG shortage. International Journal of Tuberculosis and Lung Disease. 2020;
(6): 642-643. doi.org/10.5588/ijtld.20.0240
Wise J. Covid-19: Health and care workers will be “highest priority” for vaccination,
says JCVI. BMJ. 2020; 369: m2477. doi.org/10.5588/ijtld.20.0240
Bowen RAR. Ethical and organizational considerations for mandatory COVID-
vaccination of health care workers: A clinical laboratorian’s perspective.
Clin Chim Acta. 202; 510: 421-422. doi: 10.1016/j.cca.2020.08.003
Editorial. COVID-19: protecting health-care workers. The Lancet. 2020;
: 922. doi:10.1016/S0140-6736(20)30644-9
Hall TJ, Mejia A (eds.). Health Manpower Planning: Principles, Methods,
Issues. Geneva: WHO. 1978.
Hall T: Why plan human resources for health? Human Resource Devel J.
, 2 (2): 77-86.
Lerberghe W, Adams O, Ferrinho P. Human resource impact assessment. Bulletin
of the World Health Organization. 2002; 80 (7): 525.
Ferrinho P & Dal Poz M (editors) 2003. Towards a Global Health Workforce
Strategy. Studies in HSO&P. ITG Press, Antwerp.
Ferrinho P, Omar C 2006. Recursos Humanos da Saúde em Moçambique.
Ponto de Situação. Banco Mundial, Região de África.
Sousa A, Scheffler RM, Nyoni J, Boerma T (2013). A comprehensive health
labour market framework for universal health coverage. Bulletin of the WHO.
; 91:892-894. http://dx.doi.org/10.2471/BLT.13.118927
Menezes L. Job Satisfaction and Quality Management: an empirical analysis.
International Journal of Operations & Production Management. 2013; 32 (3):
-328.
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