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Municipal governance and coordination
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| Response planning |
- The early onset and rapid spread of the epidemic hampered planning, but experience with previous epidemics helped to take the first measures |
- Regional contingency plan, articulated with SES
- Built in dialogue with universities and SUS service providers, with the participation of the Health Council |
- Participation of the OSSs that coordinate 80% of the services of the municipality |
| Crisis Committee Coordination, Composition and Operation
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- Integrated between SMS and SES
- Members of municipal and state health management
- Weekly meetings
- Weekly publications of decrees |
- Mayor’s Office
- SMS, universities, health council, and representatives of trade, union, and industry
- Weekly meetings
- Municipal decrees discussed in this group |
- Mayor’s office
- SMS, representatives of the police, fire department, and commerce
- Weekly meetings
- Decisions published through decrees |
| Response management |
- Partnerships with SES and academia enabled the epidemiological monitoring and weekly simulations, with the calculation of the TR and projections |
- Shared management from the beginning to the present
- Very close dialogue with the team |
- Focus given on monitoring indicators of services contracted by OSS |
| Communication |
- Technical notes to guide professionals and the population.
- Use of social networks |
- Use of technical notes for teams and clarify the population
- Use of social networks |
- Use of decrees and technical notes to guide professionals and the population
- Use of social networks |
| Supplies management |
- Difficulty in accessing supplies due to the rapid peak of cases
- Small laboratory capacity |
- Difficulty in acquiring PPE and supplies in general
- Huge price increase and bureaucracy for purchases, despite the relaxed legislation |
- Greater agility for the acquisition of supplies through the OSS partnership |
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Prevention and surveillance
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| Restricted mobility |
- Strict lockdown
- Social distancing with the closing of schools and commerce on March 19 |
- Strict lockdown
- Questioning whether it was not early
- Election campaign hindered the restricted mobility |
- Restrictive measures adopted |
| Surveillance |
- Scarcity of tests required rethinking sensitive indicators to track the epidemic
- Created a system that integrates PHC, secondary and tertiary information with surveillance to monitor bed occupancy rate and Sars cases
- Enabled geocoding
- of all emergency care units, hospitals, and basic units concerning suspected and confirmed patients |
- Reinforcement of the team with technical supporters of PHC
- increased knowledge of UBS operations
- Integration of surveillance (epidemiological, health, and occupational health), articulating with primary care
- Monitoring of Long-Term Care Institutions for Older Adults, prison population, therapeutic communities, and occupational health
- Heat map of the pandemic behavior within the municipality |
- Creation of IBs to notify the Sars of all public and private hospitals for monitoring severe patients and deaths
- Use of e-Notifica for Sars notification by the PHC team
- Use of phone and WhatsApp employed with patients to ensure access and tracking |
| Testing |
- Initial testing limitation delayed higher volume testing
- Need for post-mortem testing |
- Training of nursing professionals to collect PCR at home
- UBS did a quick test
- Creation of a triage center (Toll-free) to assist people with any symptoms. If suspected positive, home PCR was collected, and people were instructed to stay in isolation
- Partnership with the University to expedite test results
- Working closely with private labs |
- Drive-thru PCR testing strategy
- Call center to schedule testing by time block at the drive-thru
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| Distancing |
- Difficult to implement because more than 1 million people live in substandard settlements, with great socioeconomic inequality |
- Monitoring of all cases, contractors, contractors in isolation, which delayed community transmission
- Schools were offered for those who could not do home isolation. However, it was not used |
- In a hospital environment, when necessary |
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Health care
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| Covid-19 care organization |
- Organization of a Covid care line, articulating 12 UPA with Covid bed hospitals
- Adoption of severity criteria to guide the most appropriate place for patient care.
- Creation of community transport, different from Urgent Mobile Care Units (Samu), to allow the patient to travel during social distancing |
- Zoning strategy to avoid cross-contamination, with the definition of Covid-19 exclusive beds
- Offer of teleconsulting in partnership with universities for appointments with doctors
- Temporary suspension of elective procedures, e.g., oral health |
- Teleconsulting support and ongoing education for clinical supervision of Covid-19 cases, integrating PHC, UPA, the Best at Home program, and the hospital |
| PHC |
- Lack of PPE at the onset limited the work of PHC and Community Health Workers (ACS)
- Gradually, the 120 UBS were involved in the response
- PHC maintained routine activities and started offering oximeters
- Geocoding started to guide ACS visits to patients
- Reduced mortality and complications after PHC on the frontline
- Problem with medical professionals prescribing the ‘preventive treatment’ of the Covid kit, with hydroxychloroquine |
- PHC serviced Covid-19 and non-Covid-19 patients: patients with flu-like symptoms in the morning and all other demands in the afternoon
- PHC articulation with epidemiological surveillance to monitor all notifications of flu-like syndromes in the municipality
- Difficulties with the unsafe conditions of health teams regarding the lack of knowledge of the virus
- Maintenance of services aimed at children, newborns, women, and older adults, precisely for this most vulnerable population |
- PHC assumed a leading role, coordinating the care network
- Effective integration of PHC with surveillance for case reporting
- Establishment of flow for symptomatic and respiratory in all care units
- UBS with regular working hours attended symptomatic, pregnant respiratory, children, and chronic patients who required urgent care |
| Hospital care |
- Expansion of about 400 beds for Covid-19 patients.
- Opening of a field hospital and leasing of a private hospital |
- Organization of ICU and Covid-19 beds at the teaching hospital |
- Field hospital was not implemented
- Activation of a hospital in the central region of the city that will remain after the pandemic |
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Source: Own elaboration.