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      Primary health care response in the management of pandemics: Learnings from the COVID-19 pandemic Translated title: Respuesta de la atención primaria en la gestión de pandemias: aprendizajes de la pandemia COVID-19

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          Abstract

          Primary care is an essential foundation for the global response to COVID-19 pandemic. It plays a significant role in the health care response: identifying and triaging potential COVID-19 cases, making an early diagnosis, helping vulnerable people cope with their anxiety about the virus, strengthening compliance with prevention and protection measures, and reducing the demand for hospital services. Primary care teams have continued to address citizens’ health problems during the pandemic, adapting to strict social control measures imposed by governments such as closing of borders, lockdowns and self-isolation of cases and contacts. We describe the COVID-19 response from primary care in Hong Kong and China, based on their recent pandemic experiences. We also present that of a European country, United Kingdom, less experienced in pandemic management, but with universal and highly developed primary care with great social recognition. Finally, we point out some crucial learning for future pandemic management, highlighting the crucial need to improve the relationship between primary care and public health to improve pandemics response.

          Translated abstract

          La atención primaria es una parte esencial de los sistemas de salud para la respuesta global a la pandemia COVID-19. Desempeña un papel importante en la respuesta asistencial y en su control: identificando y clasificando los posibles casos de COVID-19, realizando un diagnóstico precoz, ayudando a las personas vulnerables a hacer frente a su ansiedad por el virus, reforzando el cumplimiento de las medidas de prevención y protección y reduciendo la demanda de servicios hospitalarios. Los equipos de atención primaria han continuado atendiendo los problemas de salud de los ciudadanos durante la pandemia, adaptándose a las estrictas medidas sociales de control impuestas por los gobiernos como el cierre de fronteras, el confinamiento de la sociedad, y el autoaislamiento de casos y contactos. En este artículo se describe la respuesta a la pandemia COVID-19 desde el nivel de atención primaria en Hong Kong y China, basada en sus experiencias de pandemias anteriores. También se describe la de Reino Unido, con menos experiencia en gestión de pandemias, pero con una atención primaria muy desarrollada, con una cobertura universal de la población y con gran reconocimiento social. Finalmente, se señalan algunos aprendizajes cruciales para la gestión de la pandemia en atención primaria de cara al futuro, entre ellas la importante necesidad de potenciar la relación entre atención primaria y salud pública.

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          A major outbreak of severe acute respiratory syndrome in Hong Kong.

          There has been an outbreak of the severe acute respiratory syndrome (SARS) worldwide. We report the clinical, laboratory, and radiologic features of 138 cases of suspected SARS during a hospital outbreak in Hong Kong. From March 11 to 25, 2003, all patients with suspected SARS after exposure to an index patient or ward were admitted to the isolation wards of the Prince of Wales Hospital. Their demographic, clinical, laboratory, and radiologic characteristics were analyzed. Clinical end points included the need for intensive care and death. Univariate and multivariate analyses were performed. There were 66 male patients and 72 female patients in this cohort, 69 of whom were health care workers. The most common symptoms included fever (in 100 percent of the patients); chills, rigors, or both (73.2 percent); and myalgia (60.9 percent). Cough and headache were also reported in more than 50 percent of the patients. Other common findings were lymphopenia (in 69.6 percent), thrombocytopenia (44.8 percent), and elevated lactate dehydrogenase and creatine kinase levels (71.0 percent and 32.1 percent, respectively). Peripheral air-space consolidation was commonly observed on thoracic computed tomographic scanning. A total of 32 patients (23.2 percent) were admitted to the intensive care unit; 5 patients died, all of whom had coexisting conditions. In a multivariate analysis, the independent predictors of an adverse outcome were advanced age (odds ratio per decade of life, 1.80; 95 percent confidence interval, 1.16 to 2.81; P=0.009), a high peak lactate dehydrogenase level (odds ratio per 100 U per liter, 2.09; 95 percent confidence interval, 1.28 to 3.42; P=0.003), and an absolute neutrophil count that exceeded the upper limit of the normal range on presentation (odds ratio, 1.60; 95 percent confidence interval, 1.03 to 2.50; P=0.04). SARS is a serious respiratory illness that led to significant morbidity and mortality in our cohort. Copyright 2003 Massachusetts Medical Society
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            The primary health-care system in China

            China has made remarkable progress in strengthening its primary health-care system. Nevertheless, the system still faces challenges in structural characteristics, incentives and policies, and quality of care, all of which diminish its preparedness to care for a fifth of the world's population, which is ageing and which has a growing prevalence of chronic non-communicable disease. These challenges include inadequate education and qualifications of its workforce, ageing and turnover of village doctors, fragmented health information technology systems, a paucity of digital data on everyday clinical practice, financial subsidies and incentives that do not encourage cost savings and good performance, insurance policies that hamper the efficiency of care delivery, an insufficient quality measurement and improvement system, and poor performance in the control of risk factors (such as hypertension and diabetes). As China deepens its health-care reform, it has the opportunity to build an integrated, cooperative primary health-care system, generating knowledge from practice that can support improvements, and bolstered by evidence-based performance indicators and incentives.
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              Is Open Access

              Covid-19 pandemic and the social determinants of health

              Lauren Paremoer and colleagues call for action to create a fairer and more sustainable post-covid world
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                Author and article information

                Journal
                Aten Primaria
                Aten Primaria
                Atencion Primaria
                The Authors. Published by Elsevier España, S.L.U.
                0212-6567
                1578-1275
                24 December 2021
                December 2021
                24 December 2021
                : 53
                : 102226
                Affiliations
                [a ]General Practitioner, WONCA World President
                [b ]Norwich Medical School, University of East Anglia, United Kingdom
                [c ]WONCA Working Party on Quality and Safety in Family Medicine, Servicio Aragonés de Salud, Zaragoza University, GIBA-IIS-Aragón, Spain
                Author notes
                [* ]Corresponding author.
                Article
                S0212-6567(21)00260-2 102226
                10.1016/j.aprim.2021.102226
                8708808
                34961573
                11cb65c7-36bd-4af0-8725-014392c7c987
                © 2021 The Authors

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

                History
                : 11 September 2021
                : 13 September 2021
                Categories
                Original Article

                covid-19,epidemics,primary care,public health,pandemic preparedness,health policy,family medicine,epidemias,atención primaria,salud pública,preparación para pandemias,política sanitaria,medicina de familia

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