Improved strategies to counter the COVID-19 pandemic: Lockdowns vs. primary and community healthcare.
Improved strategies to counter the COVID-19 pandemic: Lockdowns vs. primary and community healthcare.
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DOI：
10.1016/j.toxrep.2020.12.001
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发表时间：
2021
影响因子：
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通讯作者：
Tsatsakis A
中科院分区：
文献类型：
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作者：
Farsalinos K;Poulas K;Kouretas D;Vantarakis A;Leotsinidis M;Kouvelas D;Docea AO;Kostoff R;Gerotziafas GT;Antoniou MN;Polosa R;Barbouni A;Yiakoumaki V;Giannouchos TV;Bagos PG;Lazopoulos G;Izotov BN;Tutelyan VA;Aschner M;Hartung T;Wallace HM;Carvalho F;Domingo JL;Tsatsakis A
COVID-19疫情对许多国家的医疗能力构成挑战。严格的横向封锁对社会、经济和健康的不利影响尚未得到充分考虑。初级和社区护理在缓解COVID-19大流行方面发挥着多重作用。希腊是一个忽视基层及社区护理的国家，并于二零二零年十一月实施第二次横向封锁。基层及社区护理是长期成功缓解COVID-19疫情的唯一现实策略。COVID-19疫情缓解策略主要基于社交距离措施及加强医疗保健系统。然而，由于病毒在社区内广泛传播，对医疗保健系统的能力构成挑战，欧洲和其他地区的许多国家实施了严格的横向封锁。然而，严格的封城措施会对社会、经济及健康造成各种意想不到的不利影响，这些影响尚未得到充分阐明，而且在研究各种缓解措施效果的模型中也未予以考虑。与通常所说的不同，这一困境不是健康与财富的问题，因为长期封锁的经济破坏肯定会对人口的健康产生不利影响。此外，它们不能为遏制大流行提供持久的解决方案，可能导致连续封锁与中间中断的恶性循环。医院的准备工作一直是各国政府采用的主要战略。然而，COVID-19大流行的一个主要特征是病毒在无免疫力人群中的快速传播。因此，即使是最好的医院系统也无法满足需求。初级、社区和家庭护理是能够实现减轻大流行病目标的唯一可行战略。我们提出了希腊的情况下，一个国家遵循的战略，重点是医院的准备，但未能加强初级和社区保健的例子。这一点，加上流行病学监测方面的战略失误，导致希腊实施了第二次严格的横向封锁，并在第二波疫情期间成为欧洲COVID-19死亡率最高的国家之一。我们提供措施建议，通过保护医院免受不必要的入院，提供与COVID-19相关的一级和二级预防服务，并通过治疗非COVID-19疾病来维持人口健康，从而恢复基层和社区护理在管理当前公共卫生危机中的前沿地位。这连同更具选择性的社交距离措施（而非横向封锁）是缓解COVID-19疫情的唯一可行及现实的长期策略。
The COVID-19 pandemic has challenged the healthcare capacity of many countries. Strict, horizontal lockdowns have adverse social, economic and health effects that have not been fully considered. Primary and community care have multiple roles in COVID-19 pandemic mitigation. Greece is a case example of a country which neglected primary and community care, and in November 2020 implemented a second horizontal lockdown. Primary and community care, represents the only realistic strategy for successful COVID-19 pandemic mitigation in the long-term. COVID-19 pandemic mitigation strategies are mainly based on social distancing measures and healthcare system reinforcement. However, many countries in Europe and elsewhere implemented strict, horizontal lockdowns because of extensive viral spread in the community which challenges the capacity of the healthcare systems. However, strict lockdowns have various untintended adverse social, economic and health effects, which have yet to be fully elucidated, and have not been considered in models examining the effects of various mitigation measures. Unlike commonly suggested, the dilemma is not about health vs wealth because the economic devastation of long-lasting lockdowns will definitely have adverse health effects in the population. Furthermore, they cannot provide a lasting solution in pandemic containment, potentially resulting in a vicious cycle of consecutive lockdowns with in-between breaks. Hospital preparedness has been the main strategy used by governments. However, a major characteristic of the COVID-19 pandemic is the rapid viral transmission in populations with no immunity. Thus, even the best hospital system could not cope with the demand. Primary, community and home care are the only viable strategies that could achieve the goal of pandemic mitigation. We present the case example of Greece, a country which followed a strategy focused on hospital preparedness but failed to reinforce primary and community care. This, along with strategic mistakes in epidemiological surveillance, resulted in Greece implementing a second strict, horizontal lockdown and having one of the highest COVID-19 death rates in Europe during the second wave. We provide recommendations for measures that will reinstate primary and community care at the forefront in managing the current public health crisis by protecting hospitals from unnecessary admissions, providing primary and secondary prevention services in relation to COVID-19 and maintaining population health through treatment of non−COVID-19 conditions. This, together with more selective social distancing measures (instead of horizontal lockdowns), represents the only viable and realistic long-term strategy for COVID-19 pandemic mitigation.