La pandemia del coronavirus (covid-19) y su impacto geopolítico, económico y de salud a nivel mundial: lesiones de taiwán a partir de su epidemia de sars-cov-1.. / The Coronavirus Pandemic (COVID-19) and the geopolitical, economic and health impact worldwide: Lessons of Taiwan´s experiences from SARS-Cov-1 epidemic.

• Joffre Carrillo-Pincay Universidad de Guayaquil
• Chiu-Yen Lu National Yang-Ming University
• Bomar Mendez-Rojas Pan American Health Organization
• María Robles Urgilez Universidad de Guayaquil

Palabras clave: SARS-CoV-1, COVID-19/ SARS-CoV-2, pandemia, Ecuador, COVID-19/SARSCoV-2, pandemic, Ecuador.

Resumen

RESUMEN

La pandemia del SARS-Cov-2 (COVID-19) superó a 10 veces más la propagación del virus que el SARS-Cov-1 del 2002. Una gran recesión económica trajo consigo la pandemia que se sumo a la crisis económica del 2019, colapso los sistemas públicos y privados de países desarrollados que subestimaron la agresividad del agente viral, como Italia y España, resultando en 372.756 casos confirmados y 16231 muertes (4.3% de casos totales) a nivel global. Países como Singapur y Taiwán, desarrollaron sus protocolos con la epidemia del SARSCov-1, y demostraron al mundo como sr eficiente a una amenaza biológica mundial. En la actualidad sus estrategias permitieron aplanar la curva de propagación viral del COVID-19, y fueron referentes mundiales para afrontar la pandemia localmente. Sin embargo, China Continental, sin quedarse al margen, compite con EE.UU. por el poder económico y político de las regiones y actualmente por el descubrimiento de la vacuna contra el COVID-19. Objetivos: Determinar las estrategias e indicadores asociados al COVID-19 y su impacto político en salud y en la economía mundial y local. Determinar estrategias de salud pública basados en países eficientes en respuestas biológicas emergentes para minimizar o aplanar la curva epidemiológica del COVID-19. Resultados: Ecuador, en Suramérica, con 17 millones de habitantes, con un PIB de 9.5% inyectado a la salud pública, se convirtió en el segundo país con mayor prevalencia de casos (n=981) y se ubicó en el puesto 26º en el mundo. Las estrategias parciales tomadas a nivel nacional, sumado a la falta de cultura preventiva de la sociedad ecuatoriana, propagaron rápidamente el COVID-19. La falta de gestión de insumos médicos, y la escases del personal médico (15 médicos por cada 10.000 habitantes), así como déficit de camas hospitalarias (tasa=1.4/1.000 habitantes/nivel nacional [0.8 del sector público], por debajo de Cuba con 5.4) y pruebas de PCR-RT, pone en peligro el sistema de salud de colapsarse, por el aumento exponencial del virus analizado hasta la 6ta. semana del impacto local por el COVID-19. Sin embargo, el análisis de PIB% entre Ecuador (PIB=9.5%) y Taiwán (PIB=6.3%), y las medidas estratégicas empleadas, rectifican que el sistema universal de salud de Taiwán, es muy eficiente en estrategias y respuestas a la emergencia del COVID-19. Estrategias de Taiwán han sido reflejadas en nuestro entorno para aplanar la curva epidemiológica y reducir el gasto público local.

ABSTRACT

The SARS-Cov-2 (COVID-19) pandemic outnumbered the spread of the virus 10 times more than the SARS-Cov-1 DEL 2002. A major economic recession brought with it the pandemic that added to the 2019 economic crisis, The public and private systems of developed countries collapsed, which underestimated the aggressiveness of the viral agent, such as Italy and Spain, resulting in 372,756 confirmed cases and 16,231 deaths (4.3% of total cases) globally. Countries like Singapore and Taiwan, developed their protocols with the SARS-Cov-1 epidemic, and demonstrated to the world as efficient at a global biological threat. Currently, their strategies allowed to flatten the viral propagation curve of COVID-19, and were global benchmarks for tackling the pandemic locally. However, Mainland China, without staying on the sidelines, competes with the US. for the economic and political power of the regions and currently for the discovery of the vaccine against COVID-19. Objetives: To determine the strategies and indicators associated with COVID-19 and its political impact on health and on the world and local economy. Determine country-based public health strategies efficient in emerging biological responses to minimize or flatten the epidemiological curve of COVID-19. Results: Ecuador, in South America, with 17 million inhabitants, with a GDP of 9.5% injected into public health, became the second country with the highest prevalence of COVID-19 cases (n=981) and ranked 26th in the world. The partial strategies taken at the national level, added to the lack of preventive culture in Ecuadorian society, quickly spread COVID-19. The lack of management of medical supplies, and the shortage of medical personnel (15 doctors per 10,000 inhabitants), as well as deficits in hospital beds (rate=1.4/1,000 inhabitants / national level [0.8 of the public sector], below Cuba with 5.4) and PCR-RT tests, it puts the health system at risk of collapse, due to the exponential increase in the virus analyzed until the 6th. week of local impact by COVID-19. However, the analysis of GDP% between Ecuador (GDP = 9.5%) and Taiwan (GDP = 6.3%), and the strategic measures used, rectify that the universal health system of Taiwan is very efficient in strategies and responses to the COVID-19 emergency. Taiwan’s strategies have been reflected in our environment to flatten the epidemiological curve and reduce local public spending.

Citas

Ahmad, T., & Hui, J. (2020). One Health approach and Coronavirus Disease 2019. Hum Vaccin Im- munother, 1-2. doi:10.1080/21645515.2020.1732168

Amèrica Economia. (2020). ¿Cómo es la Salud Universal de Taiwán?. USA: AsiaLink Amèrica Economia. Retrieved from https://asialink.ameri-caeconomia.com/columna/como-es-la-salud-uni- versal-de-taiwan [22/3/2020]

Banco Interamericano de Desarrollo. (2020). BID listo para apoyar a países de MERCOSUR en respuesta al COVID-19. Retrieved from https:// www.iadb.org/es/noticias/bid-listo-para-apoyar- paises-de-mercosur-en-respuesta-al-covid-19 [acceso 24/3/2020]

Banco Mundial. (2019). Camas hospitalarias (por cada 1.000 personas). Washington: OPS Base de datos. Retrieved from https://datos.bancomun- dial.org/indicador/SH.MED.BEDS.ZS?view=map [acceso 24/3/2020]

Cao, B., et al. (2020). A Trial of Lopinavir–Ritonavir in Adults Hospitalized with Severe Covid-19. New England Journal of Medicine. doi:10.1056/NEJ- Moa2001282

CDC. (2020). Coronavirus Disease 2019 (CO- VID-19). Interim Infection Prevention and Control Recommendations for Patients with Suspected or Confirmed Coronavirus Disease 2019 (COVID-19) in Healthcare Settings. Atlanta: U.S. Department of Health & Human Services. Retrieved from ht- tps://www.cdc.gov/coronavirus/2019-ncov/infec- tion-control/control-recommendations.html?C- DC_AA_refVal=https%3A%2F%2Fwww.cdc. gov%2Fcoronavirus%2F2019-ncov%2Fhcp%2F- infection-control.html [accessed 22/3/2020]

Common Health Megazine. (2020). Chlorine dioxide disinfection products are being used correctly, are you using them rightly?. Retrie- ved from https://www.msn.com/zh-tw/health/ topic/%E4%BA%8C%E 6%B0%A7%E5%- 8C%96%E6%B0%AF%E6%B6%88%E6%A- F%92%E7%94%A8%E5%93%81%E9%81%A- D%E7%98%8B%E6%90%B6-%E4%B - D % A 0 % E 7 % 9 4 % A 8 % E 5 % B 0 % - 8D%E4%BA%86%E5%97%8E%EF%B - C%9F3%E9%87%8D%E9%BB%9E%E5%-BF%85%E7%9F%A5/ar-BB10jotd [acces 23/3/2020]

Cortegiani, A., Ingoglia, G., Ippolito, M., Giarrata- no, A., & Einav, S. (2020). A systematic review on the efficacy and safety of chloroquine for the treatment of COVID-19. J Crit Care. doi:10.1016/j. jcrc.2020.03.005

Cunningham, A. C., Goh, H. P., & Koh, D. (2020). Treatment of COVID-19: old tricks for new cha- llenges. . Crit Care 24, 91.

Dhama, K., et al. (2020). COVID-19, an emerging coronavirus infection: advances and prospects in designing and developing vaccines, immunothe- rapeutics, and therapeutics. Hum Vaccin Immu- nother, 1-7. doi:10.1080/21645515.2020.1735227

Dong, L., Hu, S., & Gao, J. (2020). Discovering drugs to treat coronavirus disease 2019 (COVID-19). Drug Discov Ther, 14(1), 58-60. doi:10.5582/ ddt.2020.01012

Feng Chuan Mei. (2020). [¿El Gobierno de Tai- pei cerrarà la ciudad? Si el número de re- producción (R0) es mayor a 1, cerraremos]. Taipei: Departamento de Salud-The Storm Media. Retrieved from https://www.msn.com/ zh-tw/health/topic/%E5%8F%B0%E5% - 8C%97%E6%9C%83%E5%B0%81%E5%9F%8E%E5%97%8E%EF%BC%9F%E8%A9%- B 9 % E 9 % 9 5 % B 7 % E 6 % A - C % 8 A r 0 % E 5 % 8 0 % B C % E 8 % - 8B%A5%E5%AE%88%E4%B8%8D%E4%B- D%8F%E9%80%99%E6%95%B8%E5%A- D%97%E5%B0%B1%E5%BE%97%E9%97%- 9C%E5%9F%8E%E9%96%80/ar-BB11BMin [accessed 23/3/2020].

Gates, B. (2020). Responding to Covid-19 — A On- ce-in-a-Century Pandemic? New England Journal of Medicine. doi:10.1056/NEJMp2003762

Hoehl, S., et al. (2020). Evidence of SARS-CoV-2 In- fection in Returning Travelers from Wuhan, China. New England Journal of Medicine. doi:10.1056/ NEJMc2001899

Hollander, J. E., & Carr, B. G. (2020). Virtually Perfect? Telemedicine for Covid-19. New England Journal of Medicine. doi:10.1056/NEJMp2003539

Hsu, Y. C., Chen, Y. L., Wei, H. N., Yang, Y. W., &Chen, Y. H. (2017). Risk and Outbreak Communication: Lessons from Taiwan’s Experiences in the Post-SARS Era. Health Secur, 15(2), 165-169. doi:10.1089/hs.2016.0111

INEC-MSP. (2018). Datos Estadìsticos del Sistema de Salud del Ecuador. Quito: INEC. Retrie- ved from https://www.ecuadorencifras.gob.ec/ camas-y-egresos-hospitalarios/ o https://www. ecuadorencifras.gob.ec/documentos/web-inec/ Estadisticas_Sociales/Camas_Egresos_Hospita- larios/Cam_Egre_Hos_2018/Boletin-tecnico%20 ECEH.pdf [acceso 22/3/2020].

Instituto de Estadistica y Censos. (2010). Población y Demografía. Resultado del Censo Poblacional. Quito: INEC. Retrieved from https://www.ecuado-rencifras.gob.ec/censo-de-poblacion-y-vivienda/ [acceso 23/3/2020]

Joffre, C. P., et al. (2013). Medical education in Ecuador. Med Teach, 35(12), 979-984. doi:10.310 9/0142159x.2013.826789

Jones, D. S. (2020). History in a Crisis — Lessons for Covid-19. New England Journal of Medicine. doi:10.1056/NEJMp2004361

Kao, H. Y., Ko, H. Y., Guo, P., Chen, C. H., & Chou, S. M. (2017). Taiwan’s Experience in Hospital Preparedness and Response for Emerging In- fectious Diseases. Health Secur, 15(2), 175-184. doi:10.1089/hs.2016.0105

Lai, C. C., Shih, T. P., Ko, W. C., Tang, H. J., & Hsueh, P. R. (2020). Severe acute respiratory sy- ndrome coronavirus 2 (SARS-CoV-2) and coro- navirus disease-2019 (COVID-19): The epidemic and the challenges. Int J Antimicrob Agents, 55(3), 105924. doi:10.1016/j.ijantimicag.2020.105924

Li, Z., et al. (2020). Caution on Kidney Dys- functions of 2019-nCoV Patients. me- dRxiv, 2020.2002.2008.20021212.

doi:10.1101/2020.02.08.20021212

Lipsitch, M., Swerdlow, D. L., & Finelli, L. (2020). Defining the Epidemiology of Covid-19 — Studies Needed. New England Journal of Medicine. doi:10.1056/NEJMp2002125

Melinda & Bill Gate Foundation. (2020). The Opti- mist. Perspectives on the global response to the 2019 novel coronavirus (COVID-19). Seattle: Melinda & Bill Gate Foundation. Retrieved from https://www.gatesfoundation.org/TheOptimist/co- ronavirus [acceso 24/3/2020]

Ministerio de Salud Pùblica. (2020). Actualiza- ción de casos de coronavirus en Ecuador. Qui- to: MSP-INSPI. Retrieved from https://www. salud.gob.ec/actualizacion-de-casos-de-coro- navirus-en-ecuador/ o https://www.salud.gob. ec/wp-content/uploads/2020/03/Boletin-co- vid_013_2020.pdf [acceso 22/3/2020]

Ministerio de Sanidad, C. y. B. S. d. E. (2020). Procedimiento de actuación frente a casos de infección por el nuevo coronavirus y Manejo Clinico Terapeutica de pacientes con SARS-CoV-2. Barcelona: MSE y Instituto de Salud Carlos III. Retrieved from https://www.mscbs.gob.es/profesionales/ saludPublica/ccayes/alertasActual/nCov-China/ documentos/Procedimiento_COVID_19.pdf o ht- tps://www.mscbs.gob.es/profesionales/saludPu- blica/ccayes/alertasActual/nCov-China/documen-

tos.htm [acceso 24/3/2020]

Ministerio de Sanidad y Consumo de España. (2006). Sistema Nacional de Salud Español. Barcelona: MSC. Retrieved from https://www.mscbs. gob.es/estadEstudios/estadisticas/docs/siap/ SIAP0405.pdf [acceso 22/3/2020]

Ministry of Health and Welfare of Taiwan. (2020). Indicators of National Health Expenditure and Gross Domestic Product from Taiwam. Taipei, MHW. Re- trieved from https://www.gender.ey.gov.tw/gecdb/ Stat_Statistics_DetailData.aspx?sn=jtg6KRQTvi- FsfOzy4n38lQ==&d=194q2o4+otzoYO+8OAM- Yew==&fbclid=IwAR3efHy2wCyXTbQukc6Meg- Bap6yxvY85H_DWk54ck-nD2wFZtEI5FedK808 [accessed 22/3/2020]

Organo de la Repùblica de Ecuador. (2004). Nor- mativas de prevención y control de vigésima codificación, Registro Oficial Suplemento 418, del 2004. Retrieved from https://www.registroficial. gob.ec/index.php/registro-oficial-web/publicacio- nes/suplementos/item/6518-suplemento-al-regis- tro-oficial-no-418 [acceso 23/3/2020].

Parmet, W. E., & Sinha, M. S. (2020). Covid-19 — The Law and Limits of Quarantine. New England Journal of Medicine. doi:10.1056/NEJMp2004211

Sayson, M. (2018). Sistema de salud de Singapur: posición 6 entre todos los países por su desem- peño. Parma: Emergencia en Vivo. Retrieved from https://www.emergency-live.com/es/sa- lud-y-la-seguridad/sistema-de-salud-singapuren- ses/ [acceso 22/3/2020]

Truog, R. D., Mitchell, C., & Daley, G. Q. (2020). The Toughest Triage — Allocating Ventilators in a Pandemic. New England Journal of Medicine. doi:10.1056/NEJMp2005689

UDN. (2020). [Implementación de prevención de epidemias independiente. 167 Nuevas estacio- nes comunitaria de inspección de neumonía para determinaciòn de COVID-19].167 Taipei: Health Department. . Retrieved from https://health.udn. com/health/story/120950/4409905?from=udn-ca- tehotnews_ch1005n&fbclid=IwAR0X3iA5IoV7S- mis6DKe-Q4_Mg7aUbqeHyMRP9pVO_-8AtvL_ HZCYfGKpbs [accessed 23/3/2020]

Universidad Johns Hopkins. (2020). Pandemia de COVID-19 o SARS-CoV 2. Reporte de Casos con- firmados de COVID-19 en el Mundo y por Paìses. Baltimore, UJH. Retrieved from https://www.bbc. com/mundo/noticias-america-latina-51881075 [acceso 23/3/2020]

Van Doremalen, N., et al. (2020). Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1. New England Journal of Medicine. doi:10.1056/NEJMc2004973

WHO. (2020). Coronavirus disease (COVID-2019) situation reports. Genova: World Health Organization. Retrieved from https://www.who.int/emer- gencies/diseases/novel-coronavirus-2019/situa- tion-reports [24/3/2020]

World Economic Forum. (2020). Flattening the COVID-19 Curve in Developing Countries. USA: WEF. Retrieved from https://www.weforum.org/ agenda/2020/03/flattening-the-covid-19-cur- ve-in-developing-countries/ [Accessed 24/3/2020]

Xinhua Company. (2020). Empresa china Huawei implementa en Ecuador sistema para detectar COVID-19. China: Xinhua News. Retrie-ved from http://spanish.xinhuanet.com/2020- 03/23/c_138905641.htm [acceso 24/3/2020]

Zahra, S., Minoosh, S., Shervin, S., & Ali, S. (2020). Aminoquinolines Against Coronavirus Disease 2019 (COVID-19): Chloroquine or Hydroxychlo- roquine. International Journal of Antimicrobial Agents,.

Zhou, D., Dai, S.-M., & Tong, Q. (2020). COVID-19:

a recommendation to examine the effect of hy- droxychloroquine in preventing infection and pro- gression. Journal of Antimicrobial Chemotherapy. doi:10.1093/jac/dkaa114

Zou, L., et al. (2020). SARS-CoV-2 Viral Load in Upper Respiratory Specimens of Infected Patients. New England Journal of Medicine, 382(12), 1177-1179. doi:10.1056/NEJMc2001737