Atenção primária à saúde e pandemia da COVID-19 (primeira onda): aspectos normativos e ocorrência de casos entre os trabalhadores da saúde, em Salvador, Bahia, Brasil.

Abstract

Introduction and justification. The COVID-19 pandemic highlighted the high risk of infection among health workers, especially in Primary Health Care (PHC), but there are still gaps regarding the relevance of institutional guidelines and the specificities of illness among these professionals, in part due to the scarcity of disaggregated data. Objectives. This study sought analyze the suitability of the guidance provided to PHC workers by municipal management and the clinical-epidemiological characteristics of those considered suspected or confirmed cases of COVID-19. Methodology. The research involved a documentary analysis of the standards issued between March and October 2020 at the municipal, state and federal levels, and a study descriptive cross-sectional observational study with data from the Municipal Health Department of Salvador, collected between August and October 2020 through an electronic questionnaire. 282 were included professionals. Results. The SMS-Salvador guidelines for PHC workers proved to be broadly aligned with state and federal guidelines regarding disease control measures engineering and administrative, especially with regard to the physical reorganization of units, supply of surgical masks and internal service flows. However, it was observed less initial emphasis on direct communication with workers, ongoing education and incorporation of technologies, which were only formalized as of June. There was no guidance about extending the opening hours of the units in none of the three spheres. About characteristics of the workers in the study, the average age was 40.8 years, the majority were male female (81.9%) and self-declared mixed race (50.3%) or black (39%). The most common professions were nursing technicians (21.6%), community health agents (16%) and nurses (12.8%). The majority worked in Family Health Units with three or more teams. As to symptoms, 83% met flu-like syndrome (GS) criteria, and 2.5% required hospitalization. Among those tested, 38.6% had a positive result. Of these, 61% reported symptoms of anxiety and 41% of depression. Age over 41 years and number of GS symptoms were predictors of positivity. The current definition of OS showed sensitivity of 89% and specificity of 20.8%; an alternative proposal reduced sensitivity to 73%, but increased specificity to 71%. Discussion. SMS-Salvador regulations for PHC were globally timely and pertinent and some actions, in particular the creation of the Center for Support for Workers (NAAT), were pioneers. Structural and operational difficulties, such as Inadequacy of space and scarcity of inputs made it difficult to apply the guidelines. The characterization of workers revealed similarities with national and international evidence, including female predominance, high frequency of flu-like symptoms and psychological symptoms. THE Defining flu syndrome criteria illustrates the challenge of balancing effective surveillance and preservation of the workforce. Methodological limitations include possible selection bias, memory and interpretation, in addition to risks of documentary under-recording. Conclusion. It is concluded that the municipal response was globally pertinent, but required local adaptations in the face of limitations contextual, offering substrate to guide public policies aimed at PHC in future health events of a similar nature.