Coping strategies and health promotion through teaching-service integration in the context of the COVID-19 pandemic

In the current situation related to 2019-nCoV β-coronavirus, the National Health Authorities have determined the elaboration of contingency plans (CP) that minimize the contagion and allow the functioning of essential activities. The CP presented defines a set of guidelines that allow the adequacy of the response of a public university in Northeast of Brazil linked to the Programa Mais Médicos para o Brasil. Descriptive and qualitative study, type of comment, from the analysis of the data of the CP for the definition of strategies for coping with public health emergencies. The CP consists of ten measures that include assistance via applications/social networks; monitoring of physicians who are at risk; screening of suspected/confirmed cases; production of guides/protocols; 24h psychological/technical assistance to physicians working at primary health care and provision of online courses. The methodology proposed provides different models from those trivially presented in academia and is essential to promote health education. Abstract


ISSN 2179-7994
In the current situation related to 2019-nCoV β-coronavirus, the National Health Authorities have determined the elaboration of contingency plans (CP) that minimize the contagion and allow the functioning of essential activities. The CP presented defines a set of guidelines that allow the adequacy of the response of a public university in Northeast of Brazil linked to the Programa Mais Médicos para o Brasil. Descriptive and qualitative study, type of comment, from the analysis of the data of the CP for the definition of strategies for coping with public health emergencies. The CP consists of ten measures that include assistance via applications/social networks; monitoring of physicians who are at risk; screening of suspected/confirmed cases; production of guides/protocols; 24h psychological/technical assistance to physicians working at primary health care and provision of online courses. The methodology proposed provides different models from those trivially presented in academia and is essential to promote health education.

Abstract
Keywords: Coronavirus Infections; Health Promotion; Health Education.

Resumen
Palabras clave: Infecciones por Coronavirus; Promoción de la Salud; Educación en la Salud. The contingency plan (CP) for COVID-19 comprises 10 intervention measures ( psychologist, as well as a partnership agreement with local psychology courses for psychological support of medical scholar professionals directly linked to assistance.
Neto et al. 6 , demonstrated satisfactory results in reaching the public using the social network as a tool to promote health education. In this way, supervisors can technically prepare themselves to offer a second formative opinion to participating physicians, strengthening the teaching-service integration, which in health units consists of the integrated work of academics, professors, managers and professionals who make up health institutions, aiming to improve individual and collective attention and reorient the educational process and professional training in the health area. 7 In addition, during pandemics, it is common for health professionals, scientists and managers to focus predominantly on the pathogen and biological risk, in an effort to understand the pathophysiological mechanisms involved and propose measures to prevent, contain and treat the disease.

Conducting periodic virtual meetings involving tutors, supervisors and invited experts.
2. Training for supervisors regarding the management of the COVID-19 and flowchart for patient care in UBS by specialists in the region.

Adoption of a longitudinal supervision model offered to doctors program participants by the supervising institution.
Telemedicine as a way to support working groups 4. Formation of technical support team.
5. Formation of psycho-emotional support team.

Formation of PMMB Partnerships with local institutions
6. Partnership with the Cariri Regional Health Superintendence as an intermediary with the Municipalities linked to the program.

Production and summarization of knowledge about COVID-19 for local health departments
7. Elaboration guidelines for physicians and their health teams subsidized by a technical note from the Health Secretariat of Estado/ CFM/AMB/ANVISA, adjusted by our team of specialists for the care of users in the UBS due to the risk of contamination of COVID-19.

Monitoring of physicians and health professionals who are in risk groups
8. Mapping of the UBS where there are physicians from a risk group and monitoring of cases of COVID-19 in the territory in which they operate, both by users and by health professionals.
9. Redistribution of supervisors in the territory in which they work with the aim of improving the assistance of physicians students. In these situations, the psychological and psychiatric implications secondary to the phenomenon, both at the individual and collective levels, tend to be underestimated and neglected, creating gaps in coping strategies and increasing the burden of associated diseases. 8 In this context, psychology plays an important role in the prevention of mental health problems for professionals and, therefore, psychological shifts for guidance about mental health care, in addition to virtual psychological cares are of paramount importance. 9 The sixth and seventh stages are the formation of partnerships with the local Regional Health Superintendence, as an intermediary between municipalities and PMMB and the Extension Project in Family and Community Medicine (Table 1), through which there is the production of epidemiological bulletins from the municipalities to the University and production of guidelines for action in UBS for compliance with COVID-19 by specialists from the University for the municipalities. This approach facilitates the entry of clinical and demographic data and information, in order to combat fake news, myths and rumors about the outbreak of COVID-19. The advancement in the use of social media as a means of information has brought with it the challenge of monitoring and responding quickly to false content disseminated on these channels. In this context, the growing movement of discredit traditional communication channels, which encourages adherence to alternative sources, also becomes a public health risk that must be faced. The communication of specialists cannot be restricted to the academic environment and professionals in the field. 10 This alternative is also in line with the proposed guidelines for medical training in SUS, 11 because, when integrating an extension project directly to assistance, there is a proposal to link medical training to generalist, humanist, critical stance and reflexive, empowering them to work in the different health services at their different levels of care.
The last three stages ( Table 1)  The literature outlines that joint efforts by the State and Universities are necessary to increase the hiring of professionals for support teams, institute action protocols for different social scenarios, ensure the necessary inputs to increase the attendance, especially of individual protection equipment, guarantee training of paramentation and desparamentation to all team professionals. 13 It is worth noting that difficulties are being encountered in the application of the CP as deficits for resources in health promotion actions with the community; in some situations, there was difficulty in matching schedules with the students 'curriculum and the supervisors' professional routine; in addition, the shift to operating scenarios is also challenging.
It is also important to note that there was no resistance from the second opinion offer to specialists. It is clear that due to the team's cohesion and longitudinal work over the past seven years, a collective commitment of tutors and supervisors to local primary care has been created, even though the training is different. In fact, the second opinion system opened the prerogative for organizations of pedagogical meetings using web conferences through an agenda on Google, sending invitations, moderating activities between participants and speakers, and evaluation processes within the program.
At the same time, the local administrations received the support offered by the PMMB in a very comprehensive way because, in the current context of the COVID-19 pandemic, many protocols with different approaches and different institutions cause insecurity and make the preparation of contingency plans difficult. Thus, the support of a local team with technical knowledge of the demands of the teams assigned in line with the main national and international guidelines is essential.
The emergence of new diseases has impacts far beyond the cases and deaths they generate. They also create an ideal context that imposes on national public health systems the task of validating their health surveillance and assistance system as for of the opportunity for early detection and the power of response that came in cascading. 10 Despite the state of pandemic and global alert, health surveillance actions based on the triple alliance between teaching-extension and management can be fundamental, especially when considering particularities of actions in different regions of the world, especially in countries with large dimensions such as the Brazil. Finally, it is noteworthy that the group keeps studying possibilities to better assess the impacts of the PC in the assisted municipalities, as well as there is a research project in preparation phase aiming at this mapping.