No abstract

This review was aimed to probe into factors that resulted in worsening of novel coronavirus disease 2019 (COVID-19) pandemic in New York City, USA. Extensive review of available information sources, such as scientific literature, COVID-19 data generating websites, expert opinions as well as government briefings and simultaneous measures, were carried out to fulfil the objectives of this paper. Data was arranged in tabular form. Gaps in responding to the pandemic were identified. There was lack of proactivity in measures taken by governments which is due to neo-liberal capitalism on one hand and lack of coordination among three tiers of government on the other. Cosmopolitan features of the city also made it prone to devastating spread of pandemic. Crowded mega cities with incompetent governments in implementing timely public health measures for prevention of spread of COVID-19 are at potential threat of high disease spread across the globe.

Background Despite of free TB care in Pakistan, patients still have to bear high costs which push them more into poverty. This study estimated the types of costs households bear for TB care, and coping mechanisms used for bearing TB expenditures among adults ≥ 18 years in Karachi, Pakistan. Methods A total of 516 TB patients with completion of at least one month intensive treatment were recruited from four public sector hospitals in Karachi, Pakistan. A standardized questionnaire to estimate patient's costs was administered. Direct medical and non-medical costs incurred as out-of-pocket and indirect costs (loss of income) during pre-diagnostic, diagnostic, treatment and hospitalization phase were estimated. Results Out of 516 participants, 52.1% were female with a mean age of 32.4 (± 13.7) years. The median costs per patient borne during the pre-diagnostic, diagnostic, treatment and hospitalization was estimated at USD63.8/ PKR7377, USD24/ PKR2755, USD10.5/ PKR1217 and USD349.0/ PKR40300, respectively. The total household median costs was estimated at USD129.2/ PKR14919 per patient. The median indirect costs were estimated at USD52.0/ PKR5950 per patient. First point of care was a private provider by 54.1% of patients, 36% attended public service, 5% and 4.1% went to dispensary and pharmacy, respectively. Conclusion TB patients bear substantial out-of-pocket costs before they are enrolled in publically funded TB program. There should be provision of transport and food vouchers, also health insurance for in-patient treatment. This advocates a critical investigation into an existing financial support network for TB patients in Pakistan with an eye towards easing the burden.