Gestión de riesgo

Along with securing the requisite data, we propose two tactical priorities. The first is infection risk stratification; the second is exposure dose management. Together, these can inform the policies, programs, and personal behaviors of Phase Two, even with the limited data we now have.-Dr. Darria Long and Dr. David L. Katz

La planificación de la gestión y la comunicación de riesgos representan un gran reto para la comunidad salubrista.


Hay dos componentes esenciales que nos permiten diseñar un plan para mitigar el riesgo de eventos nocivos: la probabilidad de que ocurra y el impacto si ocurre. La probabilidad puede ser baja, intermedia o alta; el impacto puede ser leve, moderado o severo.


Con una sencilla matriz 2x2 podemos clasificar el riesgo de un evento nocivo y diseñar estrategias para mitigar su impacto.


Existen modelos más complejos, pero esa sencilla matriz nos permite estructurar la esencia del concepto.


COVID-19: Risk-Stratification Matrix


Evidentemente, los grupos A, B y D necesitan las medidas más estrictas de protección para evitar el contacto y el contagio con el SARS-CoV-2. La población más joven y sana (grupo de riesgo I), aunque a menor riesgo de enfermar, si no puede evitarlo debe al menos minimizar la probabilidad (likelihood) de contagio, cuantificable por la dosis de exposición, esto es, por el nivel de aglomeración, el tipo de actividad, la duración y la distancia.


Factors Driving Exposure Dose

  1. Density: How many people are in one place, and how closely? What is the density of your city or of a chosen activity? Volume of airflow directly impacts infection risk and explains why a crowded bar/concert/movie theatre significantly raises risk. While being outdoors may mitigate risk, crowds themselves present an inherent risk, especially if densely packed.

  2. Degree of activity: Activities with loud speaking or intense physical activity all increase the risk of transmission, as seen in infections after choir practice in Washington State, or in group exercise classes in South Korea where a single instructor led to an outbreak of 112 individuals. Singing, shouting, exercising — each of these carry additional risk.

  3. Duration: Probability of infection is directly linked to duration of exposure. Living in the same house with someone who is acutely ill is high risk, while just a quick pass-by on a street is much less so.

  4. Distance: We all know the 6-foot rule — but let’s be clear: there is no law that COVID cannot cross 6 feet. In some instances, germs can travel 10 and even 20 feet. Meaning that the 6-foot rule is a useful guideline but no panacea.

Putting it all together, a situation in which all 4 factors were high risk would be a HIGH DOSE event, whereas one where all four were low risk would be a LOW dose event


As restrictions are loosened and the population is inevitably exposed to Covid-19, even the healthiest among us should be exposed to the lowest dose possible, potentially lowering risk of any illness, and/or severe illness.
Exposure dose management is one among the important means of advancing toward the all-clear of herd immunity with minimal hardship.

Source: medium.com


Las «prioridades tácticas» propuestas por Long y Katz no pronueven la estrategia de inmunidad de rebaño (herd immunity) para afrontar la pandemia COVID-19. Mas bien, representan un intento racional por calibrar el frágil equilibrio entre el derecho a la salud y la necesidad del sustento (actividad laboral) en nuestra actual realidad social. -JB

Editor in Chief:


José Becerra, MD, MPH, FACPM

Atlanta, GA & San Juan, Puerto Rico

Retired Centers for Disease Control Medical Epidemiologist

Adjunct Associate Professor of Epidemiology and Biostatistics

University of Puerto Rico - Medical Sciences Campus

Graduate School of Public Health

22 vistas