The President of the Republic, Marcelo Rebelo de Sousa, and the Prime Minister, António Costa, meet this Monday with experts. On the table in this meeting of Infarmed will be the evolution of the epidemiological situation of Covid-19 in Portugal.
André Peralta Santos, Directorate-General for Health,is speaking about the evolution of incidence and transmissibility.
Baltazar Nunes, from the National Health Institute Dr. Ricardo Jorge (INSA), will update the surveillance of genetic variants of the new coronavirus in Portugal.
The meeting will also include interventions by João Paulo Gomes, from INSA; João Gouveia, from the Coordination of Response in Intensive Care Medicine; Carla Nunes, from the National School of Public Health, Universidade Nova de Lisboa; Henrique de Barros, Institute of Public Health at the University of Porto; and Lieutenant Colonel Gouveia e Melo, coordinator of the “task force” for the Vaccination Plan against Covid-19 in Portugal.
André Peralta Santos, from the Directorate-General for Health, outlines the epidemiological situation in the country, highlighting a consolidation of the “very significant descent” trend in contagions.
A total of 104 counties are no longer at an extremely high risk level, with 15 counties now in that situation. The regions of Lisbon and Tagus Valley, Alentejo and Centro are the most worrying.
According to the data reported last Saturday, there are 322 new cases per 100 thousand inhabitants, which corresponds to a “relief from the situation”.
The downward trend is also maintained in all age groups, with the group of people over the age of 80 being the one with the highest incidence.
The estimate for the contagion rate is now 0.67, “the lowest since the beginning of the epidemic”. The value is below 1 across the continent and autonomous regions (ie, on average each infected person infects less than one person). That decline began in mid-January and is stabilizing, experts say.
With the first confinement measures there was a reduction in contagion, but with a different intensity depending on the regions, explains the expert. Then, with the closure of schools, the effect was “more homogeneous”.
As for the incidence by age, at the end of January it was higher among young adults and up to 50 years old and also in the elderly over 80 years old. In the period from 1 to 14 February, there is a “sharp and very clear reduction” in all ages, but the sharpest decline was even between 15 and 45 years old – and, again, in the population over 80 years old . That is, in the groups where there was more contagion there was a greater decrease.
The model identifies that there were more 8905 deaths attributable to covid-19, with an excess of more than 2000 deaths due to extreme temperatures. About 64% of the excess of deaths will be due to covid, 19% extreme temperatures and for 7% no factor or explanation is found.
The analysis now focuses on comparing the incidence rate between Portugal and Europe – Portugal now has the lowest R (t) value in Europe. “If we continue, it is possible to continue to descend at a marked speed.”
As for population mobility, on February 2 Portugal was the country with the largest reduction (-66%) in relation to the pre-pandemic period; currently it continues to be so, although with some increase in mobility (-62%), as in other countries. Confinement reached its “peak” in early February, but has been reduced.
Experts project that the rate of decrease is consistent and that at the end of March we will be below 60 cases per 100,000 inhabitants, which is consistent with the scenarios designed at the beginning of the confinement.
The occupancy of beds in intensive care is also falling, but it is high and only in the second half of March it will drop from 300. Only then, at the end of March, should it reach less than 200 (last year, the peak was 270 ). “Important” note: “None of this is acquired, none of this is certain. It will depend on the measures implemented and the behavior of the Portuguese population”.
The United Kingdom variant, detected in 87 countries, will dominate the prevalence where to enter, but Portugal is already at a level of stability, said the expert. The descent of this variant resulted from a “strict confinement”.
Between December 1 and February 21, there were 150,000 cases of the British variant, according to the national projection presented.
“When we suspect, this variant will not disappear”, warns the expert, predicting a new exponential growth of this variant. “It is more than natural”.
Only vaccination and group immunity can stop this advance.
The recipe for the “new normal” in intensive care, still “very fragile
Now João Gouveia speaks to talk about the answer in Intensive Care Medicine.
It starts by giving some data, the most important for the “new normal”: less than 242 hospitalized in intensive care beds with covid, 285 available beds and more than 600 for other patients. This is the point that specialists want to reach and João Gouveia now proposes to draw the “roadmap” to get there, criticizing the chronic shortage of financing in intensive care in Portugal.
In the last few months, he explains, we had two vacancies and a very high peak. The answer was possible with “a lot of effort” from the professionals, but also occupying spaces that should not be occupied with intensive medicine and even the construction of new spaces.
This capacity cannot, “unfortunately”, be maintained: it would take another 448 doctors and 1273 nurses, in terms of human resources alone, to maintain the response. In terms of number of beds, 914 is needed, a number “practically reached” at the end of the quarter.
To reach the desired number, it is necessary to control contagion, a transmission rate lower than 0.7, test more than high-risk contacts, have inquiries carried out in time and, above all, that vaccination runs “at an excellent rate”.
The “tidying up of the home” of intensive care can then happen if 1) it is possible to end forms of respiratory support and treatment outside of intensive care (they have been treated in structures that are not entirely adequate); that the occupancy rate in intensive care by covid is less than 80%; hospitals will need to have recovery plans, with a human resources plan to learn how and when to reopen their beds. If hospitalizations go up and the R (t) exceeds 1, this phase should be suspended.
This “return” of normal intensive care must be agreed upon, subject to a weekly assessment, maintaining critical covid beds per referral axis. “The situation of intensive care medicine in Portugal is still very fragile”, because it still depends on human resources that are not specifically in this area. Therefore, it will be necessary to complete the works in progress and “mainly” hire human resources, especially nurses, and launch the necessary competitions.
When will it be possible to get there, to the “new normal of intensive care medicine” (to the 245 patients in the ICU)? At the end of the third week of March. But only if all the assumptions are fulfilled.
The plan “is going well” in view of the availability of vaccines on the market and the reduction in deliveries during the 1st quarter, summarizes the person in charge of the task force for the vaccination plan.
In all and for the 1st quarter, the estimate is to receive 2.58 million doses, when in the initial forecasts the value pointed to more than 4 million. In the 2nd quarter, the value will already be much higher – 7.3 million doses – and even higher thereafter, to a maximum of 8.4 million. In the last three months, the forecast points to the arrival of another 5 million.
In the 2nd quarter, if the updated schedule of scheduled deliveries is confirmed, Portugal should vaccinate an average of 100 thousand people per day.
The perception of the risk of becoming infected dropped considerably, which was always high. It went from 73.5% (among those who believe the level is low / risk free) on January 22 to 56% now. A danger: a possible relaxation in behavior because of this.
Higher levels of health responsiveness are always associated with a lower level of perceived risk.
In terms of global health status, women are worse, in the case of mental health it is more severe in young people. Men and young people have less appropriate behaviors.
Then, in December and January, there was a drop in confidence levels in the Government’s response capacity and measures, which meanwhile recovered ground (more frequent when there is less schooling).
In relation to vaccines, “very high” confidence values and the intention to take it as soon as possible are maintained.