Archive for April, 2021

Infarmed Meeting – State of Emergency 13th April 2021

Tuesday, April 13th, 2021

The Minister of Health starts the meeting with experts. Marta Temido explains that today there are seven presentations.

They are: “epidemiological situation in the country. André Peralta Santos, Directorate-General for Health

Evolution of incidence and transmissibility, Baltazar Nunes, from the National Health Institute Dr. Ricardo Jorge

Update on the surveillance of genetic variants of the new coronavirus in Portugal, João Paulo Gomes, from the National Health Institute Dr. Ricardo Jorge

Local risk indicators ,, Óscar Felgueiras, from the North Regional Health Administration and Faculty of Sciences, University of Porto

EVOLUTION of critical areas in space and time, Carla Nunes | National School of Public Health, Universidade Nova de Lisboa

Schools as surveillance structures, Henrique de Barros | Institute of Public Health of the University of Porto

State of play on the vaccination plan, Henrique Gouveia e Melo | Coordinator of the Task Force for the Vaccination Plan against COVID-19 in Portugal

10.05 hrs

The first to speak, as usual, is the DGS specialist, André Peralta Santos.

André Peralta Santos, from DGS, said that Portugal currently has a “moderate incidence” of the virus, “close to 71 cases per 100 thousand inhabitants and with a slightly increasing trend”.

There are “some municipalities” with an incidence of more than 120 cases per 100 thousand inhabitants, the majority in Alentejo and Algarve. In the last week, there was also “some growth” in the areas of Greater Porto and Trás-os-Montes.

There is a “very noticeable” reduction in incidence across all age groups. There was an increase in the age group from zero to 9 years old. The decrease is greatest in the group over 80 years of age.

There are 22 municipalities with more than 120 cases per 100 thousand inhabitants, with a total of 636 thousand people, representing 6.5% of the population.

Hospitalizations maintain the downward trend, both in the ward and in the ICU, although the rate of descent has slowed. In mortality, the same phenomenon occurs.

There is an increase in testing in the active population,” said Peralta Santos.

As for testing, there was general “intensification” and, above all, the municipalities with the highest incidence are testing more. The rate of positivity has decreased and, although some municipalities are above the 4% defined as a red line by experts, most of the country remains below that threshold.

According to Peralta Santos, there is a general increase in testing in the active population , “less expressive” in the younger population. And there is an “improvement” in laboratory reporting, with a 6% delay now.

The DGS official also mentions the “good news” that Portugal is below the mortality threshold established by ECDC

10.24 hrs

Baltazar Nunes, from the National Institute of Health Dr. Ricardo Jorge, first points out the “systematic growth” of the transmissibility index, the R (t), since the beginning of February. “We have gone through a phase of growth in the number of cases per day”. Currently, the R (t) is 1.04, nationally. The whole country has R (t) above 1, except Lisbon and the Tagus Valley.

There is a reversal of the trend and new cases per day are increasing”

Baltazar Nunes, from the National Institute of Health Dr. Ricardo Jorge, first points out the “systematic growth” of the transmissibility index, the R (t), since the beginning of February. “There is an inversion of the trend, moving now to a growth of new cases per day”. Currently, the R (t) is 1.04, nationally – the whole country has R (t) above 1, except Lisbon and the Tagus Valley.

On April 8, to which the most recent data report, the R was at 1.09 (at the last meeting at Infarmed, it was at 0.89). “The time it takes for the number and cases to double is 35 days,” said Baltazar Nunes.

As for the rate of incidence of the disease per 100 thousand inhabitants in 14 days, the expert estimates that Portugal reaches 120 thousand cases per 100 thousand inhabitants “between two weeks and one month”.

Two weeks to a month to exceed threshold

As for the rate of incidence of the disease per 100 thousand inhabitants in 14 days, the expert estimates that Portugal reaches 120 thousand cases per 100 thousand inhabitants (threshold of the risk matrix) “between two weeks and one month”.

With regard to the incidence by age, Baltazar Nunes indicates that there is a “very significant increase in the trend in the age groups below 9 years old , mainly close to 5, 6 years old” – an increase that explains the opening of the first cycle of schools . Although with lower values ​​than in the younger age groups, there is also an increase in the incidence in the groups of 10 to 19 years of age and 25 and 50. But, on the other hand, the reduction of the incidence in people over 65 years old is a “very positive” sign.

Vaccines prevented 78 to 140 deaths

Stressing the importance of vaccination in reducing the number of cases in people over 80, the specialist at the Dr. Ricardo Jorge Institute points out that vaccines have prevented, so far, 78 to 140 deaths by covid-19 in Portugal. “There is a significant effect of vaccination coverage on the population aged 80 and over.”

Compared to the rest of Europe, “Portugal has a much lower incidence level” , even though the R is increasing. The country today has fewer restrictive measures than many other European countries and there has been ” an increase in the number of contacts , mainly in the age groups under 69″, although it is less than what happened at Christmas time.

The increase in Rt and mobility in the country, which is advancing in the process of deflation, obliges to compensate with other health security rules.

Baltazar Nunes listed the main ones, such as increasing testing , isolating cases and tracking contacts , reducing the number of contacts outside the family bubble , and reinforcing measures in places such as school and work.

Last but not least, increase vaccine coverage, especially over the age of 65 .

 

10.41hrs

United Kingdom variant accounted for 83% of cases in March

João Paulo Gomes, from INSA, said that there was a “significant reduction” of the original variant in Portuguese territory, which appeared in Spain, and that it has been progressively replaced by the United Kingdom variant. In March, this represented 83% of cases of covid-19 in Portugal. In the North it is “clearly less represented”, at 71%; in the Algarve and Madeira, it reaches 94%.

South Africa variant with “very significant growth”

The Manaus (Brazil) variant represents 0.4% of cases in Portugal. South Africa, on the other hand, showed “very significant growth”, rising from 0.1% in February to 2.5% in March.

There are now 29 cases of the Brazilian variant, a number in line with what is recorded at European level. João Paulo Gomes recalled that these values ​​are “residual”, confessing himself surprised due to the proximity between Portugal and Brazil.

The South African variant currently represents 53 cases in the country. The expert stressed the importance of border control “to try to understand if there is a lack of control” of the spread of this variant, which he said was being introduced, mainly, from Mozambique.

João Paulo Gomes recalled that there are signs that this variant may be more resistant to vaccines, but clarified that the situation is not a cause for alarm.

The Brazilian variant is “very controlled”, said João Paulo Gomes. The South African variant, on the other hand, deserves “some concern” and requires attention to border control.

 

10.57 hrs

Óscar Felgueiras, from the Regional Health Administration of the North and Faculty of Sciences of the University of Porto, talks about local risk indicators. He proposes to combine two indicators – the neighbouring incidence and the municipal incidence – in order to obtain the adjusted incidence indicator The objective is to correct the low specificity of the neighbouring incidence.

The specialist points out problems in taking into account the incidence by municipalities as a “single indicator”. One of them is the fact that small counties where the number of cases is not very high have a very high incidence, as in Vimioso. The municipality has an incidence of 249 cases for a population of 4 thousand inhabitants, but, taking into account the four neighbouring municipalities, there are 36 cases in the region for 67 thousand inhabitants. If the region is considered in its entirety, the incidence would be 53, far below that recorded in Vimioso. “We can think about defining an incidence indicator next to the municipality in question”, but in this case there is the disadvantage of “mitigating the risk” in some places.

Thus, the specialist proposes to combine two indicators – the neighbouring incidence and the municipal incidence. Thus, the adjusted incidence indicator is obtained , whose objective is to correct the weaknesses of the previous ones, reflecting the risk of proximity and mobility expected between municipalities and promising to be a tool to implement health measures at the local level.

 

11.19 hrs

“There is no clear relationship” between incidence and population density

Carla Nunes, from the Escola Superior de Saúde Pública at Universidade Nova de Lisboa, said that, between February and the beginning of April, the areas of greatest risk in the country were “the whole coast” and also the South of the country.

With regard to the spread of the virus, there has been a greater concentration of cases. “There is no clear relationship” between incidence and population density, said the expert.

As for the Portuguese’s perception of the disease, Carla Nunes revealed that there has been a “change in behavior” in the last two weeks. On 2 April, 7.5% of respondents in a study coordinated by the specialist stated that they had been in groups of 10 or more people , against 4.9% on 19 March.

Of the respondents, 87.7% said they considered vaccination to be safe or very safe, against 8.4% who considered it to be little or not at all safe. 87.5% believe that vaccines are effective or very effective, against 14.6% who think they are not.

One in four people say they feel agitated or sad due to the rules of social detachment. One in two rated their health status as very poor and reasonable.

There are still 22.4% of respondents with little or no confidence in health care related to covid-19, a figure that rises to 51.7% with respect to other diseases. In this parameter, there were no major changes compared to the previous period, the same occurring in relation to the assessment of Government measures : currently, 31.7% of respondents say that they are little or not adequate.

Greater difficulties were also reported in complying with measures , namely the use of a mask (increase from 7.5% to 14.5%), teleworking (from 34.7% to 42.4%), the duty to stay at home (from 27.5% to 33.3%) and precautions regarding visits to friends or family (from 34.4% to 41.5%).

11.36 hrs

Schools show safety

Henrique Barros, from the Public Health Institute of the University of Porto (ISPUP), reinforces that “the rate of infection reduction has changed”, with the incidence now increasing in most age groups, with the exception of older ages, where vaccination has an effect. “The vaccine encirclement that is coming from the oldest to the youngest, makes these ages more susceptible to the circulation of the virus”, says the expert.

Stressing the increase in incidence among children, the specialist spoke of schools as “surveillance structures” and presented data on specific school groups. Henrique Barros concludes that, “contrary to what is seen in employees, who are adults, in proportion of infection marker is much lower ”. That is, although there is an increase in cases at these ages, this is very small, summarizes the expert. In addition, there is an “enormous variability” in the infection rate depending on the classes, which places the risk outside the school and not on the school grounds.

11.52 hrs

Henrique Gouveia e Melo, coordinator of the task force for vaccination against covid-19, confirms the forecast of receiving 1.9 million vaccines in April and a total of 11 million over the second quarter.

Until last Sunday, Portugal received 2.6 million vaccines and administered about 2.1 million doses: first doses were 1.5 million people, that is, more than 15% of the population has one dose taken, and 6% took two doses.

With the priority groups for phase 1 of the vaccination plan with high rates of vaccination coverage (values ​​between 80% and 99%), the process has now moved on to phase 2, which includes people over 65 who were not been vaccinated before. And so far 400,000 people in this group have been vaccinated, equivalent to 27% of this group, announced Henrique Gouveia e Melo.

The main criterion for this phase is that of age, that is, advancing from the oldest to the youngest.

Portugal will vaccinate the entire population over 60 “between the last week of May and the first week of June, which gives us some hope”. The 70% vaccinated with the first dose – which implies vaccination for all over 30 years of age – “between July and August”. In terms of serious illness, hospitalizations and deaths, this advance will provide “quite high protection”.

In update from live news

 

COVID-19 GOVERNMENT TO INCREASE INSPECTIONS BY GNR, PSP AND ACT IN MUNICIPALITIES WITH HIGHEST INCIDENCE

Tuesday, April 6th, 2021

Lisbon, April 6, 2021 (Lusa) – The prime minister announced today that the inspection by security forces in the municipalities with the highest incidence of cases of covid-19 will be reinforced and inspections of the health conditions of temporary housing intensified.

These measures were announced by António Costa after having met by videoconference with the mayors of the seven municipalities that register more than 240 cases of covid-19 per one hundred thousand inhabitants in the last 15 days: Alandroal, Carregal do Sal, Moura, Odemira, Portimão, Ribeira de Pena and Rio Maior.

According to the prime minister, in relation to the covid-19 outbreaks that occur in these municipalities, there is the existence of “a common pattern”.

In most cases, the origin of the outbreaks lies in “the concentration of people, in precarious and temporary housing associated or in large public works, or even working in industrial units that use local housing”.

“We will articulate specific actions by the Authority for Working Conditions (ACT), together with the public health authorities, with a view to creating better sanitary conditions in these places of residence and, also, to develop massive testing actions in cases in which they are not in progress. It is necessary to detect infected people and break the transmission chains “, declared António Costa.

In the specific case of agriculture, the Prime Minister said that, in partnership with producer organizations, there will be preventive work, with the dissemination of “good practices and testing”, taking into account the harvest calendar, which is now starting and that will continue until the harvest period.

The Minister of Internal Administration, Eduardo Cabrita, “stated that, in the next 15 days, there will be a reinforcement of the number of GNR or PSP in the 20 municipalities with more than 120 cases of covid-19 per hundred thousand inhabitants in the last 15 days. “Inspection actions will be reinforced”, stressed António Costa.

At the press conference, the Prime Minister left an appeal to employers to organize “the best possible way” working conditions, with testing of their workers and monitoring the health situation of each one.

“But I also appeal to workers to be extremely careful in the use of personal protective equipment. It is essential that when stopping, namely at meal times, distance safety rules are respected to avoid increased contamination risks”, he added.

 

PRIME MINISTERS ADDRESS TO THE NATION CONCERNING EASING OF MEASURES

Thursday, April 1st, 2021

EASING OF MEASURES CONTINUES, BUT GOVERNMENT KEEPS 19 MUNICIPALITIES UNDER SURVEILLANCE

BORDER WITH SPAIN TO REMAIN CLOSED

TRAVEL BAN BETWEEN MUNICIPALITIES TO BE LIFTED AFTER 5TH APRIL

António Costa confirmed the next phase of the de-confinement, recalling that the transmission rate had a favourable evolution, having decreased from 118 cases per 100 thousand inhabitants (on 9th March) to 62.4 cases per 100 thousand inhabitants on 31st March. Taking into account the incidence levels of R(t), the country is still in the green zone.

Although the prime-minister stated that the de-confinement plan will progress – due to the fact that Portugal is still in the “green zone” – but António Costa gives a warning to the municipalities. If any municipality registers, in two consecutive evaluations, an incidence rate higher than 1 and an average of new cases per 100,000 inhabitants higher than 120, it will not advance in the next phase of confinement.

At the moment, there are 19 municipalities at risk, the prime minister said.

Municipalities at risk

Between 120 and 240 cases:

Alandroal, Albufeira. Beja, Borba, Cinfães, Figueira da Foz, Figueiró dos Vinhos, Lagoa, Marinha Grande, Penela, Soure, Vila do Bispo, Vimioso

More than 240 cases: Carregal do Sal, Moura, Odemira, Portimão, Ribeira de Pena andRio Maior

Asked about possible measures in the 19 municipalities that are currently outside the green zone of the de-confining traffic light, i.e. have more than 120 cases per 100,000 inhabitants, António Costa said that it is necessary to have “measures with stability” and that, therefore, the evaluation will always be made every 15 days. “No interim measures will be taken,” he mentioned.

The programme presented on 11 March foresees, from Monday

From 5 April

– 2nd and 3rd cycle of basic education (and ATLs for the same ages)

– social facilities in the area of ​​disability

– museums, monuments, palaces, art galleries and the like

– stores up to 200 m2 with door to the street

– fairs and non-food markets (municipal decision)

– terraces only (max 4 people per table)

– outdoor physical activity for up to 4 people and gyms without group classes

 

The Prime Minister calls on the Portuguese to take special care during the Easter festive season. While speaking, António Costa shows the images of a group of people at the table, illustrating the circulation of particles in this context. “I renew the appeal that we all make the effort to avoid an unhappy Easter”.

The Prime Minister again thanked the Portuguese “for the way they have collectively managed to control this pandemic”. “In this third wave we managed to bring with great sacrifice, determination and persistence, from days when we were the worst in the world to the situation in which we find ourselves today, in which in Europe only Iceland is better than Portugal”.

It was also announced that the level of border control in place will be maintained, “There is a de facto agreement with the kingdom of Spain for us to keep the land borders closed so as to prevent an increase in the pandemic and to keep a properly controlled situation. Borders will remain closed with the exceptions that have been announced.”

Possible changes will be introduced in relation to countries that had the third wave earlier and facilitate movement between countries. Among the novelties is also the possible resumption of flights between Portugal and Brazil, subject to mandatory testing and quarantine.

António Costa clarified that the measure banning travel between municipalities will no longer be in force after next Monday, 5 April. “In the next fortnight there is no provision for a ban on movement between municipalities, either during the week or at the weekend,” the Prime Minister said.

In response to journalists, António Costa reiterated that events such as Formula 1, Moto GP and football matches will continue without audiences, as they represent “an increased risk”. “We will continue to avoid it,” he stressed.

Source: PÚBLICO.

 

 

 

 

 

VICE-ADMIRAL GOUVEIA E MELO, CORDINATOR OF THE VACCINATION PLAN AGAINST COVID-INTERVIEW WITH RADIO RENASCENÇA AND PÚBLICO

Thursday, April 1st, 2021

In an interview in which he address a wide range of topics concerning the vaccination program he stated the following;

It is necessary to end vaccination by groups of diseases and move towards vaccination by age – that is what Vice-Admiral Gouveia e Melo, coordinator of the vaccination plan against Covid-19, asks, in an interview with Renascença and Público, that “it doesn’t make sense for most of the population to wait for all the groups to get vaccinated.

In the program Hora da Verdade, by Rádio Renascença and PÚBLICO, Gouveia e Melo revealed that the first test of this new methodology should advance in the third week of April. As for the vaccination of teachers and school staff, he says it is serving to “test the vaccination process” en masse and believes that it will not affect the immunization of other priority groups, because most of the 280 thousand will be vaccinated by the end of -week of 10 and 11 of April, when almost 100 percent of the elderly from the age of 80 and the most at risk patients will have already taken the first dose.

The vice-admiral defends the use of the age criterion, arguing that, by continuing to vaccinate by “small groups”, we will accumulate doses in the warehouse that could be protecting people.

The first phase should have ended by the end of March. When will all elderly people over 80 and people with higher risk diseases be vaccinated?
According to our estimates, after the second week of April. We are making a very big effort so that, by April 11, practically 100 percent of the elderly and people with phase 1 comorbidities are all vaccinated. Of course, 100% is never guaranteed because there are always bags of people left behind, because they were unable to contact each other.

How are these grants going to resolve?
We have a finer process with the help of municipalities, health centers, trying to reach these elderly people who are either isolated or bedridden, or who are info-excluded.

Ministers of Education and Higher Education have always insisted that schools are safe places. Despite this, 280,000 teachers and staff were placed in front of thousands of first-stage patients, such as cardiac and severe kidney and lung patients. The experts of the technical vaccination commission of the Directorate-General for Health (DGS) contest this decision. How is the inclusion of this new group in the first phase justified?
I find it strange that experts challenge this priority, because the priority comes from DGS. We carry out a plan according to priorities defined by the DGS. We need to gain the resilience of the State so that it is possible to respond during the pandemic, but, on the other hand, while vaccines are scarce, we have to concentrate as much as possible on the most vulnerable and elderly population. We defined a simple rule: 90% of the vaccines available went to accelerate this process of saving lives and 10% to gain the resilience of the State. [In addition], the large tranche of teachers and non-teachers, 200 thousand, is vaccinated on the weekend of [10 and] 11 April, when phase 1 is practically closed, because we have reached 100% of the other groups. We are preparing for a massive vaccination phase and we have to test massive systems.

Are teachers being used for this test, therefore?
Teachers also serve to test the entire [mass vaccination] system.

What about resilience outside the state?
It will be won with vaccination by age groups. What is at stake for the second phase? At this moment, we are discussing with the DGS whether or not we should continue to [prioritize] large groups, for example diabetics, hypertensive patients, which could be three million people. By vaccinating by age, we are also vaccinating for illnesses, which are closely related to age. Most diseases are associated with age. Diseases that are not associated with age should be prioritized. We are fighting with a strategy with two things at the same time, also [we want] to go and find less elderly people who would have to wait a long time, but who have diseases that can be very critical.

Like transplant recipients, for example?
It seems to us that it is more fair. The sickest people are the oldest people. The exception should be for other small groups that have rare or very specific diseases and that, according to age, would have to wait months.

When will the decision be made to use the age criterion?

It is being taken at the moment, these are decisions that require some reflection. Plans have to change. We were expecting a lot more vaccines. There is a phase when there are very few vaccines and suddenly there is a tidal wave of vaccines.

Are you confident that what calls the tidal wave of vaccines will arrive even in April?
If there is no tsunami, the plan must be readjusted again. In the first quarter, 2 million vaccines arrived and 4.4 million were expected. [In the second] 9 million will arrive and we cannot be making a filigree-like progress, we have to move forward with another one, in which the speed, the pace of vaccination is the most important. I must not create difficulties at this rate because [if I do] I will be accumulating vaccines. This is what is unacceptable. The process is complex and, if I have to look for so many disease codes and this and that, I can’t vaccinate 100,000 to 120,000 people every day.

Does group vaccination hinder the speed of the operation?
Of course, because the organization is very complex and full of rules that hinder all the logistics and the efficiency of the process. And the difference between people being vaccinated using group criteria or being vaccinated by age criteria is a matter of days. Now, it is not a matter of days if you try to do the opposite. It does not make sense to keep the majority of the population waiting for these small groups to be vaccinated and to accumulate vaccines that could be giving protection to people.

I already said that a website will be created for people to self-register. But won’t that make those with the most initiative, probably the youngest , sign up first?
No, because the self-registration will be done by age groups, from x to x time it opens an age group for registration. And the two methods will continue to exist, that of the central system that goes to the database and that is seeing who was not called and the self-scheduling. People will be able to choose the date and location because it makes the process a lot easier. I have 100,000 seats to fill every day, and instead of looking for 100,000 people to fill the seats, I want these people to step up and proactively try to fill them. The first test will be in the third week of April. Let’s start with the age group that is to be filled, I assume it will be in the 70s, then 60s, then 50s, then 40s, until we finish.

But you need staff to vaccinate. Are these accounts done?
We need about 2500 nurses, 400 doctors and 2300 assistants, roughly speaking. In primary health care there are about 9,000 nurses. It is acceptable to use up to 20% of these nurses for vaccination. But primary care has to recover the care activity [which has yet to be done]. So, what we are trying to do is have between 1,000 to 1,500 SNS professionals to frame the answer and then go and get others. Either people who are not employed or who are now leaving nursing schools, who are finishing their training, or nurses working overtime.

Can they then be nursing students?
Not students, but people who are moving from the teaching stage to the professional stage. What is needed is to find solutions inside and outside the NHS.

How do you respond to patient associations that claim to be prioritized?
They are all right, except that the number of vaccines does not allow everyone to be vaccinated. This prioritization hurts a lot of people but the indecision is that it cannot happen.

How many doses are ordered?
We have 35.8 million doses ordered and promised. The Government did not save and bought a different range of vaccines to avoid becoming dependent on one type of vaccine. In the second half of April we will receive 80 thousand doses of the Janssen vaccine.

In Canada and Berlin, it has now been decided to give only the AstraZeneca vaccine under 55 years of age. Aren’t you worried?
There are many episodes about Astrazeneca … if they correspond to an effective health concern or something else, I will not comment on that, I leave it to the imagination and the interpretive capacity of people. There is a European regulator that has scientists and data and a capacity that no single country regulator has and that it says is safe and effective.

Is the risk of not getting the Covid-19 vaccine higher?

I can make a very simple account. There is a thromboembolic event in half a million people, and there is still no certainty that it is related to the AstraZeneca vaccine. In Portugal, more than 16 thousand people have died with Covid, that is, for every 600 Portuguese people, one has died. Not having the vaccine has a risk almost a thousand times higher.

The price of the AstraZeneca vaccine is much lower than that of Pfizer and that of Moderna. Some say there may be a trade war here.
I can’t comment, I leave that to the good judgment of people. The reality is that the vaccine is cheaper, they do without profit, it is what it is.

Are we really going to get to group immunity in August, as I said?
I like the concept of group protection more than group immunity. Group immunity means that the vaccinated person is not a virus transmitter, group protection means that that person is protected. If vaccinations arrive, by the end of the summer we will have more than 70% of the population with one dose, I do not mean the date a, b or c.

When will you be vaccinated?
I should have been vaccinated for my military duties, but I did not need the vaccine because I think that in these functions I have to set an example, I will take a chance and try to give my vaccine to those who need it most. In that position, it does not seem very curiously in ethical terms to be using my military function to vaccinate me.