Infarmed meeting Thursday 16th September 2021
At the end of the metting
At the end of the presentation, Marcelo Rebelo de Sousa took the stage to praise the pandemic vaccination task force, the Ministry of Health and the Portuguese. “Just yesterday at an international meeting where there were 14 European countries, Portugal was by far the one with the highest vaccination rate by far. And I’m talking about the most economically advanced countries in Europe and they correlated this rate with vaccination and the measures taken. It was a race against time that made the difference against”. He then thanked the collaboration between the vice-admiral and the Ministry of Health, which withstood the “wear and tear”. “There was a team and there was leadership.”
Finally, the PR addressed the Portuguese: “And there was a response from the Portuguese, because they were not obliged to be vaccinated. I have known many young people in my family who hesitated to be vaccinated; they and their parents hesitated. Even those who hesitated decided to move forward. This response from the Portuguese is a key to the vaccination process. Nobody forced vaccination in Portugal. The Portuguese realized the importance. It is good to accentuate the tonic accent in those who adhered to the vaccination. This is very impressive and makes a difference compared to other countries where deniers have a greater expression. It is necessary to demonstrate this ultra-minority negative character in Portugal. I don’t know if it causes them tension, but the reality is this: the Portuguese people voted with an expression that there was no other election ”.And voted for vaccination.
A meeting of Infarmed was held on Thursday 16th September 2021.
The meeting, which maintains a semi-attendance format, is attended by the President of the Republic, Marcelo Rebelo de Sousa, the President of the Assembly of the Republic, Ferro Rodrigues, and the Prime Minister, António Costa.
The Minister of Health, Marta Temido, opens the meeting at Infarmed and gives the floor to Dr. Pedro Pinto Leite, head of the Division of Epidemiology and Statistics at DGS, to update the epidemiological situation in Portugal.
Portugal has 195 cases per 100,000 inhabitants, with a decreasing trend
The pandemic had four large waves, four peaks, the largest on January 29, 2021. Currently, the country has an incidence of 195 new cases per 100,000 inhabitants, with a decreasing trend. “We are at the end of a pandemic phase”, says Pedro Pinto Leite, now head of the information services department of the General Directorate of Health (DGS).
Up to 9 years of age, the incidence trend is stable to increasing, and in all other age groups the number of new cases is declining. The positivity is also decreasing, which is a sign that we are having “less virus circulating”, explains the expert.
The number of tests notified by age, on the one hand, shows a decrease in tests performed in young people and young adults, but an increase in testing in adults over 40 years of age, explained by the increase in screenings in schools and in the work context.
Admissions continue to go down
Pedro Pinto Leite, from DGS, says that there was a visible increase in admissions after the appearance of Delta, with a peak in July and August, but the trend has been decreasing. The same trend is seen in admissions to intensive care units, recovering the same pattern that existed in relation to age groups.
There are now 13 deaths per million inhabitants, below the ECDC threshold (20 deaths per million). Portugal now has 85% of the population with at least one dose of vaccine and 80% with full vaccination.
The protection afforded by the vaccine continues to give clear positive signs: for every five cases of covid, four had not been fully vaccinated. And for every 15 cases admitted to intensive care, 14 did not have the complete vaccination schedule. Pedro Pinto Leite, from DGS, reinforces the “importance” of vaccination, making it clear that the risk of death is lower in all age groups after the protection provided by vaccines.
“The vaccination against covid-19 is a success”, he emphasizes. “And a phase of the pandemic ends.”
Rt has never been this low without confinement
As the Director-General of Health had previously mentioned, the DGS is working with three scenarios for the next autumn-winter, a phase that brings “uncertainty” and “some challenges”, including low temperatures and “others virus in circulation”.
Pedro Pinto Leite, from DGS, explained that the three scenarios play with the emergence or not of new variants of concern and with the evolution of immunity, which can have different impacts on incidence, hospitalizations and mortality.
In the first scenario, there is no new variant and immunity lasts an average of three years; in the second scenario, there is also no new variant but immunity has an average duration of one year; and in the third scenario, one works with the possibility of emerging a new variant, with immunity having an average duration of one year.
Each of these scenarios predicts a different type of response. In scenario 1, it is a “transition” response; in scenario 2, “control”; and in scenario 3 of “mitigation”.
“It is essential to maintain epidemiological surveillance and monitoring”, especially in the most vulnerable population groups.
Baltazar Nunes, responsible for the Epidemiological Investigation Unit of the Ricardo Jorge Institute, is now speaking about transmissibility and incidence.
It’s a fact. Portugal currently has an estimated infection transmissibility index of 0.84, the lowest value without having the Portuguese confined. Madeira is the only region in the country a little higher, but with a decreasing trend.
Baltazar Nunes, a mathematician and epidemiologist at the Ricardo Jorge Institute, confirms that the country is “clearly at the end of a pandemic phase.” Transmission of the pandemic virus is now very low and the merit is the high rate of vaccination. The expert explained that two to six weeks after inoculation, the vaccine is highly effective, remaining longer except for protection against infection, and there may be new patients and at least one symptom.
Published studies show that there is a reduction in effectiveness after 12 to 24 weeks against the infection, being more pronounced in older age groups. For now, the vaccine is a shield for 70% of infections and 95% of hospitalizations for covid-19.
There are several scenarios ahead of us, and the current resumption of activity is one of the critical points. On the table are three autumn/winter scenarios and the eventual emergence of new hazard variants and a reduction in vaccine effectiveness after one year are critical. If the vaccine loses properties, it is expected that transmission will increase and that in time it will coincide with the Christmas and New Year festivities. If that happened, January 2022 would once again be a period with mortality above the incarnate lines, immediately due to the circulation of other respiratory viruses.
Baltazar Nunes warned, however, that these are scenarios and not predictions and that we are in a situation of great pandemic control.
The expert spoke of several scenarios. In the first, in which there is no reduction in effectiveness, Portugal will remain below the red lines. However, in scenario 2 and 3, if there is a reduction in effectiveness the country could be above the red lines in the first half of January.
Indicators to be monitored in the autumn-winter phase:
– Incidence, hospitalizations and mortality of the most fragile age groups;
– Seroprevalence of antibodies against influenza and SARS-CoV-2;
– Effectiveness of covid-19 and flu vaccines;
– Ambient temperatures;
– Frequency of other respiratory viruses.
Fátima Ventura, director of the Scientific Evaluation Unit at Infarmed, is speaking about the development of vaccines against covid-19.
“Many vaccines continue to be developed. There are 30 vaccines in phase 3 and eight of them in phase 4, which means that they have already been approved. We also have two new contracts still under discussion”, he pointed out.
The specialist also referred that “vaccines also have their own life cycle” and, being “medicines of biological origin, they must follow the centralized procedure, that is, they must be approved by the European Commission”.
An extension of vaccination for children under 12 has not yet been submitted,” but it is expected that “by the end of the year” a request will be submitted for those over five to be eligible for vaccination, the expert noted.
About the booster dose of the Pfizer vaccine, the forecast is that it will be made six months after the second dose, in people over 12 years old.
The contracts signed with vaccine manufacturers provide for the supply of vaccines adapted to the variants of covid-19, explained the expert.
Vaccines still under evaluation:
– Sputnik V
It is the turn of João Paulo Gomes, a researcher at the Ricardo Jorge Institute, who talks about the variants of the SARS-CoV-2 coronavirus.
“We have sequenced more than 16,000 virus genomes. The Delta variant completely dominated as of mid-May. We have practically 100% prevalence of this variant in all regions of the country.”
No case of the Beta variant was detected from South Africa, and one case of Gama was detected in Lisbon and Vale do Tejo.
Delta is spread all over the world and more than 95% of the viruses belong to this genetic variant”, said João Paulo Gomes.
According to the expert, in countries with a low rate of vaccination, there is less immunity, therefore, there is more virus circulating and, consequently, more risk of mutations that create the new variants.
The Delta variant has a prevalence between 98% and 100% for eight consecutive weeks. The expert also said that an increase in the number of variants is expected, especially in countries with a low rate of vaccination.
Henrique Barros, an epidemiologist at the Institute of Public Health of the University of Porto (ISPUP), is now speaking about tests for covid-19.
“The first big decision we have to make is to make greater surveillance of asymptomatic people, wastewater and surfaces,” explained the expert, advocating greater screening “at the entrance” of different places, activities and events.
We carried out many more tests in 2021 than we did in a similar period in the previous year”, pointed out Henrique Barros, justifying this difference with the fact that this year there was greater mobility of people and more circumstances that caused the infection.
For Henriques Barros, rapid antigen tests are faster, cheaper and have a high specificity.
Carla Nunes, a professor at the National School of Public Health (ENSP), is now speaking about social perceptions about covid-19.
“The youngest since May have stood out from other age groups, with an increasing trend”, in relation to the frequency with which they feel agitated, anxious, down or sad due to the measures of the pandemic.
26% of respondents believe that the measures implemented by the Government to combat covid-19 are little or not adequate.
Between July 2020 and January 2021, 85% of people said they would wear the mask even if it was no longer mandatory.
Among the biggest concerns is the mental health of younger people;
Very high values in relation to expectations about the end of restrictions;
New challenges under analysis regarding vaccination and flu.
Raquel Duarte, a pulmonologist at the Vila Nova de Gaia Hospital Center, speaks now about the proposed measures for this month.
The specialist recommends the promotion of voluntary and free testing and the maintenance of the obligation to present the digital certificate in circumstances of greater risk.
Vice Admiral Henrique Gouveia e Melo, coordinator of the task force on vaccination against covid-19, begins by stating that the country has reached 86% of first doses and 81.5% of complete vaccination.
“We have to continue, the war is not over yet. But at least, in my perception, the first battle is won”, says Gouveia e Melo.
Stressing that the booster of vaccines arrived in the country between June and August, the vice admiral welcomed the adhesion of young people to the vaccination plan even during vacations: almost 600,000 between 12 and 17 years old have already received a dose , while 329 young people are fully protected with two doses.
And he says he expects the country to reach 85% of full vaccination, starting at the end of September or at the latest in early October. “That’s a lot of good news,” he noted.
Gouveia and Melo also emphasize that the vaccines needed to guarantee the vaccination plan and about 1.1 million vaccines in reserve should arrive in the country in the fourth quarter, given the need for an eventual booster dose for the elderly.
Vaccination plan may extend until March 2022 if the third dose is administered to people over 65 years of age.
The President of the Assembly of the Republic, Ferro Rodrigues, began by saying that he was not going to talk about the deniers who insulted him last Saturday at a restaurant in Lisbon. But he left a warning: “There are issues that are of the rule of law and not merely legal”.
Praising the role of the Ministry of Health, the General Directorate of Health and the Vice-Admiral, Ferro said that the “vaccination process is a real success”, but asked experts for explanations why several elderly people continue to die from covid- 19 even with the two doses of the vaccine.
“We are doing very well, with a very good evolution, but we still have many vaccinated elderly people dying after the two vaccines. In order not to feed these denials, it was very good that there was an answer to this”, he appealed.