Safe Communities Presentation at the 7th National Meeting of Resilent
INFARMED meeting Lisbon 9th February 2021
In the lead up to the renewal of the State of Emergency government are once again gathering to hear from experts and political parties at Infarmed, in Lisbon, to hear the experts take stock of the situation and give advice over the next few days:
EPIDEMIOLOGICAL SITUATION IN THE COUNTRY
André Peralta Santos | Directorate-General for Health
EVOLUTION OF INCIDENCE AND TRANSMISSIBILITY
Baltazar Nunes | National Institute of Health Dr. Ricardo Jorge
UPDATE OF THE SURVEILLANCE OF GENETIC VARIANTES OF THE NEW CORONAVIRUS IN PORTUGAL
João Paulo Gomes | National Institute of Health Dr. Ricardo Jorge
EPIDEMIOLOGICAL EVOLUTION AND ACTION CRITERIA
Manuel do Carmo Gomes | Faculty of Sciences, University of Lisbon
EFFECT OF VACCINATION ON INTERNAL AND MORTALITY
Henrique de Barros | Institute of Public Health of the University of Porto (Videoconference)
SOCIAL PERCEPTIONS ABOUT COVID-19 AND MORTALITY IN A HOSPITAL CONTEXT
Carla Nunes | National School of Public Health, Universidade Nova de Lisboa
POINT OF VIEW OF THE VACCINATION PLAN AGAINST
Henrique Gouveia e Melo | Task Force Coordinator for the Vaccination Plan against COVID-19 in Portugal
Minister of Health opens the session, explaining that experts are in the room, but politicians are following online – for the first time. Therefore, the usual reactions of parties and MPs will have to be postponed.
André Peralta Santos, from the Directorate-General for Health, begins by saying that the country started a downward path, peaking on January 29 – with 1669 cases per 100 thousand inhabitants. The weekly change is minus 29%. The downward trend was accentuated.
DGS: containment works, also against new variant. Situation has improved, but is still alert
Most municipalities remain at high risk of transmission.
In early January, the epidemic was booming. At this time only in Madeira there is no decrease in transmission – but with a much lower incidence of departure.
In the North, the January period was very similar to November and December – the same pattern also for hospitalizations in terms of hospitalizations and ICU. Already in Lisbon and Tagus Valley, had “growing quite fast in a short period”, with acceleration to 30 January. But in the last week there has already been a general decrease (even at higher levels). As for hospitalizations and mortality, the phenomenon is the same.
The age groups above 60 years are the ones that cause the greatest concern for hospitalizations – with very high incidences above 80 years, yet with no decrease between 60 and 80.
The total hospitalizations already have peak training indication, but still no clearly defined trend.
In terms of mortality, “what we see is a very significant increase during January – almost three times compared to December, but already with a clear formation of a peak in the first week of February”.
As for the new variant, this is the state of play: a progression of cases, with a greater focus on the Lisbon and Tagus Valley regions, with a focus on the Alentejo Litoral and Coimbra region. The North is less prevalent.
Here, then, are the conclusions: the incidence remains “extremely high”, although decreasing. “This level of confinement seems sufficient to stop the spread, including the new variant.”
The estimated value for the average of the last five days analysed, between January 30 and February 3, is 0.82 for Rt (average number of people who each infected). “It is a low value, which clearly indicates a reduction in incidence,” says Baltazar Nunes, responsible for the Epidemiological Research Unit of the National Institute of Health Dr. Ricardo Jorge (INSA).
The value is below 1 in all regions of the Mainland and in the Azores. Only in Madeira it is at 1.13, “which indicates a phase of growth”, says the expert.
Contrary to what happened in the first weeks of January, Portugal is now one of the countries with the most marked reduction in mobility in the European Union, “in the order of 66%”, says Baltazar Nunes, an INSA epidemiologist.
It takes two months to contain less than 200 patients in intensive care
The models indicate that it is necessary to maintain the confinement measures equivalent to March and April, with schools closed, for two months, in order to achieve lower levels of incidence and hospitalizations in intensive care.
“We need to maintain these measures for a period of two months to bring the number of beds in intensive care below 200 and the incidence to 14 days below 60 cases per 100 thousand inhabitants”, said Baltazar Nunes, from INSA
João Paulo Gomes, from the National Institute of Health Dr. Ricardo Jorge, says that between December 1 and February 7, around 120 thousand circulated in the country with a pattern of mutations associated with the United Kingdom variant.
If in the last meeting of Infarmed the projections indicated that about 65% of the cases of covid-19 registered next Sunday would be caused by the British variant, the expectation is now more positive. “We totally deviated from the curve projected at the time. We stopped having an exponential growth, the curve started to have an S curve and this is great news”, points out the expert.
Variants of the new coronavirus from the United Kingdom, South Africa and Brazil have “a common mutation” that results in increased transmissibility. However, the Brazil and South Africa variants have an “additional mutation” in relation to the British one, which brings “increased concerns”, stresses João Paulo Gomes.
“It is also associated with a greater escape from our immune system,” he warns.
João Paulo Gomes, from the National Institute of Health Dr. Ricardo Jorge, says that the English, Brazilian and South African variants have “a common mutation”, which makes them much more transmissible.
In Portugal, since the beginning of December, more than 200 thousand tests have been carried out, about 40 thousand positive. Of these, 9 thousand were of the British variant. The expert estimates that, between December 1 and February 7, there were “more than 120 thousand” cases of this variant in Portugal.
However, he said there was “great news” : although it was predicted that, from January to February, the number of cases of this strain would rise from 8% to 65%, these are only about 16% of the total cases . In other words, “we have completely deviated” from these projections, moving from the possibility of “exponential growth” to a “plateau” situation.
Still, João Paulo Gomes expressed some concern about the new California variant , which he says may be more resistant to antibodies and seems to represent, for now, 6.8% of cases in Portugal. “We will be attentive”, guaranteed.
Manuel Carmo Gomes, from the University of Lisbon, now takes the floor.
Confirming what was disclosed by Baltazar Nunes, he concluded that the risk of infection, in January, rose in the 20-30 age groups and over 80.
Between 7 and 15 January, the speed of the increase in cases stabilized, the result of the first measures in January. As of January 22 (general confinement), the decline is evident, says the expert.
Henrique de Barros, from the Public Health Institute of the University of Porto, said that if it is assumed that “” 70% of the Portuguese population will be vaccinated by the end of September “, we can expect to leave the current situation” at the end of Summer”.
In a scenario in which vaccination is 90% effective and takes place at the rate initially foreseen – an optimistic hypothesis, admitted Henrique de Barros -, “we saved 3500 lives until the end of September”.
In the last two weeks the change in the behavior of the Portuguese after a relaxation in the period of Christmas and New Year is noticeable, points out Carla Nunes, from the National School of Public Health of the Universidade Nova de Lisboa.
“Regarding behaviors, in the general sense there was a positive recovery after the parties”, says the expert.
If on December 11, about 35% of people admitted leaving home all or almost every day, on February 5, only 15% of respondents said leaving home.
Asked whether they kept two meters at a distance from other people when they left the house, 20% ticked ‘Sometimes / Never’ on 8 January, while only 13% chose this option on 5 February.
Regarding the question: “In the past two weeks, have you been in a group of ten or more people who do not live with you?”, 20% of respondents answered affirmatively on December 25, while only 5% admitted yes on February 5.
If on November 13, 20% of Portuguese said they wanted to get the vaccine against covid-19, currently 75% admit they want to “get the vaccine as soon as it is available” , says Carla Nunes.
Also confiançe in health services has increased in recent months , with half of the Portuguese to ensure trust in the responsiveness of the NHS to covid-19.
Henrique Gouveia e Melo, coordinator of the Task Force for the Vaccination Plan, admits that “we are at a time of strangulation of vaccine availability”. Thus, there is a significant decrease in vaccines (compared to the contracted), expecting that we have 1.98 million doses applied in the first quarter – for the moment, the country has 60 thousand vaccines in reserve, for safety reasons to ensure that they are second doses are applied.
This is the state of play in relation to the priority plan: the elderly and most at risk population is 1.14 million, the state employees are 235 thousand people. But “with these two groups we will not be able to finish the first phase until March 31, we will extend it to April. It is not a problem of administration, nor logistical, it is access to vaccines”, said the military.
Now, the goal is “to finish the first phase in April. And with the vaccines available, we have 22,000 vaccines per day, which still does not require the solutions established within the NHS.”
In the second quarter it will be four times more. “And there will eventually be a need for faster vaccination solutions, despite the fact that the NHS still has the capacity to respond.” Only in the third quarter, with an even higher rate of vaccination, “it is certain that the extension to new processes of rapid vaccination posts will be one of the solutions. If the vaccines reach the expected rate, if we can do it in time – I think capacity for this – we should reach 70% of the population in late August, early September “, admitted the task force coordinator .
Ending with a commitment: “We must finish the entire population later this year, in December.
The current level of confinement is having an effect – including the number of hospitalizations, at a later stage, intensive care and deaths. Effects also on the control of new variants: “circulation estimates were 60% at the moment, but we managed to reduce their prevalence”;
For the Minister of Health, “it is quite clear that the greater the intensity of the confinement, the faster the reduction of the risk of transmission”. The effects of the measures, he acknowledges, “were different after the first measures of the January 21 aggravation”;
“Although these measures are producing results, it is quite evident that the current confinement has to be prolonged for a longer time, for now, but probably for a period of 60 days from the beginning . Having been mentioned that this will be what will allow us to CI below 200 beds and incidence below 60 cases per 100 thousand inhabitants. The incidence level is still extremely high ”, admitted Marta Temido.
The minister noted a “high intention of the population to be vaccinated, an important indicator for the country’s recovery, but that must be read with the shortage of vaccines that we are facing”. At this moment, noted the minister, Portugal has contracts signed to receive 4 million in the first quarter, but “we are only sure of the delivery of 1.9 million vaccines”.
Marta Temido now advocates extending and multiplying massive testing. “Testing and screening are essential,” he says, including the use of “rapid antigen tests” here. In this sense, the minister says that she will “insist on the DGS” to redefine the “technical criterion for extending testing”, in the sense of “testing contacts, regardless of their degree of risk”. “The Ministry of Health has already asked DGS for this, to assess this possibility, which we consider to be a good opportunity. If someone has been in contact with a positive case, let them always benefit from a test. We don’t have a testing problem today, there is a strengthening of public and private testing capacity. ”
Meeting finished 1230 hrs
Safe Communities Presentation at the 7th National Meeting of Resilent
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