Meeting at Infarmed

This Monday morning’s Infarmed meeting marks the start of the deflation plan.

In today’s program, politicians hear from experts about the country’s epidemiological situation, but also proposals for how the situation should be managed in the future.

From 10:30, the session begins.

Here is the program:

1 – Epidemiological situation in the country – André Peralta Santos, from DGS

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

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

In the second part, “proposals for the future”:

1 – Response to the pandemic, Path to decision – Henrique de Barros, from the Public Health Institute of the University of Porto

2 – Criteria for a controlled pandemic: Phases 2 and 3 – Baltazar Nunes, from the National Health Institute Dr Ricardo Jorge

3 – Plan to reduce restrictive measures – Óscar Felgueiras, from the Northern Regional Health Administration and Faculty of Sciences of the University of Porto and Raquel Duarte, from the Northern Regional Health Administration and the Public Health Institute of the University of Porto

1047 hrs

The Minister of Health, Marta Temido, opens the session. This is followed by the usual intervention by André Peralta Santos, from DGS.

André Peralta Santos, from DGS, revealed that there is a “maintenance of the downward trend” in the incidence of the virus, now with a national average of 141 cases per 100 thousand inhabitants. Lisbon and some municipalities in Alentejo have slightly higher numbers than in the rest of the country.

There are 354 hospitalized in intensive care units (ICU), a number “similar to the first week of November”, recalled the specialist. The age group with the highest number of cases in the ICU is the one between 60 and 69 years old.

There is also a “downward trend” in deaths; now with 56 dead per million inhabitants and “similar” to the third week of October.

The British variant has been growing: in Lisbon and Vale do Tejo it has a prevalence of 66%, while, in the North and in the Centre, it is “over 50%”.

Hospitalizations fall back to the values ​​of the first week of November, according to DGS

Hospitalizations in the infirmary and intensive care are also decreasing, falling back to the values ​​of the first week of November 2020, according to André Peralta Santos, responsible for the DGS statistics department.

Among hospital admissions in the ward, there are a greater number of people over 80 years old, while in intensive care “the age group with the largest number of cases is from 60 to 69 years old”.

According to Peralta Santos, this aspect is “particularly relevant, as we vaccinate the population over 80 years old”, as this protection has an impact on the decrease in mortality. In order to see these effects in younger age groups, it will be necessary to wait for vaccination “to spread and have great expression in groups over 50 years old”.

Rt levels – Baltazar Nunes, from the National School of Public Health:

Index Rt is 0.74 for the last five days and is below 1 across the continent. In the autonomous regions, it is above one.

The lowest value of this transmissibility index was reached around February 10, but the downward trend has been decelerating over time.

We have the lowest in Europe, with an incidence level of 120 per hundred thousand inhabitants. Central and eastern Europe is in counter- cycling with Portugal, Spain and Ireland, which have Rt below one.

Portugal remains the country with the most reduced mobility, but there is an increase.

He estimate that the 240 inpatients in the ICU will be reached in mid-March and the 120 beds occupied at the end of the month. Remember that experts have set a maximum occupancy of 242 beds in ICU for covid patients as a manageable number by the NHS.

João Paulo Gomes, from the Dr. Ricardo Jorge Institute, referred that there was a “more pronounced growth” of the United Kingdom variant over the last week, “of about 20%”.

He talks about the new variants of the new coronavirus in Portugal. It starts by framing Portugal in the world panorama in the face of the so-called British variant: England and Ireland have levels around 90%, Denmark almost 80% and Portugal and Switzerland present “growing trends” in relation to the British variant.

The experts’ projection shows that only yesterday we reached 65% presence of the British variant, a value that the experts estimated to have reached three weeks ago. “Although there has been a 10% growth stabilization per week, in the last week there has been a more marked growth of 20%” for the British variant.

In February, the South African variant had eight more cases registered, now totalling twelve since the beginning of the pandemic. The Brazilian variant, on the other hand, registered nine cases, amounting to a total of eleven. Despite the “concern” that these variants contain due to their high transmissibility, “everything is perfectly controlled”, guaranteed the expert.

João Paulo Gomes also said that, unlike PCR tests, rapid tests do not guarantee the monitoring of variants. However, he stated that health authorities are aware of this issue and are acting accordingly.

The expert also warned that in the future, variants “potentially as serious or even more serious” as the current ones should emerge. “This, of course, is worrisome,” he said, asking for “extra attention” in border control at the time of deflation, especially in the control of citizens from “slightly more sloppy” countries in the chapter on variants.

 

Henrique Barros suggests a five-level technical roadmap for the lack of definition

Baltazar Nunes, from the Ricardo Jorge Institute, presents on behalf of the group of experts with which the Government is working and which includes elements from DGS, the Faculty of Sciences of the University of Lisbon and the National School of Public Health, now presents the limits and warning signs that should guide the Government’s action to control the epidemic. Among the warning signs are:
1.Incidence of new cases 14 days below 240 per 100 thousand inhabitants and ideally around 60 cases per 100 thousand inhabitants2. Incidence should be dropping steadily with an Rt below 1 or close to it.3. Positivity rate below 4%, that is, no more than 4 out of 100 tests are positive, which allows you to ‘detect asymptomatic cases and prevent them from transmitting the infection without knowing it.4. 90% of cases with isolation in 24 hours, which implies fast and comprehensive screening

5. ICU occupancy rate must be less than 85% of the bed capacity. In the case of covid patients, a maximum allowable of 246.

If only the new cases were linked, Portugal would be unrestricted. But it is necessary to “consider a set of measures”, says Henrique de Barros

Thus, Henrique de Barros proposes five phases of confinement / de-confinement measures, according to the various indicators, namely the cases foreseen for the next 14 days, of hospitalizations and hospitalizations in ICUs. In other words, for the specialist, it is possible to predict the situation in which he will be in the next 14 days, according to a technical model.

In fact, he says, if we decided only according to specific indicators and did not take into account other factors, we would be, in 15 days, in phases 1 and 2, that is, only measures of respiratory etiquette or prohibition of agglomeration of more 50 people.

However, he said, “if it is done based on hospitalizations, it has a different severity” and therefore “there are different points where the decision has to be changed”.

For the teacher, at this stage we have to “work with the accumulated experience”, which has limited information, and that it is necessary to “consider a set of measures” and not just “singular measures”. “This may be relevant to decide,” he said.

The proposal that he makes, of these five levels, is, admits “in a conservative model”, but that allows, ensures, “to anticipate the answer both at national and regional level”. Bearing in mind that there can be no “rigid limits”, that is, when a certain indicator is reached, the country is ready to be at a certain level, it suggests that one should pay attention to the “possible effect of variants with transmissibility”

Henrique de Barros says he aims to present a proposal for an adaptation strategy based on the identification of specific criteria and also on the experience of other countries. Henrique de Barros suggests a proposal to approach the pandemic in a local / regional way and which is divided into five levels. Looking at the experience of other countries, the levels he proposes are:

1 -There are no measures other than individual and non-pharmacological – respiratory etiquette rules

2 – Second level – Prevent meetings with more than 50 people

3 – Third level – Intervention on cafes, restaurants and different aspects of trade

4 – Fourth level – Interrupt classroom activities from secondary school

5 – Interrupt activities in basic education and day care centres

Maximum risk level should rise to 240 cases per 100 thousand inhabitants

Óscar Felgueiras, from ARS Norte and Faculty of Sciences of the University of Porto, presents a proposal for indicators to be used in a deconfinition plan, suggesting new levels of risk at national level:

Level 5 – high – above 240 new cases per 100 thousand inhabitants in 14 days
Level 4 – high – above 120
Level 3 – medium – above 60
Level 2 – low – above 30
Level 1 – very low – up to 30

In addition, it proposes an additional indicator: the 14-day percentage growth. If the incidence is at a high level but is growing by 30%, then the situation enters the maximum risk level (level 5 instead of 4). If the growth is 60% and there are more than 60, it goes from level 3 to 5.

 


Sign up for Newsletter

Please enter your email address