It is not a sprint. It’s a marathon. Facing covid-19 will take time. How much? It is not known for sure, although the mathematical models drawn up by the technicians of the Directorate-General for Health point to the month of May. And it seems that it will not be a matter of a few days, but a period of time, which can be up to two weeks, he informed, this Friday, in Press conference, the director general of Health. “The peak will not be an isolated moment in time, but a plateau. We know that this disease lasts for a long time. It is what is happening in other countries”, said Graça Freitas, who speaks about a Portuguese trend to slow the speed of the epidemiological curve of this coronavirus, prolonging, on the other hand, the response time to the pandemic outbreak.
“If we have a peak curve, it is evident that it will be a very specific moment. In the end, it would be a single day with the largest number of cases, followed by an abrupt decline,” explains António Diniz, pulmonologist, coordinator of the immunodeficiency unit from Centro Hospitalar Lisboa Norte and member of the emergency group of the Ordem dos Médicos. On the other hand, there is the desirable scenario: “If we manage to flatten the curve, the period in which there are more cases will extend over time, but will allow for a smoother response” health system, adds the advisor to the Directorate-General for Health.
Portugal has increased the number of confirmed cases every day by about 20%. The last data available by health authorities, at the closing time of this edition, point to 4268 infected, 76 dead and 43 recovered. The country ranks 15th in the table of nations with the largest number of patients, led by the United States of America (more than 93 thousand cases and 1385 deaths), Italy (86 498 infected and 9134 dead), China (81 340 cases, 3292) – where the outbreak came at the end of last year and where it seems that it has already been controlled – and by neighboring Spain, which now has more than 64,000 infected and 4924 dead.
Watching the Portuguese curve rise steadily may cause some alarm, but António Diniz and Ricardo Mexia, the president of the Association of Public Health Doctors, prefer to be more contained in the analysis. And both admit that the numbers now known will grow at a faster rate over the next week, following the tendency to further test suspected new coronavirus infection. At midnight on Thursday, a rule came into force that promises an increase in the carrying out of biological tests for screening covid-19, which now cover people who have only one of the main symptoms associated with the disease (fever, cough, difficulties respiratory), with priority given to the risk groups, previously stipulated, which include the elderly, immunodepressed patients, pregnant women, health professionals. “It cannot be inferred that there are more cases in Portugal. What I do know is that there are more cases diagnosed. The curve showing a more pronounced climb does not tell me anything “, says pulmonologist António Diniz.
This Thursday (most recent data available) about 2500 PCR tests (those used in the screening of covid-19) were carried out in Portugal of a testing capacity evaluated in 5600 tests, according to the Secretary of State for Health, António Lacerda Sales . It is the first approach to “test, test, test”, recommended by the World Health Organization (WHO) to all countries.
“We have to look at these numbers [infetados portugueses] very cautiously. The perception we have is that during the mitigation phase [terceira e última do combate ao surto, que já prevê contágio comunitário] more tests will be carried out and, therefore, the cases will increase, “reinforces Ricardo Mexia.” And despite everything, there was not such a big increase in mortality in the last days. It is evident that this will increase more when the system is saturated, which is not possible to predict when it will be “, adds the public health doctor. The Portuguese lethality rate is 1.8%, in the accounts of the Director-General of Health, therefore below the world level, which, according to WHO, is around 3.4%.
For the two specialists, it is still early for the measures taken in containment – such as the closure of schools or the state of emergency – to be reflected in the Portuguese diagnosis and, therefore, also difficult to compare with other countries, establishing parallels with the curve. Italy, Spain or France, which at the same stage of development reveals fewer confirmed cases. With caution, the representative of the Order of Doctors ventures: “Despite the curve of the diagnosed cases [em Portugal] it’s not as exponential as it could be, but I don’t compromise, because it’s too early for optimistic views, which I don’t share at this point. “
Enable all responses
The big difference between the containment and mitigation phases, in which we find ourselves, “is that now is the time to limit the damage, the damage from the outbreak,” says Ricardo Mexia. The answer becomes more comprehensive. Instead of referral hospitals, all hospital units (with the exception of the three Portuguese oncology institutes in Lisbon, Porto and Coimbra) will be able to receive patients with covid-19, health centers gain relevance in the national strategy, accompanying patients from the area of residence at home and the SNS 24 line (808 24 24 24) – which no longer publishes data on the number of calls answered on 9 March – remains the preferred port of entry for patients in the National Service of Cheers. “There is a need to reorganize the system, which was previously very dependent on the SNS 24 line”, continues the public health specialist.
But the fundamental principles of this struggle have not changed. “It is increasingly important to tell people to stay at home. Exits are only those that really have to be, what is essential, particularly for the most vulnerable groups, the elderly and the chronically ill. Families and neighbors must prevent them from leaving, the local structures themselves and the IPSS are arranging aid mechanisms “, recalls Ricardo Mexia, adding:” Protecting the most fragile to the maximum is imperative. “
Mitigation phase. What changes?
What is the difference between the containment phase and the mitigation phase?
The National Preparedness and Response Plan for the new coronavirus establishes three levels and six sub-levels, according to the risk assessment for covid-19 and its impact on Portugal. According to the DGS document, the mitigation phase, red alert and response level three corresponds to the presence of cases in the national territory and is divided between the sub-levels of “indoor transmission chains” and “indoor transmission chains” open “. Portugal has already reached the latter, although the transmission is not “uncontrolled”, according to the director-general of Health.
Who is considered a suspect?
All people who have one of the main symptoms (fever of 38 ° C or more, cough, breathing difficulties). And not just anyone who has been in contact with an infected person, has traveled to a risk area or has all the symptoms. That is, the criteria to be tested have been extended at this stage.
According to the current regulation, all suspected cases registered in the National Epidemiological Surveillance System must be subjected to screening tests.
What to do?
Call SNS 24 (808 24 24 24) and explain your clinical condition to a nurse. It will also be possible from now on to call the line of your health center or family health unit and ask to contact your family doctor and in case you do not have it with another professional.
Who has priority?
To perform a biological analysis, priority is given to hospitalized patients, pregnant women and newborns, immunosuppressed people (cancer patients, for example) or with chronic disease (diabetes, asthma, heart failure), the elderly, symptomatic health professionals and contacts of all those mentioned earlier.
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