The purchase of 535 fans was made on an “early payment” basis early in the morning, over the weekend, and cost Portugal 9.3 million euros (the 10 million dollars mentioned by António Costa in the Assembly of the Republic). Prime Minister’s word, detailed during the biweekly debate in Parliament. This Friday, the Government leader announced that Portugal is in a position to move towards its own fan production – and that, in six months, it could be 10,000. Until the beginning of the pandemic in the country, 1,142 fans were available in Portugal and the Government decided to increase this number by almost 50% (43.7%, to be exact), with the acquisition of 535 fans from China. Out of these accounts are all acquisitions already announced by municipalities, inter-municipal communities and donations, individually or collectively.
Now we need to think about how they will be used. In addition to the material, trained teams are required. And the type of ventilation that the most serious patients with Covid-19 need is invasive ventilation, which not all professionals are qualified to perform.
In addition, it is necessary to decide how they will be distributed across the country. And, in this regard, the experts heard by the Observer are divided: between the need to concentrate them in dedicated units or to spread them out across hospitals across the country, with good supervision. In the daily press conference this Friday, the Secretary of State for Health, António Sales, explained that the strategy will be defined by a team of internists and intensivists, who have the function of monitoring and identifying the needs in the country.
It is certain that the equipment purchased from China will begin to arrive in the country accompanied by cardiac monitors, pumps and infusion syringes, necessary for the correct ventilation of the patient. Also this Friday, António Sales guaranteed that the fans ordered included all the necessary material. It is not clear whether this will happen in relation to the equipment being donated.
Adding to the 1,142 fans that already existed in the NHS, donations and the acquisition of municipalities and the Government the number of fans – assuming that all orders reach the peak of the pandemic in Portugal, when it is expected that they are most needed – will amount to almost 2,000 . But it is not enough that there are thousands of ventilators (and all the necessary material besides the ventilator) to treat the patient. It will also be necessary that, in the various units where this equipment will arrive, there will also be specialized teams for the type of invasive ventilation that Covid-19 critically ill patients need – and that requires a high level of professional expertise.
This is what explains to the Observer a pulmonologist from Guimarães, who warns that “Not everything can be solved with fans”.
We are not talking about a saline solution that any nurse puts. We are talking about a lot of structure that takes time to form, ”he says to the Observer, adding the example of Chinese aid to Italy:“ In addition to the material, it has also arrived staff to work ”.
Asked which specialists will be best prepared to perform this type of ventilation, the doctor clarifies that it will be anesthesiologists and intensivists, but notes that “there are few in Portugal”, contrasting with the experience of intensive care that there is, for example, in Italy.
A similar opinion comes from the Portuguese Society of Intensive Care, which points out that if a patient is poorly ventilated, they can die. “It takes a person to work with the ventilator, a monitor to be able to monitor what is being done”, he pointed out, stressing the need to transfer patients who need ventilation to differentiated units and not to keep them dispersed throughout the country in several hospitals .
The first point is that having only fans is of no use. It is necessary to have a structure [de profissionais] and knowing how to use the fans. Secondly, it is necessary to transfer patients to dedicated units, which must have an increased response capacity ”, defends the source of the Portuguese Society of Intensive Care.
For the health professional, the solution, in addition to having fans, is also to transfer the most serious patients to dedicated hospitals and, with that, try “as much as possible to centralize teams”. “The advantage of dedicated and referral hospitals is that there are several people with sufficient knowledge and who can and know how to coordinate others,” he says, explaining that in hospitals that are not referrals, there are fewer professionals with the necessary knowledge, which limits the coordination of teams available for the necessary procedures.
“It is necessary to increase the capacity of the reference hospitals, to increase the Covid intensive care units dedicated in these hospitals and not to create more intensive care beds, dispersing them by other hospitals”, notes the professional. In his view, the transfer of the most acute patients (in need of intensive care) to these dedicated units should be chosen.
Tomás Lamas, an intensivist at the Egas Moniz hospital in Lisbon, notes that “no country” is prepared for a situation similar to this and that in Portugal the same thing will happen in Spain or Italy, for example. In other words, once the more specialized resources in ventilation have been exhausted, other doctors will take over these tasks, supervised by an intensivist.
Human and health resources are very limited. Each of the hospitals and intensive care units will know how to organize. Each unit knows its reality and who is available to work ”, defends the specialist, who stresses that logistics should be organized “site by site”.
“Spain and Italy have organized themselves internally to respond to what was needed and we will also have to respond,” said the doctor, recalling the difficulties that the country will face “in the coming weeks” and the need to stay at home.
“If they leave in the morning, just for a run, they are already at risk. Only staying indoors does the risk of being infected be 0%. As soon as you leave the door, that risk increases ”, stressed the intensive care doctor.
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