As of next week, hospitals and health centers will start separating covid-19 patients from all others.The ones who got transferred to nursing homes will always have to be tested at the door. Healthcare professionals will be monitored daily.
The rise in the curve of new cases of infection by novel coronavirus has been slowing down in Portugal for two consecutive days. That’s a sign that the containment measures decreed a week ago may be starting to show results - the closing down of schools, clubs and other establishments. But little time has passed. So, this data should be looked at with caution, and it should be underlined that we can’t become complacent and lax, because “the danger is very real”, warns André Peralta Santos, a member of the direction of the National Public Healthcare Doctors Association, (ANMSP).
To get a better understanding of how the situation will evolve, we still need to take into account covid-19’s incubation period, which is of 5 days on average, and add to it at least two more days, until an infected person starts showing symptoms and seeks out public healthcare. For now “the indicators look good”, but we have to look at the data “with precaution, due to the epidemic’s dynamic nature”, stresses the specialist. The “slowing down of the growth of epidemic outbreak curve” was fairly stressed this Saturday by Marta Temido, minister of health at the daily press conference to take stock of the situation. The minister reminded that the numbers in the country point to a less abrupt rise in the number of confirmed cases and suspect cases over the last couple of days in Portugal. Marta Temido stated this evolution, linked to the “available estimate epidemiological calculations” allow to predict a possible date for a peak in the epidemic curve “around April 14”. That is to say, in around 3 weeks.
Is it possible to have such a precise prediction on the peak of the covid-19 outbreak in Portugal? With no access to the studies the projection is based on, André Peralta Gomes observes that a mathematical model is always “an interpretation of reality”, and explains that “the bigger the projection time, the lower the certainty”. What we can do is assess what happened in China and South Korea, two countries that now have few cases, to try to understand what might happen here, he says. For now ANMSP, (whose data are based on the Directorate General of Health’s report - DGS) will only present a projection for the next 3 days on its website. According to that projection, next Tuesday, March 24, there will be up to 732 new confirmed cases in just a day.
Looking back, the data indicates the number of positive cases in Portugal has been growing exponentially after it started slowly rising at the beginning of March. It went from 1020 on Friday to 1280 this Saturday, with the total of suspect cases nearing 10,000. The rise in the number of confirmed cases is of around 25%, even so, we’re far from the growth rate observed in the previous days, which went over 40%. (There was even a day when it surpassed 50%).
Looking at a map of the country, the north region is the most affected, with a total of 644 positive cases and 4 out of the 12 deaths. It’s followed by Lisboa e Vale do Tejo, (Lisbon and the Tagus Valley), and by the center region.
When questioned by journalist about any regrets, in light of the measures adopted in the north, Marta Temido admitted that “we can always look back and think we could have done things differently somewhere”, but she emphasized that “we’ve always followed WHO’s guidelines and kept track of the situation in other countries”.
While public healthcare teams are on the ground, they’re in “constant training”, the strategies may be different from one region to another, according to Graça Freitas, General Director of Health. “We may have a sanitary chain in one area, and minimize the import of new cases in another”, she explained.
Fatality rate of 1%
Aside from this, the numbers available for Portugal fit within the pattern of epidemic evolution observed in other countries. For now, only 1% of the total number of patients (35) are in ICUs, due to the severity of their clinical condition. 88% of covid-19 patients are receiving care in their homes.
The fatality rate now is of about 1%, well “below” numbers registered in other countries - in Italy it’s close to 8% and in Spain 4% - but the Director General of Health warns the numbers in Portugal could evolve, seeing as the country still has “very few patients with prolonged hospital stays”. Cases only started being detected and admitted to hospitals on March 2. The hospitalized patients are mainly older people with morbidities, with pathologies like cancer, obesity, and heart conditions. Of the mortal victims, the youngest was aged 64 and the oldest aged 94.
The strategies to combat the novel coronavirus also evolve as the number of cases in the country rises. As of next week, covid-19 patients will be separated from all others in hospitals and health centers, and they will follow different circuits. This new approach will start being applied from next Thursday, to give healthcare services time to adapt, the minister explained. At the same time, the patients that get transferred from hospitals to nursing homes, will always get tested on arrival, to guarantee they’re not infected, and will remain “as isolated as possible”. After an initial phase where the number of laboratory diagnoses was very low, the order now is to multiply the tests. The testing capacity is of around nine thousand in the national healthcare service, and of around 17 thousand in private laboratories, said Marta Temido. In “rough numbers”, there are now at least 1400 tests carried out daily, explained Graça Freitas.
Under much criticism as news of contagion among healthcare workers get out, as well as news that staff keep working in some hospitals in spite of having had contact with covid-19 patients, DGS issued a guideline this Saturday. As of now, healthcare workers will need to do a self assessment every day, including a temperature check and registration, so that eventual symptoms can be detected early. If any symptom is confirmed,the healthcare worker in question will be considered a suspect and follow through to an isolated area where they’ll have tests done. There are now three definited degrees of risk of exposure to covid-19 patients - low, medium and high - and a healthcare professional with a high risk of exposure will have to remain in prophylactic isolation and under active surveillance for 14 days.