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It was the great message left in the final part of the meeting by the specialists who participated in the Infarmed meeting on Thursday: the Government could and should have taken tougher and earlier measures, as did several European counterparts when recording figures even less contagion. to which the country registered when the Government decided to tighten the mesh.
The criticisms were made behind closed doors, after the television cameras were turned off, but confirmed by two sources to the Observer. One of the experts who defended in this part of the meeting that the measures should have been taken already in September was the epidemiologist Manuel Carmo Gomes. This was not the strategy and the panorama that remained of this meeting that brought together health experts, representatives of parties with parliamentary seats, social partners and the most prominent figures of the State is anything but encouraging: the vaccine is still a mirage, hospitals are Near the breakout, the peak of the second wave of the pandemic will appear in late November and there is no guarantee that there will not be a third and fourth wave, on the contrary. Among many doubts, only one certainty: despite the measures adopted by the Government, the worst is yet to come.
Contrary to what happened in other meetings, it was the first time that Marcelo Rebelo de Sousa allowed part of his speech to be broadcast on television. The President of the Republic left a wide range of questions, specifically about the effectiveness of the measures adopted, the existence or not of a possible third wave, the breaking point of intensive care or the degree of contagion in schools and universities. But the most important question was another: how long will we have to have restrictive measures?
“For how long? Mr. President, I have no answer for that,” said Manuel Carmo Gomes, an epidemiologist at the Faculty of Sciences of the University of Lisbon, almost as if he were venting. In the end, everyone, including the political parties, They recognized the obvious: the situation is very serious.
“I am convinced that there will be a third and a fourth wave and that we will have a period of time in which we will have to live with this virus. We cannot maintain the type of expansion that we have now, reactive, because it is not compatible with normal medical activity. We are not yet in a catastrophic situation, but we are breaking down in many places ”. This was the scenario posed by João Gouveia, president of the Portuguese Society of Intensive Care, in response to Marcelo Rebelo de Sousa, already after comparing hospitals with a “bucket full of water but poorly patched, with water coming out for everyone” . the holes “.
The specialist even said that the risk of not being able to treat all Covid-19 patients is real and that the intensive care occupancy rate is very worrying, especially in the north of the country. “We have an occupancy rate of 84% for beds dedicated to Covid-19 and we are already at risk of not being able to receive all the patients who need intensive care. It is a value with a huge regional variety, we have units in the North at 113% and others with less in other areas of the country. But those that are 40% or 60% are in smaller services and therefore with fewer beds ”, he pointed out.
Another of the conclusions of this Thursday’s meeting may have consequences for the strategy that the Government designed to contain this second wave of the pandemic: Henrique de Barros, president of the National Health Council, presented a study from which it can be concluded that “ the use of transport services, the frequency of eating spaces and the frequency of commercial and hospitality spaces do not seem to increase the probability of infection ”.
At a time when the government is under strong political pressure to reopen the restoration beyond curfew hours, these findings may force António Costa to readjust the strategy. On the other hand, the specialist pointed out that the largest contagion outbreaks occur in the workplace and at home, especially when there are no living conditions.
It was another of the issues that dominated the agenda: in the audience with the parties, Marcelo Rebelo de Sousa raised the possibility of closing universities to curb infections. He ended up being contradicted by Manuel Heitor and, more specifically, by Henrique de Barros: “There is no overexposure to the virus related to this activity,” stressed the specialist.
According to Manuel do Carmo Gomes, with the current current trend in the transmission rate, the country will reach the peak of this second wave between November 25 and 30, with 7 thousand cases per day.
In addition to this projection, the specialist pointed out the peak of deaths caused by Covid-19 for the second week of December, when 95 to 100 daily deaths should be registered.
Another equally relevant conclusion was the one presented by Óscar Felgueiras, from the Faculty of Sciences of the University of Porto. According to the expert, it is necessary “to spend a month and a half between the time the measures are taken and the situation returns to the incidence of the exit.”
With the main political leaders in the audience, Manuel Carmo Gomes argued that it was necessary to readjust the measures to the reality of the field. “I have always advocated that we use a scalpel and not a blunt one, which takes the country as a whole. I have always advocated for risk levels, with a clear definition of how to go from one level to another and an attempt to adapt the general and specific measures to each municipality, ”he emphasized.
The expert understands that the criteria used by the Government to define the municipalities with the highest risk – the number of new cases per 100,000 inhabitants in the last 14 days – may not be the most appropriate in isolation and that it is necessary to look at the rate of new infections, the reality of the surrounding regions and the origin of the outbreaks in each municipality. OR mixture One of these four criteria may force the Government to rethink the map currently in force for municipalities at risk. “We need to refine the measures according to local realities. And for that, it is necessary to have the local health authorities, which are the ones who best know the reality, ”warned Carmo Gomes.
Another note left, this time, by Baltazar Nunes, from the National Institute of Health Dr. Ricardo Jorge: the R index (which measures how many people a patient can infect) has stabilized in recent weeks, but the situation remains very worrying .
Transferability is “growing for 88 days”, with a daily average of 6,488 new cases, which is “six times higher” than that registered in the first wave, between March and April.
Then there is another fact: it is not enough to lower R to 1; it must be lowered significantly “to a manageable level in terms of hospital admissions,” warned Manuel Carmo Gomes. This is because, explained the specialist, even if a reduction of R to 1 is achieved, the incidence of new cases per day can remain in several thousand, entering “a plateau from which it is not easy to get out.”
It was the most positive data that remained in the meeting: Rui Ivo, president of Infarmed admitted that the first vaccines occurred at the beginning of next year. Deliveries are expected to be made in chunks throughout 2021: five million doses in the first quarter, around eight million in the second quarter, and two million more in the last quarter of 2021.
But there are many doubts, from the beginning, about the authorization schedule by the European agency that oversees the sector. Furthermore, at the European level, there is no contractual agreement with Moderna for the acquisition of what appears to be the most effective vaccine against the virus. And the government has not provided data on what level of vaccination is needed to ensure herd immunity.
During the interventions, doubts arose as to whether or not the majority of infections occurred in family contagion. In their latest interventions, António Costa and Graça Freitas have pointed out that the context of family or social life has been responsible for 68% of infections.
According to data presented by André Peralta Santos, from the General Health Directorate, at the meeting, in 81.4% of Covid-19 cases, the authorities do not know where the infection occurred. In other words, in Portugal, epidemiological surveillance systems can only reach 19% of infections. All the others go through community transmission, which means that it is not known where they come from or how they happen.
After all, only 10% of cases have been proven to run in families. More than 80% of Covid cases in Portugal are of unknown origin
António Costa even presented a graph during the instructions of the Council of Ministers of November 7 that pointed out the family context as the main source of contagion (responsible for 68% of infections) without mentioning that the origin of the contagion was not known in the vast majority of cases.
Already this Wednesday, Marta Temido had explained in an interview to a PS podcast that, based on the data collected in epidemiological surveys, they only managed to know the context of contagion in 25% of the cases in the North, which shows a shadow on the origin. sprouts.
The recognition of the lack of sufficient data was the motto of Ricardo Batista Leite, deputy and vice president of the PSD bench, to launch harsh criticism of the government’s strategy. “When we hear that 68% of people have been infected in a family context, today we realize that in reality it is a much lower percentage, because objectively we do not know. And when you don’t know, you can’t take firm action. We are a sailboat, sailing in the dark and without a compass ”.
