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The increase in covid-19 cases in recent days has led to a revision of the projections on the epidemic. If the evolution seemed serious a week ago, yesterday after all the warning was evident. The North region is once again the epicenter of the coming struggle, but the scenario is expected to worsen substantially throughout the country.
Óscar Felgueiras, a mathematician specializing in epidemiology at the University of Porto, who earlier this week warned of the now unprecedented growth of cases in the North, confirms a worsening of the epidemiological situation and warns that next week should be very difficult for the teams. In the balance of a week in which the country successively broke records of new cases and passed the barrier of 2,000 new infections before, with the North region registering more than a thousand daily cases, the researcher considers that at this time the increase. explosive. “If we compare the last seven days with the previous seven days, the growth in the number of cases was 107%, that is, more than double. In the previous week it had been 65% and in the previous 14%. In exponential growth, this growth is assumed to be constant. This is not the current situation, it is worse.
The data released this Friday by the Ricardo Jorge Institute on the epidemiological curve and the evolution of RT indicate a worsening of the situation throughout the country, with a foreseeable increase in new cases. The national RT rose to 1.27 in the last INSA calculation, when in last Friday’s report it was 1.10. The worsening is noticeable in the North, where the RT rises from 1.22 at the end of last week to 1.36 in this latest analysis, reveals the report made available by the organization. Given these figures, Óscar Felgueiras says that projections indicate that it is practically certain that 2,000 cases will be exceeded in the North region. “It is not impossible to have a day when 3,000 are reached, if the measures taken do not take effect,” says the researcher, who earlier in the week also warned that the more rapid increase in cases could begin to pose difficulties for the detection and diagnosis.
SOL questioned the General Directorate of Health and the Ministry of Health about the growth of cases in the North and the combination of an RT of 1.36 when more than a thousand cases are registered, an unprecedented situation. Until closing time it was not possible to get a response. At Friday’s conference, there were no references to the evolution of RT. The Secretary of State for Health highlighted the concern over the evolution of the number of cases and the need for the entire population to adhere to the measures, reiterating that there is a response capacity both in the SNS24 and in terms of tests, which tripled with relative to March, he said. – and in the hospitals of the National Health Service, especially in the North and Lisbon, where the majority of cases are registered. However, the concern during the week was demonstrated by a doctor from the public health teams in the region and also in São João, measures were taken to anticipate greater hospitalization capacity in the coming days.
Pressure in S. João similar to the peaks of March and April
Yesterday afternoon, Nelson Pereira, director of the management unit of the emergency and intensive care service at Hospital de São João, told SOL that the pressure registered in recent days has already been very similar to that registered in the hospital in March and April. . At that time, São João was the hospital that felt the strongest impact from the explosive increase in patients. Now, despite the fact that there are more hospitals responding to the increase in cases in the North, at that time the referral was only to first-level hospitals, in recent days the São João emergency room received an average of 150 to 180 cases suspects, people with symptoms and between 25% and 35% tested positive depending on the days. A scenario that, despite measures taken to increase capacity, left teams more apprehensive. “We have 17 patients in intensive care, twice as many as last week, and we should reach the end of the day at 20. It is rampant. We believe that in the next few days we will continue to climb and we are very concerned, ”admitted Nelson Pereira. “This week we did not break the record of 350 suspects on the same day, I think March 26, but it was at the time when the mitigation phase was about to enter into force, the health centers were not yet organized. It is not comparable for that. In terms of urgency pressure, it is very similar. In terms of pressure in nursing and intensive care it is still lower, but we have twice as many people.
Almost 90% of those infected say the same: let their guard down
Who are the patients? They are mostly young, but also older, because the infection is spreading. Nelson Pereira says that most people, maybe even 90%, make the same report: “They were in contact with someone, with a security breach, without a mask and that someone in the meantime was positive. It is almost always in the family context, leisure and closeness with someone you know. The percentage of patients who become infected in a different context must be very small. ‘
When asked if there were already symptoms, the answer is usually also common, reinforces the doctor. “They tell us ‘yes, I have had a cold.’ And when we ask why they were together, they often say the same thing: ‘I didn’t think.’ Then people feel some regret, but it turns out that it is too late.
‘People thought it was someone else’s problem’
For the physician, therefore, greater social awareness and greater responsibility are important. “Either because of the inability to receive the message or because the message is not transmitted in the best way, people have understood this as a problem for others. They got it right ‘everyone goes home, nobody moves’, now that they say move at will, but they certainly couldn’t make that connection. Here is a feeling that only two speeds are known, eight or eighty, and here there has to be an intermediate speed ”, says the doctor, leaving an appeal:“ We can maintain some social activity, until we can go out to dinner with our home, but we can’t party with friends, be at work without a mask, we can’t take a smoke break with a friend and break security. It is in these little things that the point of the question lies, not in the big breaks and more media gatherings. I’m not defending them and there is probably work to be done there, but that’s it.
Nelson Pereira admits, however, that what scares teams right now is the granularity of the epidemic, the way it gets to this point and is much more widespread than in March, which will translate into a huge burden of patients. “It’s everywhere, we can hardly identify outbreaks. The feeling is that things are so widespread that there are no sprouts. Almost everyone knows someone who is infected or quarantined, which is significantly different from what happened in the first wave.
Regarding the storm that is approaching the health services, he admits that the strategy of identifying, isolating and controlling may not be feasible after a certain moment, changes that are for the health authorities to evaluate, but he admits that at this rate of Increasing cases will be difficult to survey and even the follow-up of patients who may stay at home will run into difficulties. On what is currently needed in hospitals, he reinforces the need for a network response, in which everyone prepares in advance to guarantee the response to patients. “It is not enough to say that I have already closed, each hospital must take responsibility for the effective implementation of its contingency plan and we are not exactly witnessing an equitable response. Put an end to the hardest-working hospitals and open the most jobs, under more pressure. We are a reference center in the North and an ECMO Center and we have to reserve ourselves for those patients that no one else can treat, ”he insists. It also reinforces the call to quickly create structures to receive patients who have no family history, social cases that end up in hospitals, which is also being noticed in São João with the increase in cases of hospitalized elderly people. “It is foreseen in the autumn / winter plan but we have not yet seen a sufficiently articulated response.”
Regarding the need for more measures after those announced this week by the Government, he insists on the need to transmit the current risk to the population. “People are not realizing the urgent need to adopt these measures, perhaps in a week they will perceive it in the worst way. When it is said that there is responsiveness in the NHS, it is true, no one has collapsed, the question is whether we are introducing sufficient measures so that the figure in ten days stops rising and realizes that it does not happen the next day . There is the time it takes people to have symptoms, to seek health services, to get worse. If today we have 2,600 infected people, there is a percentage who will need to be hospitalized and will need intensive care and it is not today, it is in a few days. It is not enough to say that everything is fine and there is capacity. A week ago we had half the patients we have today in nursing and intensive care. If it increases to 100%, what will it be like in a week? ».
Óscar Felgueiras also warns that, if there is a breakdown in the health system, it is a real risk that could disappear if the weekly doubling of cases continues. “Although the measures taken are generally a step in the right direction, there is a clear risk that they will not be enough.”
