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In the meeting session at Infarmed – attended by the Government, the President of the Republic, activists and health experts – the epidemiologist Manuel Carmo Gomes anticipated what the progression of the pandemic will be next month.
According to the expert, the Rt (transmissibility index) will enter a downward path, albeit slow, at the end of the month, but the increase in the number of cases will not stop for now. At the rate of infections, the number of daily cases is expected to rise to 7,000 between November 25 and 30.
Given this same progression, it is expected that, with the number of infections, there will be a peak of deaths in Portugal in the second week of December, reaching values between 90 and 100 deaths per day.
Carmo Gomes thus assumes that it is essential to lower the transmissibility index below 1. “If we do not put the R below 1, we are guaranteed a plateau from which it is not easy to get out,” he warned, admitting the difficulty of lowering the wave. even with tough measures and fearing the increase in hospitalizations.
Currently, the R will be at 1.11 and in the evolution models presented at Infarmed it should be at 1 at the end of November and the beginning of December, said Carmo Gomes, considering that you cannot “lower your guard, because at the first opportunity , the R goes up again ”.
He argued that it is necessary “to significantly lower the R to a manageable level in terms of hospital admissions,” since it is projected that in the transition from November to December the average number of new cases per day will reach 7,000.
The point, he pointed out, is that 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” and that will continue. to reflect more hospitalized cases and more deaths.
Therefore, according to the models you have presented, it is necessary to “keep the R below 1 continuously”.
Also referring to the transmissibility index, Baltazar Nunes, from the National Institute of Health Dr. Ricardo Jorge, said that the national R is “growing in 88 days”, with a daily average of 6,488 new cases (calculated with the effective numbers during seven days ), which is “six times higher” than what happened in the first wave of March / April.
This incidence has had “a positive trend in recent weeks,” he indicated, referring to the fact that the time it takes to double the number of new daily cases has increased.
“They keep growing [os novos casos por dia] but with less marked growth since mid-October ”, he declared.
According to the models brought to the meeting by Baltazar Nunes, “only with a reduction in contacts in the community of more than 60 percent and a high coverage of mask use is it possible to lower the R to 1” and keep it there. “For several weeks. “
To calculate the R factor, consider the length of time that an infected person is in the population, the number of contacts they have, the probability of transmission after contact, and their susceptibility to infection.
Baltazar Nunes pointed out that the European countries that managed to lower the transmissibility index are those that applied “more restrictive measures and have lower levels of mobility.”
Portugal has “higher levels of mobility than these countries,” he noted.
North registers slowdown but the incidence is still seven times higher compared to April
Prior to this intervention, Óscar Felgueiras, a specialist from the Faculty of Sciences of the University of Porto, revealed that the northern region is experiencing a slowdown in the growth of the covid-19 pandemic, but the incidence is still almost seven times higher than in April.
“Currently we have a situation in which growth in general is slowing down” in the north of the country, the area where there are more cases of contagion, said Óscar Felgueiras.
According to the expert, even where the pandemic is growing, in general, there is a slowdown and eventually, where it is decreasing, the trend is down in many regions.
By monitoring the daily average of cases in a window for seven days and in a window of cases for 14 days, it is observed that there has been a great growth.
“We are currently experiencing an incidence that is almost seven times higher than that registered in April at the peak of the pandemic and recently the trend was for there to be a certain slowdown”, highlighted Óscar Felgueiras.
As in the country, the age groups with the highest incidence are those of the active population between 20 and 49 years old, followed by those over 80 years of age, as well as those between 70 and 79 years old.
“Even in the case of the elderly, the current incidence is more of the cork oak than the one reached in the April peak,” he stressed.
According to Óscar Felgueiras, at this moment there are about 200 daily cases of people aged 80 and over. The truth is that the incidence is quite high ”.
The 14-day incidence rate increased by 16% in the last week, with a trend, however, to slow down, with a growth variation of less than 9%.
Regarding the age groups that are growing, they are children, 32% more, adolescents, 24% more, and the elderly over 80 years (26%) and 70 to 79 years, 21% more.
The expert added that the realities in the northern region are not absolutely homogeneous.
There is a high trend in Aveiro, but it is growing at a slower rate, in Braga it is higher, with growth of 28%, but growth is also slowing down, while Bragança is growing fast, but at a lower level.
The Porto district is where some stabilization is taking place and that is occurring mainly in the age groups of the workforce, not so much in the young and the elderly continue to rise a bit.
The first vaccines could occur in early 2021
During the interventions, the president of the National Medicines Authority (Infarmed) admitted that the first vaccinations against covid-19 happen at the beginning of next year, depending on the authorizations of the European agency that supervises the sector.
Rui Ivo said vaccine deliveries will take place in tranches throughout 2021 and that more than five million doses may be available in the first quarter, about eight million in the second quarter and another two million in the last. quarter of next year.
Rui Ivo indicated that there are contracts signed for four vaccines, three of which (BioNTech / Pfizer, AstraZeneca / Oxford and J & J / Janssen) are in a more advanced stage of development and for another Sanofi brand vaccine.
All are subject to evaluation and authorization by the European Medicines Agency, he stressed, a process that may still have developments this year.
Marcelo leaves questions, experts answer
After the speeches of the specialists, the President of the Republic, Marcelo Rebelo de Sousa, asked some questions in order to clarify some of the issues discussed during the morning.
Addressing the epidemiologist Manuel Carmo Gomes, Marcelo asked what measures to maintain to reduce transmissibility, does it make sense to graduate by groups of municipalities, distinguishing those with 240 and 480 daily cases? [por 100 mil habitantes], of those who have between 480 and 960 and of those who are over 960. In addition, the head of state also asked if it is possible to adopt more extreme measures and if there will be a peak of the pandemic next year.
For the President of the Republic, Carmo Gomes said that he sees “no alternative” other than the adoption of measures by the municipality, asking that “blunt scalpel” be replaced by “surgical scalpel”. The epidemiologist argued that one should not return to a general confinement such as the one that occurred at the beginning of the pandemic, but rather before working with the local health authorities to carry out a follow-up that allows the adoption of specific measures.
Regarding the possibility of a new peak, the epidemiologist admitted “having no answers” about this eventuality, stressing, however, that everything depends on the action to be taken at this time. “If we keep up the pressure, the R will drop below 1,” and “it is up to us if we are going to peak in January and February,” he said.
Marcelo, for his part, questioned João Gouveia, president of the Portuguese Society of Intensive Care, about the pressure that intensive care units currently face, and gave a bleak prognosis, saying he was “very concerned.”
With the ICU occupancy rate at 84%, the intensivist says Portugal is “at risk of not being able to receive all Covid-19 patients who need intensive care”, and regional variation dictates that there are hospitals in the In the north of the country with 113% capacity and others with less. However, those with less, between 40 and 60%, have smaller services, so that “the actual number of available beds is less.”
João Gouveia admitted that there is a “mattress” and “expandability” to reach 967 intensive care beds. However, for this to happen, it will be necessary to sacrifice “scheduled activity and assistance to other patients”, being a “bill that we will pay in the future.”
In addition, the president of the Portuguese Society of Intensive Care said that he believed that “a third and fourth wave” would appear, so it is not sustainable “to maintain the type of reactive expansion because it is not compatible with normal medical activity” and this may affect care of patients with other pathologies.
Marcelo also questioned Rui Ivo, from the National Medicines Authority, about the eventual start of vaccination and how long it will last. The official responded that “perhaps in January” the first doses of vaccine can be had and that the process takes place during the year, hoping that in the summer there will be “a significant number of people covered” by the vaccine.
