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Mortality up to March of this year, in the territory covered by the North ARS, was in the average of the last five years, in some weeks even below that average. Until, with the first wave of covid-19 in the country, the scenario changed, the mortality curve rose and has remained high since then. The districts that make up Minho, Braga and Viana do Castelo, follow this trend of increased mortality.
None of this would be surprising if it were possible to explain this increase with deaths from covid-19. But it’s not like that. In May-July there was a mortality peak that the General Directorate of Health (DGS) he says it coincides “with periods in which there were higher temperatures in Portugal.” The DGS affirms that it was in the period between July 6 and August 2 that the “ÍCARO System (an epidemiological observation instrument coordinated by INSA, which measures the effect of heat on health) early identified a period of extreme heat , predicting significant impacts on mortality ”.
Data from the Portuguese Institute of the Sea and Atmosphere (IPMA) reveal that July 2020 was the warmest month since 1931. The heat waves in July mainly reached the central region and the northern interior of the country. This may be part of the explanation for the increase in mortality in the north.
As for the first sudden increase in mortality, in March, DGS can only be explained in covid-19. In the absence of “another robust explanation, it is hypothesized that the covid-19 pandemic was the most likely cause of the increased mortality in this period.”
Source: SNS
However, following the graph, it appears that mortality peaked again in September and October and is rising to November. Regarding this last phase, an assessment by the DGS is not yet known, but it is likely that the explanation lies in the reduction of the “non-covid” activity of the SNS.
“In primary care we lost seven million face-to-face contacts, between medical and nursing consultations, in hospitals we are talking about more than a million consultations, more than 100 thousand surgeries, this until July of this year, which can have effects on health , mainly for elderly patients and chronically ill patients ”, says Alexandre Lourenço, president of the Portuguese Association of Hospital Administrators. “In these scheduled activities – in surgeries, in consultations – we are now seeing some recovery, but we continue with a lower activity than in the pre-covid era,” he adds.
Hypertension, diabetes and cancer out of control in Minho
As previously reported by the MINHO, in July of this year there were 31% fewer diabetic patients with a foot examination performed and 29% fewer hypertensive patients with blood pressure below 150/90, in the last six months, in the ARS North. These two indicators represent the proportion of the diabetic and hypertensive population that the system has under control. In both cases, the reduction was very large.
In the North ARS, in 2020, until October 31, 31,267 people, 2,688 more than in 2019 and 3,254 more than the average of the last five years. If we look at October 25, for example, in 2020, in ARS Norte, 115 people died, on the same day, in 2019, 80 died and, in the worst year of the last five, 2018, they died, that same day. , 94.
There is an increase of 1,577 deaths that cannot be explained by covid-19
We know that 1,111 of these deaths were due to covid-19, leaving 1,577 to be attributed to other causes. This was at a time when the government once again authorized health units to suspend “no covid” activity, to direct resources to combat the pandemic. The Senhora da Oliveira Hospital, in Guimarães, is an example of this resource management. In this hospital, one of the operating rooms was transformed into an extension of the Covid Multipurpose Intensive Care Unit, allowing the placement of three additional beds. Two other operating rooms may soon follow suit. This allocation of resources is carried out with the natural detriment of non-urgent surgeries.
The increase in mortality was greater in the district of Braga than in the district of Viana do Castelo
The increase in mortality was most noticeable in Baixo Minho, with the district of Braga registering an increase in mortality, from 2019 to 2020, of 10.4%. The increase in the number of deaths, compared to the previous year, in the district of Viana do Castelo, stood at 6.3%.
Source: SNS
Among the municipalities of the Braga district, only three registered a lower mortality in 2020 than in 2019: Terras de Bouro, Vieira do Minho and Vizela. The first is part of the short list of municipalities in Minho that are not included in the list of municipalities with a high risk of transmission. In any case, the reductions are slight, within what would be expected in a normal framework. In Terras de Bouro it went from 69 dead in 2019 to 67 this year. Vieira do Minho, which was added to the list of high-risk territories after the government’s revaluation, on October 12, registered a decrease from 136 to 122 deaths. In Vizela, there was a reduction of four deaths compared to the same period last year, but the municipality is surrounded by some of those most affected by the pandemic and, therefore, is included in the list of “high risk”, from the first moment.
There are two criteria defined by the Government to consider a municipality as “high risk”: the first is the existence of 240 cases per 100,000 inhabitants in the last 14 days, the second is the proximity of other municipalities that comply to this criterion.
In the municipalities of Viana do Castelo and Ponte de Lima, mortality decreased
In the Viana do Castelo district, there are two municipalities that did not keep up with the increase in mortality figures in 2020: the municipality of Viana and that of Ponte de Lima. In Vila Nova de Cerveira, the mortality until October 2020 was exactly the same as the previous year. The fact that the municipality of Viana do Castelo does not register an increase in mortality ends up contributing to the behavior of the district as a whole, there were only 161 more deaths in this territory, this year. Although there are regions, such as Arcos de Valdevez (another of the counties that have been part of the high-risk group since 12) and Monção, where there were significant increases in mortality, plus 36 and 57 deaths respectively.
Source: SNS
In Braga there were 133 more deaths, only 80 were attributed to covid-19
In a single municipality, the difference between the total number of deaths and deaths from covid is not as obvious as when the analysis is extended to the district or Health Region. In the municipality of Guimarães, the number of deaths from covid-19, announced by ACES do Alto Ave, is 33. In this municipality there were 31 more deaths in 2020, which means that, here, the pandemic fully explains the increase in mortality.
In Braga, the increase in mortality was 133 records, of which only 80 are attributed to covid-19. A scenario similar to what happens in Arcos de Valdevez, where there were 36 more deaths than in the same period in 2019, although there were only ten deaths from covid-19. The same is true in Monção, where there was an increase of 57 deaths, but only 33 of them are attributed to the new coronavirus.
Source: SNS
DGS has not yet begun to investigate the causes of this excess mortality and it is not known when it will. It is true that, for almost the entire Miño region (similar to what happens in the country), the Portuguese are dying more in 2020 than in previous years and the covid-19 only explains a part of these deaths.
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