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“Good news: the peak came earlier, between November 18 and 20”. The phrase was said by epidemiologist Manuel Carmo Gomes at the meeting that this morning takes place at the Infarmed headquarters in Lisbon, which brings together experts and politicians. The first part of this meeting was dedicated to an assessment of the current epidemiological situation in Portugal and projections for the coming weeks. So let’s start with the good news. “The peak occurred between 18 and 21, but we had projected [o pico] for later because we still could not capture the impact of the November measures, “explained Manuel Carmo Gomes. The peak of infections will have occurred between November 12 and 15. “From then on, contagions began to fall”, which occurs shortly after the measures announced by the Government.
I had already mentioned André Peralta Santos, a public health doctor from the General Health Directorate (DGS) who inaugurated this meeting, who pointed out the “consolidation of a peak” on November 25 and the respective “downward trend” that should it will be consolidated in the next few days. “This is good news,” sums up André Peralta Santos. The North, he added, has a higher incidence, but it also has a downward pattern. However, there are also alerts: Alentejo and the Autonomous Region of the Azores are increasing in the number of infections.
André Peralta Santos also said that the incidence begins to increase in the most active populations, that is, between 20 and 40 years of age. “The good news is that the 60-80 group is relatively protected. The group with more than 80 years has greater dependency and greater intensity of contacts and has a greater incidence ”, he explains.
Rt below 1
Another good news: the reproduction speed of the virus is decreasing and is already below 1, which means that on average one positive person does not infect another. The amount was advanced by Baltazar Nunes, coordinator of the Epidemiological Research Unit of the National Institute of Health Dr. Ricardo Jorge (Insa). “There was a first period of increased transferability at the end of August, associated with the end of the holiday period, which led to a second phase of faster growth,” he says.
At the moment, the transmissibility (Rt) is decreasing, after it reached its peak (nationally) on November 6. Currently, the average Rt of the last 15 days is set at 0.99. It differs from region to region. In the north it is 0.96; in the Center region it is 1.0 (bottom); in the region of Lisbon and the Tagus Valley it is at 1.00 (being that it never had values as high as in other regions, after having reached its maximum between November 16 and 23); in the Alentejo region (where there is less population, the behavior is not as standard) it is at 1.12 and in the Algarve at 1.08. In the Azores it is at 1.1 and in Madeira at 1.05 in a “stable trend”.
The restriction measures imposed on weekends contributed to this restriction, defended Baltazar Nunes, when “the reduction was more pronounced and close to the values of April.” What factors were associated with this reduction in transmission? Transferability begins to decrease before the state of calamity (October 14) and continues to decrease with the implementation of the remaining measures (such as the mandatory use of a mask and differentiated measures by municipality). There is still a reduction in mobility in the same period, but this indicator measures only mobility and not contacts.
Mathematical models show that it is possible to keep the transmissibility index below 1 by reducing close and unmasked contacts.
Therefore, one cannot relax for now. The number of daily cases for the Christmas season, explains the expert, will depend on the ability to reduce the daily rate of cases, which will imply “discipline and measures that force these results.” But it is Baltazar Nunes who recognizes that some scenarios are very ambitious and is attentive to what may happen when the measures are relaxed. “It was the case in the Netherlands that eased after falling to 1000 cases per day and now it is again at 6000 cases per day,” he says. “This is a warning to us. As soon as we release spring, spring rises again ”, he concludes. And that will be the stage until “we are able to vaccinate a significant part of the population.”
Deaths keep increasing
And if cases are already declining, there are other indicators that have not yet peaked, such as hospitalizations and deaths. Manuel Carmo Gomes’ predictions suggest that the peak of deaths will be reached by the end of this month, with an average of 76 deaths per day. “By the end of 2020, we will have between 6,000 and 6,500 deaths,” admits the epidemiologist. The deaths have had some oscillations, which makes the projection more unpredictable. There is some randomness because the numbers are lower than the new cases, he says. The peak of deaths is expected later this month.
The DGS doctor, André Peralta-Santos, points in the same direction, saying that although “the peak of incidents has passed, there is still no clear peak of hospitalizations.” “It is waiting, it is part of the evolution of the disease,” he explains. In the mortality rate “it seems that it is already beginning to peak”, but it must be interpreted with caution.
Who is hospitalized?
Manuel Carmo Gomes presented data on the age profile of people who are hospitalized for covid-19. And he revealed that it is the group between 70 and 79 years old that spends the most time in the hospital, followed by the group between 60 and 69 years old.
Carmo Gomes believes that the country is “near the peak of hospitalizations.” The majority of people admitted to the hospital are 80 or older (41%), based on data available on December 1. Soon after, there are 24% of people between 70 and 79 years old; 17% between 60 and 69 years old and 9% between 50 and 59 years old. In short, hospital admissions to the plant are mainly for people “over 60”.
Regarding intensive care units, the proportion of hospitalized patients aged 80 years and over is lower. The largest portions are between the ages of 50 and 59 (17%), 60 to 69 years (34%), and 70 to 79 years (32%). “The 70 to 79 age group is the one that stays in the hospital the longest; it is followed by people between 60 and 69 years old, ”he says. This explains why they “dominate in terms of occupation” of intensive care. These ages must be taken into account when analyzing vaccination priorities, argues the epidemiologist.
