Excess mortality: “There’s so much more still to come”

President of General Medical Council spells out collateral damage of pandemic

Miguel Guimarães, president of the general medical council, has warned “we ain’t seen nothing yet” in terms of the numbers of excess deaths affecting Portugal.

“The big problem is yet to come”, he told a parliamentary committee tasked with analysing mortality due to all causes registered in Portugal.

He said he believes the figures for 2020 resulted from “a conjugation of many factors that led to many patients losing the opportunity to be observed”.

PSD MP Rui Cristina pointed out that in May of 2020, mortality for all causes registered the highest level in decades for this particular month of the year – and it could not be explained away by the pandemic, even in the rather expedient way that authorities rank causes of death (Covid-19 being listed as the 4th most frequent cause in May 2020, when cancers were all listed separately).

He stressed the PSD “considers it imperative to study the causes of these increases…”

Miguel Guimarães reiterated the well-worn explanations of the pandemic – how “many patients with symptoms of disease, like heart attacks or strokes, didn’t seek out medical help at casualty departments for fear of Covid-19”.

The arrival of patients suffering strokes in 2020 fell, for example, by almost 50%.

“Equally, various services ended up failing to function as they should have”. Mr Guimarães referred to 4.8 MILLION hospital consultations that failed to take place

On this basis alone, it “is perfectly natural that during 2020 there was an increase in mortality and an increase in illnesses. I believe the big problem is still to come”, he told the committee.

Hospitals, for example, “even without data from 2022” have to recover around 500,000 patient appointments, 116,000 surgeries and “several million” complementary, diagnostic and therapeutic tests.

“Even though we are in 2022, we are at the stage we were in 2019 – in some cases even more behind. The truth is there is a great deal to recover. When one considers chronic illnesses like diabetes, heart failure, hypertension, it is obvious that patients will start appearing in casualty units due to lack of previous care, or even a preliminary diagnosis”.

Miguel Guimarães cited European data referring to Portugal as “the second worst country in Europe” in terms of health necessities that were not satisfied in 2020. The score, 34%, was only ‘topped’ by Hungary, which came in with failure to satisfy 35% of necessities.

“During the pandemic there were many failings I consider important”, said the frequent critic of management of Portugal’s State health care. “The reality is that we took much too long to tell people, clearly, that if they had the symptoms of a possible heart attack or stroke they should not be afraid to go to A&E…”

Other failings stemmed from what Miguel Guimarães calls “the saturation of primary care” – the insistence that GPs should follow all patients positive for SARS-CoV-2 infection “even those without symptoms”. There was no justification for this measure, he said.

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