Health chiefs brace for unusually demanding autumn/winter

With summer hurtling towards autumn, a number of very stark realities have come clear: the Covid situation this August is markedly worse than it was last August (before the arrival of the vaccines), the Delta variant has kicked the notion of herd immunity deep into the long grass and no-one can be sure ‘what will happen next’.

Experts talking on national television have variously said “we may need to go backwards” in terms of ‘deconfinement’, and that “we should go forwards faster” as the SARS-CoV-2 virus is now endemic, and there seems little that anyone can do to change this.

Conflicting views and information can be found at every turn.

But in the morass of uncertainty, DGS health chiefs are taking no chances.

Reports on Wednesday explain they have drawn up a plan for autumn/winter to try and respond to what they can see is coming: elevated pressure on the nation’s health service – already exhausted from the last two years fighting Covid, and many would say still critically understaffed.

The problem with the plan is that it depends on new variants (of concern) not appearing – and even then, it seems to accept that pressure and mortality “could become elevated”.

Said Sol online on Wednesday: “In the worst-case scenario, which could occur if a new variant appears and/or a rapid reduction in the efficacy of the vaccines, the pressure on the (health) system will again be high and could result in excess mortality from all causes – an alteration of the current course of the pandemic which experts warn could happen quickly.”

Elsewhere, newspapers have been carrying reports of hospitals in the north and centre suffering unusually high demands – particularly with regard to A&E fluxes which are higher than they were in the days ‘pre-pandemic’.

In Lisbon, for example, an official source at Hospital de Santa Maria – one of the largest health units in the country – reported that people arriving in A&E through August have had “more complex” situations than usual for this time of year, “implying longer processing and very often resulting in internment”.

Predictions (by doctors, in the early days of the pandemic) that tunnel-focus on Covid was going to leave non-Covid issues to fester appear to be coming home to roost.

Again, on Wednesday, tabloid Correio da Manhã reported that “over the last few days, there have been an average of 400 emergency episodes per day” in several Lisbon A&E departments. “Doctors have warned that many patients are arriving with serious conditions after two years of pandemic without the necessary care,” said the paper.

Against this backdrop, Jornal i outlined the health authority’s ‘plan’ for the coming months – stressing that “all scenarios traced by specialists at DGS and INSA (public health institute Dr Ricardo Jorge) point to months of pressure”.

The ‘first scenario’ is one in which “current transmission of Covid-19 (sic: this is a common mistake, transmission is of SARS-CoV-2, not Covid-19) remains as it is, without new variants and without alterations in the effectiveness of the vaccines”.

In this case, pressure on the health system and deaths are expected to remain moderate. The winter should be ‘less serious’ than it was last year “when non-urgent activity was suspended to respond to the increase of critical Covid patients”.

The second scenario is one in which “no new more transmissible variants appear but there is a slow reduction in the effectiveness of the vaccines”.

In this situation, “services should prepare for elevated pressure and moderate to elevated mortality”.

Then, the worst case – as already explained – anticipates “excess mortality from all causes” and an acceleration in the course of the pandemic.

Solutions/preparation – beyond the fact that 85% of the population will soon be covered by the vaccines – involve:
■ vaccinating priority groups against flu
■ making the flu vaccine available in more places than usual
■ administering third shots of the Covid vaccines to the immunosuppressed
■ increasing working hours at health centres to respond to heightened demands

This is not a ‘hard and fast’ policy yet: opinions are still being sought from the General Medical Council, the Order of Nurses and other health bodies.

Ana Rita Cavaco, president of the Order of Nurses, has stressed the plan has to be ‘workable’ – and for that to happen, the health service needs more nurses, she says: “not just in hospitals and primary health care but in continuous care and ERPI facilities (old people’s homes)”.

“Vaccination can lead to an easing of consciences with regard to what happened last winter, but with one nurse to dozens of old people, it is impossible to have any control of infection in an old people’s home,” Ms Cavaco warned.

Numerous reports have indeed surfaced through the last few weeks concerning outbreaks of Covid-19 in old people’s homes where residents and staff have all been fully vaccinated. The drop-off in effectiveness of Covid vaccines is no longer a tabu. It is just a question of whether authorities can keep up with it.

Talking to SIC earlier in the week, intensive care specialist Roberto Roncon was presented as one of the experts believing it is time to accept SARS-CoV-2 infections as ‘endemic’ and reopen society regardless.

As he said, “the economy and the country don’t close down in winter because of the flu…”

Public health expert Tiago Correia was more hesitant, however. In his opinion, there has to be “an exceptional strengthening of institutional communication so that the government can explain that we are one of the most advanced countries in the world in terms of vaccinations – this is excellent news – but if there are some setbacks and the country has to take a step back in ‘deconfinement’, (the government has to be able to explain) why this is happening”.

Eight months on from the most ambitious vaccination campaign Portugal has ever seen, and no-one seems able to predict how much protection citizens have really been afforded.

New rules for schools
Only too aware that vaccine cover reduces in age groups below 50 years old, DGS health chiefs have decided to tighten preventative measures in schools.

To this end, mass testing will be going ahead – first of teaching and non-teaching staff from next Monday, then of pupils from the start of term – while mask mandates are being extended to the over-10s.

Even children from the ages of six will now be “strongly recommended” to wear masks during the school day.

The only ‘relief’ seems to be likely when it comes to isolated cases of infection being flagged. In these situations, whole classes will not be sent home for two weeks at a time, explain reports – although it is still not clear who will be sent home, and for how long.

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