October 1, ‘Freedom Day’

October 1 has been given as the date Portugal relaxes pandemic restrictions on a massive scale. Gone will be most of the ‘obligations’ to conform to this or that rule as experts insist it’s time for “civilisational responsibility” – a scenario where individuals can evaluate risks for themselves.

The immediate changes will be seen in the hospitality sector. After 19 months in which bars and discos have been prevented from operating in any meaningful way, doors can finally be flung wide open.

Access will be restricted to those presenting Covid Digital Certificates (it is still not clear whether this includes the option to simply show a negative test, and it is highly likely that people will still be expected to wear masks, for example, on the dance floor).

Disco owners/managers have made it clear they will accept DGS sanitary requirements: all they want is to be allowed to open in safety and finally turn the page on one of the grimmest periods in living memory.

Restaurants, cafés, ‘pastelarias’ will also finally be allowed to function with ‘no limits’ to the number of clients, either inside or on terraces.

These changes are expected to be outlined at a press conference following the Council of Ministers today (Thursday). They come as a result of the meeting the government had with experts at medicines agency Infarmed last week.

As the meeting heard, Portugal has arrived at this ‘brave new moment’ in the pandemic by dint of its exceptional vaccination roll-out. Not only has the programme been handled with deft military precision (by naval vice-admiral Henrique Gouveia e Melo who has become a household name), but it has been embraced by the population in general.

By the end of this week, Portugal should have 85% of its citizens fully vaccinated – and this, insist the experts, has been the key to the country’s success.

Incidence has been falling relentlessly for weeks, as has the Rt (transmission) number. People suffering from the worst symptoms of Covid-19 are reducing.

Hospital numbers haven’t been this ‘good’ for months.

“I am very optimistic,” Manuel Carmo Guedes, one of the country’s leading experts, has said.

What could possibly go wrong?

This, of course, is the loaded question.

In short, a great deal could go wrong – not least because 10 months into the vaccination roll-out, no one can be sure how long the shots give protection.

Data available this far has suggested that immunity conferred by the vaccines falls dramatically after five months, particularly in the elderly (the most vulnerable group when it comes to SARS-CoV-2 infection).

A new study coming out of the Pharmaceutical Faculty of Lisbon University has found that one in five over-65s do not develop antibodies to the virus even after two shots of the (Pfizer) vaccine.

In other words, irrespective of Portugal’s vaccination ‘success’, there is the downside that the shots are fallible – and that is before any new variants appear.

The scenario of a new variant – more capable even than the Delta to evade the protection conferred by the vaccines – is ‘on the table’ as Portugal’s ‘worst case’ possibility.

A slightly less dire forecast is simply entering winter months – post mass-celebrations of Christmas and New Year – at a point when the efficiency of the vaccines has started to wane dramatically.

This, experts have explained, would prompt serious pressure on the health service (likely to exceed red lines in terms of hospital admissions) and see yet another spike in death tolls.

And this is where the thin ice really starts to appear: the catatonic focus on Covid-19 for the last year-and-a-half has ensured that other illnesses have been sidelined to the point that when people displaying them finally get to a doctor, or to a hospital, their needs are far more urgent, and far more complex, than they would have been pre-pandemic when access to healthcare was a lot easier.

Put another way: Portugal is expected to declare ‘Freedom Day’ at a point when temperatures are still amenable; there has been no cold snap to prompt respiratory infections; people are still very much enjoying life outdoors and vaccination immunity is still ‘very new’ in large sections of the community.

Another few months, and all this could change – with no-one really sure what that change will bring.

Schools on tenterhooks

Schools, meantime, are on tenterhooks. The general idea is that with the crushing majority of 12-17-year-olds fully vaccinated, the likelihood of outbreaks will be greatly reduced. But again, no-one can be sure, for the simple reason that current vaccines do not fully stop transmission or infection.

Experts at the Infarmed meeting last week thus raised the possibility of booster shots being required for 12-17-year-olds within the next six months; booster shots being required by the elderly (by December this year) and booster shots being required by the population in general.

The topic was not dwelt on for long – nor expanded. But popped into the mix was the admission that “an extension to the vaccination programme in the under-12s is being considered”.

If one takes a step back and looks carefully at what is being said, no-one seems to know what to expect.

‘Freedom Day’ may end up being just another bend in a very long road.

Focus on pandemic negationists

For reasons unclear, national media has suddenly started focusing on ‘pandemic negationists’. Considering 85% of the population has shown themselves not to be pandemic negationists (by accepting the vaccine), and 11% of the unvaccinated 15% are under the age of 12, it is a curious development – prompted very possibly by the remarks of a former presidential candidate that he would “never” vaccinate any of his children or grandchildren.

Fernando Nobre, however, is not just a former presidential candidate (who incidentally came third, behind Cavaco Silva and Manuel Alegre in the elections of 2011). He is a medical doctor and founder of Portuguese NGO AMI – Assistência Médica Internacional. He has vast experience of all kinds of epidemics and has participated in humanitarian missions throughout the world.

As such, his speech at a recent rally on the steps of parliament in Lisbon may have been seen as threatening the official medical approach. Certainly, it has led to disciplinary proceedings being opened against him by the General Medical Council to which Dr Nobre now has 15 days to respond.

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