Defibrillation hangs in the municipalities with the highest risk

The reopening of the country starts from this second stage, which starts on Monday after Easter, to be able to have different speeds in the country. The Government evaluates and decides this Thursday in the Council of Ministers the measures for the next fortnight and if it is necessary to have the first adjustments to the deconfination plan presented on March 11th. And despite the fact that throughout the country the terraces are preparing to open and the Lisbon Chamber and even the Directorate-General for Cultural Heritage (DGPC) have announced before any formal announcement by the Government that national museums, monuments and palaces will reopen from April 5, with free weekend tickets, the country may not proceed to the new stage at the same pace.

The red lines were announced by the Government three weeks ago and, in general terms, the country is within the comfortable zone, with an incidence at national level below 120 cases per 100 thousand inhabitants and an RT that, according to the calculations of the National Institute of Health Dr. Ricardo Jorge, converges to 1 but has not yet reached that value. Therefore, in the risk matrix presented by the Prime Minister, the country is in the green zone. However, the Ministry of Health confirmed to the Sunrise that the Government has adopted a model in which the deflation is unblocked in the municipalities with a more favorable epidemiological situation, which may be suspended if it is in the orange zone (a cumulative incidence of 14 days exceeding 120 cases per 100 thousand inhabitants) or falling back if reach the red zone (more than 240 cases per 100 thousand inhabitants), which will be applied at the municipal level.

If in the past year the risk analysis system by municipality had already been in place, there is now another novelty: the incidence calculation used to make decisions starts to be made in order to weigh the risk of neighboring municipalities and at the same time correct the effect population density in this indicator – in a municipality with few inhabitants, relatively few cases could put the municipality immediately in the red. In practice, to correct this effect, the 14-day incidence, calculated strictly according to the new cases and the population of each municipality, is no longer used, and a calculation is made that encompasses neighboring municipalities.

The idea was suggested by the team of the Northern Regional Health Administration that presented the proposal for a deconfinition plan at the request of the Ministry of Health, led by Óscar Felgueiras and Raquel Duarte. At Nascer do SOL, the Ministry of Health advanced the general lines of how decisions will be taken from now on and forwarded decisions and announcements to this Thursday: «The risk matrix, combining two criteria (incidence and transmissibility), allows monitor the evolution of the epidemiological situation at the level of the continent. If we evolve to the yellow zone, the process of deflation may not proceed according to the planned schedules. If we move to the red zone, there may even have to be a setback in the deflation measures. In the event that it is necessary to make such decisions – stop or retreat – they will apply only to the municipalities at greatest risk, depending on the respective municipal incidence corrected by the incidence of the neighboring municipalities ».

Bulletin incidences do not allow foresight of brakes

In the update of the cumulative incidence to 14 days per municipality made available by DGS this Monday there were 32 municipalities above the threshold of 120 cases per 100 thousand inhabitants, in this orange zone, nine of which with more than 240 cases per 100 thousand inhabitants.

However, these data will no longer be the data analyzed this Thursday by the Government. DGS has maintained the methodology of updating the calculation of the cumulative incidence at 14 days per municipality on Mondays, but with reference to the cases reported up to the beginning of the previous week. And last year, the decisions were made by the Government with the most up-to-date calculations, from the current week. Thus, this list that places 32 counties above the level of 120 cases per 100 thousand inhabitants refers to what was the country’s epidemiological situation on March 23. However, the incidence of new cases of covid-19 at 14 days has continued to fall across the country, although an increase in diagnoses has been noted in recent days.

On the other hand, with the use of an adjusted incidence calculation, the fact that a municipality appears with more than 120 or more than 240 cases per 100 thousand inhabitants in the DGS bulletins may not mean that there will be a brake on the deflation because it may be the case that, considering the neighboring counties, this effect is diluted. A municipality apparently below the risk threshold that is surrounded by others with a strong epidemic activity can be seen above this level. With the current epidemiological situation, there will be few municipalities in this situation and especially in the south of the country, which is also the only one in the country where INSA calculates a RT greater than 1. The team from the Faculty of Sciences of the University de Lisboa calculates a RT higher than 1 at national level since last week and there is some apprehension among experts heard by Nascer do SOL regarding the fact that this is an atypical week and in which there may be, despite the rules, greater mobility. In the last edition, the epidemiologist Manuel Carmo Gomes also admitted apprehension with the conclusions of a modeling of hospitalizations for the coming months, taking into account the evolution of vaccination coverage and the dominant, more transmissible English variant, which suggests that a level of deflation this fall, this spring, with the full opening of schools, would not prevent a fourth place in May. The Ministry of Health did not clarify whether this study, the first modeling of the impact that deflation can have in the country due to the percentage of people vaccinated, was analyzed and whether it can motivate any changes in the vaccination plan or in the deflation plan.

Nascer do SOL also sought to understand whether all indicators defined as red lines will be published on a regular basis by the working group that brought together experts from FCUL, INSA and DGS: in addition to the incidence and RT, the rate of positivity, the percentage of cases and isolated and tracked contacts within the first 24 hours after notification and the percentage of confirmed cases notified late. The Ministry of Health indicated that daily, through the covid-19 bulletin, the main indicators are revealed, not clarifying whether the rest will also be advertised.

If there is a brake on the debunking at this stage, one of the decisions will have to pass on whether it is total or if some activities reopen in the meantime, and the Government has hitherto pointed out the resumption of school activity as a priority. For the next week, it is the turn of the students of the 2nd and 3rd cycle and 15 days later, in the third stage of the deflation, students of the secondary and higher education.

Mass testing has not yet taken off

The first days of the week were marked by an increase in diagnoses compared to last week, and yesterday there was still no data available on the number of tests done in the last days. With schools closed and holidays on Friday, they may be less and the effect of Easter on both testing and increased contagion will only be measurable after the start of the second stage of deflation.

Last week the tests went down and, with the exception of the first week of deflation, there has not yet been a significant jump in testing. Portugal maintains the lowest incidence rate of new cases at European level and a positivity also below 2%, but there are countries with lower positivities and testing more.

According to the last weekly report by the European Center for Disease Prevention and Control, referring to the week of 15 to 21 March, the first of reopening, the country was the 17th in the EU to do more tests per 100 thousand inhabitants and last week it will have back down. In the last week, with comparable data at European level, Portugal carried out about 2500 tests per 100 thousand inhabitants. In Denmark, one of the countries given as a reference in mass testing, more than 30 thousand tests are performed per 100 thousand inhabitants in a week. In Austria more than 20 thousand.

In both countries, access to regular tests is free for the population. In Portugal, there is still no news about the reimbursement of tests in addition to the periodic screenings foreseen in sectors such as homes and schools. This Wednesday, tests to be done at home in the Pingo Doce parapharmacies began to be sold and should soon arrive at pharmacies. One of ECDC’s alerts was already for the need to have mechanisms for reporting positive and negative results, as access to tests without prescription can interfere with the calculation of positivity, one of the indicators that allows monitoring the epidemiological situation (results from the total of positive in the total of tests done in the country). Another concern is equitable access. DGS, Infarmed and INSA, in a joint response to Nascer do SOL, indicated yesterday that the platform for online notification of results, provided for in the ordinance that regulated the use of self-tests, will be made available “in due course”. At this moment the procedure to be followed by those who buy a test to do at home and have a positive or inclusive result is to call the SNS24 line.

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