Deaths from covid in Portugal are above the “red line”, but we are not talking about that: “Everyone wants to return to normality, the question is at what price”
In the DGS risk matrix, we have been in the red for a long time. The unprecedented value, driven by new variations of Ómicron variation, caused the risk to increase. However, the pressure on services is further from reaching the situation of a reassuring factor. According to the latest report from the lines of services, the occupancy in intensive care stands at 60% of the alert level, at the national level.
There is, however, one “annoying indicator”: mortality. Per day, for the last two weeks, the median number of deaths in the covid-19 bulletin is 37.3 – a value far from the dark months of January and February 2021, but one that still raises questions. “The only reference element we have is the value of the ECDC [Centro Europeu de Prevenção e Controlo das Doenças]”, which traces the red line on the 20 dead, in 14 days per million inhabitants, explains researcher Tiago Correia. Portugal is clearly above: on January 19, according to the DGS red lines report, the value was 37.6, an increase of 47% compared to the previous week. This has been the case since December 10, with an increasing trend.
Despite the accumulation of five and vacancies, two years of variation were created by the new variation of vacancies and two years of pandemic experience were created. “The issue is that we do not have a term of comparison between what is a mortality due to covid or what is acceptable and will be normal”, says the professor of International Health and researcher at the Institute of Hygiene and Tropical Medicine at the Universidade Nova de Lisboa. At this point, the transition from the pandemic to the level of endemic is already being considered – an installation installed in the community, but with a predictable pattern, in which some epidemiologists say we have already found ourselves.
“We have cases, but with very limited severity”
This Wednesday, a new maximum of new infections was recorded (more than 65 thousand). In contrast, admissions (2313) change to about a third of those a year ago. Despite several cases, the number of severe cases is close to one month (15 cases).
“Looking at the general panorama, there is a situation that is not exactly out of control”, considering mathematician Óscar Felgueiras. After all, the characteristics of the new variant are generated “many cases with a limited severity”.
The indications indicate that this scenario should maintain. “We are not going to get to the red lines of admissions and intensive care. This makes us assume that things are going well, but they are already on the red line of deaths”counter-arguments Tiago Correia.
What are the “red lines” anyway?
The discrepancy in the analysis of the current situation of the pandemic arises in mortality. “Right now we are not having a discussion or seeing an interpretation about mortality, because it is the uncomfortable indicator. It is a gray area that is difficult to interpret.”says Tiago Correia.
Those registered since Wednesday (42) are much longer than the 303 registered a year ago, on January 31, 2021, the day with the highest mortality or the beginning of the pandemic. However, the average is above the red line, the classification already in the classification of “high risk”. This reference, charted by ECDC in March 2021 based no WHO guide, results from a matrix that establishes six levels for the epidemiological situation. Portugal is not currently at the fourth severity level.
These reference matrices aim to provide “a coherent, but not prescriptive, framework to fine-tune as measures to respond to covid”, explains the ECDC. In other words, the aim is to help governments study their situation at hand to act accordingly.
“ONE [linha vermelha] is an ECDC convention that serves as a reference. The future will always be below that reference line.” Explains mathematician Óscar Felgueiras. “In circumstances like the current one, it certainly deserves some thought in terms of do’s and don’ts in terms of measures.”
Tiago Correia knows that everyone wants “return to normality”Nobody wants to hear about a lockdown, not even about limited deadlines in trade or even about the presentation of certificates. The question is “what price” do we accept to pay: “At this point there is some reflection on what is the acceptable number from an ethical point of view so that it cannot return to normality.”
“Most of the deaths are elderly, as always”
The WHO considers mortality an “indirect indicator of insufficiency” that provides a “delayed” measure of its evolution. rise in the numbers of new cases started from mid-October, the red line of deaths was only outdated about a month and a half ago.
According to Óscar Felgueiras, this discrepancy is justified because “mortality is highly conditioned by the evolution of the elderly”. “Most are elderly, as they always have been.”, explains the math. Of the 42 deaths recorded this Wednesday, 24 were over 80 years old and another 10 were between 70 and 79.
“There has been a recent rise, which means that there may have been an increase in cases, namely in the 80+. This is a unique age group has not yet reached the peak of the possible it reached in January of last year. The elderly are quite protected, with relatively low disability”, explains Óscar Felgueiras.
The question that arises is what will be the evolution from here. “Everyone expects it to go down, but if we assume we’re going to have this infection circulating, is to be expected while people go further and heavy.”
“It’s always a bit uncertain, but hopefully [depois deste pico] there is some normalization”due to the additional protection no, corroboration for the protection, but also for the infection, Oscar, but also for the infe. “In terms of measures, it is difficult to say at what point the elderly are completely protected from this situation”adds the specialist from the Northern Regional Health Administration team that follows the pandemic.
“Talking about endemic does not mean that a virus disappears or that it becomes harmless”
For the future, defining what constitutes excess mortality will also depend on the evolution of the pandemic itself. In recent weeks there has been talk about entering a new phase, the endemic. Although Marcelo Rebelo de Sousa has already assumed that the country is at that moment – as are some epidemiologists – Tiago Correia is more cautious.
“My expectation is that we are entering this endemic path, without being able to call it endemic”, says. Changed into kids “The endemic means that the problem of the virus and its behavior, to anticipate where it will appear, in which people The most obvious sign that it still doesn’t do that is that it doesn’t know how often we have to vaccines”. 2022 will thus be, in his opinion, a year of a progressive transition to this new phase.
And the covid-19 endemic can still bring surprises, he explains. “One endemic disease is not necessarily the same as another. For example, malaria is endemic in many African countries, it kills and there is no cure”, but the complaint is also endemic and has a completely different expression. Which also depends on the treatments that come up.
Therefore, “talking about endemic does not mean that a virus disappears or that it becomes harmless” and its configuration “It will greatly affect what will be the mortality of covid-19”.
“Excessive mortality” from winter can “normalize” covid deaths
In this analysis, Tiago Correia also highlights that, in Portugal, there is excessive mortality from respiratory diseases and infections in winter that existed long before covid-19.
“We know that we have a very vulnerable population. [a estas patologias] from an epidemiological point of view, but also from a social point of view. Our older population is poorer and lives in energy poverty with no conditions to sometimes become, in addition to lack of access to health professionals.”
This can contribute to a certain “normalization” of covid mortality, similar to what happened with a complaint. “At the beginning of this pandemic there was, and well, a concern with very covid mortality.
“What I think is happening is that nothing is found with the pandemic. These deaths are happening, but it seems that this number does not exist. This number of deaths is assumed to be normal without any certainty as to whether or not they are preventable.”
“Massification takes a lot from the individual experience and this can bring about a vulgarization of suffering”
The psychological and sociological dimension is added to the ethical reflection on this mortality. As a society, we have developed a strategy to survive the pandemic, which, collectively, naturally undergoes relativization. The DGS conferences stand out both at the beginning of the 2020 conference and in the 2020 conference, it was the DGS conferences that so widened their relevance.
“Today we continue to have very intense numbers, but, after the impact of the moment, they are valued. As changes in the virus itself potentiate this, [achamos que] it is all less serious than in the past and the other variant is that it was more dangerous”, says psychologist Eduardo Carqueja.
“On the one hand, [essa desvalorização] helps, but on the other hand it also distorts the impact that each person can have on their life. It is the problem of the massification of the event due to the individualization of suffering. Massification takes much of the individual experience. This can bring here a vulgarization of the look at people’s suffering”, develops the president of the Direction of the North Regional Delegation of the Order of Portuguese Psychologists.
For now, the specialist will consider it too early to realize that the impact is that this mortality on our society, but it is something that “it will be interesting to study in a few years”.
“We are at a time of excellence to compensate for the type of intervention that we can make or have in the future for people in mourning. If not, we are merely reactive to events. It seems that, after this pandemic, an endemic is becoming more common, but as we continue to have the value it had until this time. As these people need to continue to be few tides into account”, he analyzes.