Covid-19 still causes damage in Portugal: almost 200 people died in three months and the “number of new cases is immensely higher than reported”

Experts highlight a decrease in the severity of cases, but are quick to warn that SARS-CoV-2 has not disappeared (and even say that it could be remembered annually with a new vaccine)

Portugal is the seventh European country with the most cases of covid-19 and goes against the downward trend seen on the European continent. According to the most recent data from the Directorate-General for Health, since January 1, 3,593 new cases of SARS-CoV-2 infection have been reported, and 197 fatalities have also been reported.

Doctors Filipe Froes, pulmonologist and one of the DGS experts on the pandemic, and Gustavo Tato Borges, president of the National Association of Public Health Doctors, look at these numbers with caution and, even rejecting alarmism, recognize that the number of infected people could , in fact, be considerably higher than reported.

“The total number of new cases of covid-19 is immensely higher than what is reported, without a doubt, but we do not know the real size of the number of cases”, whether in Portugal – “where people are still looking for “something” – or in “the rest of the world”, begins by saying Gustavo Tato Borges.

But how many more cases could Portugal have? “It’s difficult to answer”, continues the Public Health specialist. “The truth is that we are getting a sense of the severity of Covid-19 in Portugal at the moment [pelo número de internamentos, por exemplo]but not its real incidence”, warns Tato Borges.

“It is important to continue monitoring the number of cases, but the impact on society is increasingly difficult to assess”, considers Filipe Froes, who says that this must be a “moment of great balance”, as “we are almost entering the first anniversary of the end of the pandemic and we have already passed the fourth anniversary of the declaration of its beginning”.

Almost 200 deaths in three months

According to data from the World Health Organization, between December 11, 2023 and January 7, 2024, Portugal had 43% more new cases compared to the period from November 13 to December 10, 2023, but 13% less of hospitalizations comparing these two periods. At issue are the recent variants and their respective sublineages, all from the Ómicron family, that is, more transmissible, but less aggressive and disease-causing.

Overall, “there is no variant of concern identified in circulation, which is good”, in other words, “the levels of transmission and severity are within expectations”, says Filipe Froes, adding that the vaccine that is currently in market, with the XBB1.5 variant, “is effective for the JN.1 sublineage”, which has proven to be dominant in Portugal, as revealed by the most recent data from the Dr. Ricardo Jorge National Institute of Health.

“Although [a variante em maior circulação] is more transmissible, it no longer has a clinical impact in terms of severity”, says Filipe Froes. Even so, the year began with 197 fatalities, with no one knowing whether they died from Covid or from Covid, a question that is not new and that compromises the real understanding of the data, say the experts interviewed by CNN Portugal.

“We don’t know if the inflammatory response triggered by Covid-19 has an impact on other pathologies, there are differences between dying with and from [infeção com SARS-CoV-2]. For example, the person may have a myocardial infarction, but to what extent was the virus response a determining factor? Still, these people died from a situation that did not exist before the pandemic. There is one more cause of death to add to those that already existed”, asks Filipe Froes.

Gustavo Tato Borges also considers that “covid-19 could have been just another drop in the number of diseases”, making the scenario fatal, and adds that “it is necessary to continue to warn that the disease can kill the most vulnerable people”, even because, he emphasizes, whether directly or indirectly,“197 [óbitos] out of 3,593 could be significant, it’s about 5%.”

“There is no doubt that around 27 thousand people died in Portugal during the pandemic and, unfortunately, now they continue to die, some of them preventably with SARS-CoV-2 infection.”, adds the pulmonologist, warning that this will continue to be a reality.

Avoid past mistakes

Since testing is no longer mandatory and appears to have ceased to be a routine practice in the presence of symptoms – which compromises, as experts say, having a real perception of the number of newly infected people -, many of the known cases by health authorities are due to visits to emergency rooms and health centers or contacts with the SNS24 line.

But Filipe Froes says that we need to go beyond that and stop being hostage to “people’s voluntarism”. It is necessary, he adds, to anticipate new cases and, to this end, he advocates “the screening of viral activity in wastewater, like other countries, so that we are not so dependent on people’s goodwill and voluntarism”.

“This allows the monitoring of other microorganisms and also allows us to anticipate increases in activity in the community, in order to take correct measures”, explains the pulmonologist.

But vaccination is where the secret lies, experts say. Although Portugal continues to have a higher vaccination rate than most countries, the last round was lower than expected. According to Filipe Froes, the most recent data points to a “vaccination coverage rate of 55% for people over 60 years of age”, rushing to say that “it is little, it is half of the people” who should be vaccinated. And he adds: “In every three people we have one over 80 years of age who is not vaccinated.”

“We should have higher values, but these values ​​are better than in other countries”, recognizes the pulmonologist. According to the most recent data from the DGS, 1,988,679 people were vaccinated against covid-19 in this, still ongoing, vaccination campaign.

Gustavo Tato Borges points the finger at “tiredness” – the so-called pandemic fatigue – and at “communication that is not very clear and based on a comedic tone, which stops the target [da vacina] it would not have gone down in the best way”, which may not have effectively conveyed the message of the importance of vaccination.

“People don’t understand why they took so many [vacinas], but it must be explained that they took so many because the virus was evolving. Unlike the flu, there were many developments in a short space of time and this meant more vaccines. And, given the new variant, the vaccine remains effective”, assures Filipe Froes.

Furthermore, Tato Borges also criticizes the lack of proactivity of health authorities. “We were hoping that the user would be the one to schedule [a vacinação]but we, the National Health Service, have to be the ones to reach out to the user”, he warns, explaining that this may have been one of the reasons why people did not adhere to the vaccination in pharmacies as expected, although he argues that they were a “added value and a very important partner” in the process.

From this year onwards, the two experts believe, the vaccine against Covid-19 will be part of the seasonal ‘menu’, with the most certainty that a combined vaccine for influenza and Covid-19 will arrive soon, however, the scenario of “Interim vaccination” – in which, in the absence of mutations, the same vaccine is valid for more than one year – may also be a reality. However, although this already seems to be an almost certain scenario for those working in the field, Tato Borges argues that the message must reach people as soon as possible.

“I think it will also be important that the DGS and the Executive Directorate of the SNS, when planning the next vaccination season, have an extension calendar planned for younger age groups, informing that the first [a serem vacinados] they are the most vulnerable and then we can expand, this gives a sign of more professionalism”, says the Public Health doctor.

But in the end, Froes guarantees, “we will have another vaccine every year”.