Rapid tests should be “free or easily accessible,” suggests the epidemiologist Coronavirus

Portugal has already managed to quickly achieve a transmission index (Rt) of infection with the new coronavirus below 1, but is continuing the positive rate of diagnostic tests, which is now around 15% and the daily average is still very high. The epidemiologist Manuel Carmo Gomes, one of the experts advising the government at Infarmed meetings, is unavoidable: the decision to opt out must be made based on these three indicators. If we have already achieved one of the goals – “an RT below 1.1” – the rate of positive diagnostic tests needs to be reduced to “at least” less than 10% and the incidence reduced to an average of less than 10% 2,000 new tests Cases per day, emphasizes the professor of epidemiology at the Faculty of Science in Lisbon.

It is therefore not easy for the epidemiologist to determine when the delivery should end. This Tuesday, at the Infarmed meeting, Carmo Gomes suggested respecting these three “red lines”, objective barriers over which we must be restricted. And if the incidence continues to decline in the next few days, strategy will need to be changed and investment in mass testing to detect cases of infection early, disrupt transmission chains and reduce the rate of positive tests, advocates. “I think testing is the main weapon we should be using, not the limitation,” he said.

How is that done? Mostly by relying more on rapid antigen tests and continuing to do PCR diagnostic tests, he told PUBLIC. The difference is that “the first ones are cheaper and give results in a few hours”. For this reason, rapid tests should be “free or easily available” and their use should be encouraged in the population “who should be encouraged to take tests”.

But is there no limit to the number of daily tests that can be done in Portugal? What the Minister of Health said is that the problem is not in the number of tests, but in the follow-up of the detected cases of infection, which implies a strengthening of human resources for following up contacts, recalls Carmo Gomes. “I ask: what is cheaper? Are you serious about investing or staying closed for weeks? “.

At the Infarmed meeting, the intervention of Carmo Gomes, who will no longer be part of the expert panel in order to have more time to work in the Technical Vaccination Commission of the Directorate-General for Health (DGS), was very open and bluntly critical. The epidemiology professor believed the measures were late in being adopted by the government to “follow the epidemic” which has helped divide public opinion on the appropriate restrictions to curb the growth of new cases.

“We dealt with the epidemic by reading the indicators that typically arrive seven days late to take action that seemed appropriate to the situation. It then took us a week to 15 days to see the results of the measures. Usually the measures are not enough and we keep doing it, ”he said. And he summarized: The past shows that the strategy of “step-by-step measures” adopted by the government has proven to be “ineffective”.

But only the Ministry of Health can define the boundaries from which one can presume: “We need to understand the number of new cases, hospitalizations and hospitalizations in the intensive care unit that help patients with Covid-19 and do not affect the care of other patients. And that’s what the Ministry of Health has to say. “

Locked up until mid-March?

The experts who advised the government see no other alternative than staying in detention until mid-March, according to Baltazar Nunes, epidemiologist at the National Institute of Health, Dr. Ricardo Jorge (Insa) stated.

The specialist announced that Insa has examined three containment scenarios: 30, 45 and 60 days. However, the two-month detention scenario from January 15 to March 15 has the greatest effect. “The mathematical models tell us that we need to maintain these measures for two months to reduce the number of ICU beds under 200 and the accumulated incidence under 60 cases per 100,000 population,” he said.

Baltazar Nunes also gave good news that for the last five days analyzed (from January 30th to February 3rd) the Rt was then 0.82 and that the decrease was observed near the day the restrictive measures were applied. The worst is behind us: According to André Peralta Santos of DGS, the peak of the incidence occurred on January 29th and that of the mortality, which tripled from the December peak, will have been reached in the first week of this month.

For the President of the Public Health Institute at the University of Porto, Henrique Barros, the data show that the lightest containment measures also showed some effectiveness, but it will be necessary to analyze other variables such as the influence of temperature and temperature Heterogeneity of mortality rates in different regions of the country. Henrique Barros analyzed the effects of vaccination on hospital admissions and mortality and concluded that with scheduled surgery we “will save 3,500 lives by the end of September”.

“A lack of definition shouldn’t appear in the next 15 days or a month,” said Carla Nunes, director of the National School of Public Health at Universidade Nova de Lisboa, who presented the results of two studies at the meeting. One proves that confidence in vaccines has increased significantly and the other shows that Portugal ranks fourth out of a group of seven countries in terms of the number of years of potential life lost per 10,000 inhabitants, which is 39.82. This number is the sum of all the years that may have been lost by those who died below average life expectancy in old age.

At the end of the meeting, the Minister of Health assumed that she supported the massive testing strategy and again announced that she would ask the DGS to redefine the test criteria in order to extend them to all risk contacts, regardless of the risk level, as opposed to what is happening today.

with Cláudia Carvalho Silva