Manuel de Almeida / Lusa
The former Minister of Health, Marta Temido, asked for the new INSA study, which now reveals new data.
A period of excess deaths may be “an indication of previous circulation of SARS-CoV-2 that it was not possible to identify”. What does the study say about the impact of the pandemic on mortality between March 2020 and December 31, 2021.
The Ricardo Jorge Institute admits that the SARS-CoV-2 virus may have circulated in Portugal before March 2020when the first case was identified, as one of the peaks in mortality from unknown causes occurred that month.
The study on the direct and indirect impact of the covid-19 pandemic on mortality in Portugal between March 2020 and December 31, 2021 indicates that ill-defined or unknown causes of death were the second cause of death directly most affected by covid -19 in the first two years of the pandemic and suggests that, in the future, any unexpected increase in this cause of death will act as a “early warning sign”.
“The first demonstrations that take place, and this is how the pandemic, for example, in Wuhan [China] was discovered, a set of cases of diseases that cannot be explained”, Ana Paula Rodrigues, the researcher who coordinated the INSA study, told Lusa, which had been requested by former minister Marta Temido, who was responsible for the Health portfolio when the pandemic arrived in Portugal.
Unidentified prior circulation
INSA’s investigation indicates that the two periods of excess mortality higher due to an ill-defined or unknown cause, they occurred in March 2020 and in January-February 2021. In the first case, of lower intensity, the researchers admit that it is associated with lower testing capacity and the scarcity of resources existing during that period.
“The fact that the increase in this cause of death began before the first death from Covid-19 in the country could be a evidence of a previous circulation of SARS-CoV-2 that it was not possible to identify”, says the research.
The second highest excess mortality from this cause coincided with the period during which health services and professionals were under high pressure in responding to Covid-19, making it plausible, under these conditions, “a lower capacity for diagnosis and clarification of all deaths”, admit the investigators.
It is phenomenon has been identified in other countries, such as the USA, Brazil and Italy and therefore suggest: “From the point of view of preparing the response to an upcoming public health crisis, these results suggest that unexpected changes in the frequency of deaths from ill-defined or unknown causes can be used as an early warning signal”.
More than 20 thousand deaths above expectations in the first 2 years
The was notified on March 2, 2020 and on March 16. By December 31, 2021 — the end of the INSA study period — 1,408,420 confirmed cases of SARS-CoV-2 infection and 18,977 deaths from Covid-19 had been reported.
Between March 2020 and the end of 2021, there were four pandemic wavesthe most serious between October 2020 and February 2021, with a maximum number of 296 deaths on January 27, 2021.
Vaccination would only take place on December 27, 2020.
In the first two years of the pandemic, the disease caused 19,119 more deaths than expected for the same period and excess mortality mainly affected the elderly and chronically ill, according to the Ricardo Jorge Institute.
The study requested by former minister Marta Temido, who was in charge of the Health department when the pandemic arrived in Portugal, in March 2020, estimates that between then and December 31, 2021, 21,243 excess deaths90% of which (19,119) attributable to covid-19.
Much more intense impact on the elderly
The work of the National Institute of Health Doutor Ricardo Jorge (INSA), to which Lusa had access, concluded that the pandemic had a very high intensity impact on mortality, mainly due to deaths from covid-19and that these were not the same for the entire population, being more intense in older age groups and in people with chronic illnesses.
“This reinforces the need to prioritize these population groups in the preparation and response to future pandemics, whether in protection against infection and its complications, or in preventing and mitigating the side effects of non-pharmacological measures”, says the study.
Speaking to Lusa, researcher Ana Paula Rodrigues, responsible for this work, said it was not surprising that Covid-19 was the main cause of excess mortality in that period, remembering: “It was a new infection, none of us had immunity and we were all at great risk”.
“The data is close to official statistics, which validates the study and indicates that Portugal had the capacity, for most of the period (…), to diagnose”he added.
For the researcher, it is normal that those most affected were the elderly, because age is a risk factor for Covid-19 and can be fatal in the elderly, in addition to the long life expectancy of the Brazilian population, but with the end of a life lived “with disability and illness”.
“It is these, the most vulnerable, who must be valued and protected, but also the workforce, because otherwise we will have no one to respond to the pandemic,” he said.
The researcher recalled that the elderly and chronically ill people were prioritized in vaccination, but said that, in the future, Portugal “must have the capacity to identify other measures, within the non-pharmacological ones, that specifically protect these age groups”.
“On top of that, some are institutionalized and institutionalization itself is an added factor for infectious diseases, due to the proximity of people”, found the specialist, also remembering that those who are not in institutions, “are very isolated”.
Looking at the characteristics of the Brazilian population, he stated: “We have to look at this entire social context and, in addition to specific protective measures, in the next pandemic, develop other social and health measures to also protect them from other effects, not putting them at risk of worsening other pathologies they already have.”
The study showed excess mortality from all causes in age groups over 65 years old, increasing with age, but highlighted that the direct effect of covid-19 decreased with ageadmitting that the older population may have been “those who most felt the side effects of social changes and the organization and access to health services during the pandemic”.
The researchers also say that changes in economic and social conditions resulting from the implementation of non-pharmacological measures, in addition to the reorganization of health services, “may have contributed to the indirect increase in some causes of deaths during the pandemic”, whether due to delays or avoidance of medical care, an increase in the consumption of illicit substances and suicidal ideation, or even an increase in interpersonal violence.
As in other countries, in Portugal the population with the highest level of economic deprivation was the one in which a point estimate of excess mortality directly attributable to Covid-19 was highest (89%).
