Marta Temido, health minister and one of the best-known figures of Portugal’s fight against coronavirus, stood outside a beleaguered hospital near Lisbon this week and made an impassioned plea.
“We are mobilising every health resource at our disposal,” she said. “But there is a limit, and people have to know that we are very close to that limit.”
Her appeal for the country to respect the rules of a second national lockdown came as record numbers of new cases and hospitalisations threatened to overwhelm a national health service struggling to find more beds and more staff.
After infection rates began soaring in early January, Portugal this week became the country with the highest seven-day average of new coronavirus cases per 100,000 inhabitants in the world, according to Johns Hopkins University.
Health services were coming under “brutal pressure” and doctors suffering “burnout and moral anguish” from having to make complex and difficult decisions over prioritising patients, Miguel Guimarães, head of the Portuguese Medical Association, a professional body representing doctors, said in a statement on Monday.
In March and April, Portugal won international praise for its rapid and effective response to the first wave of the pandemic. But it has since become one of the European countries hardest hit by a second wave that took hold in November and has surged to record levels this year.
António Costa, prime minister, on Monday warned the number of Covid-19 infections and deaths would continue to increase this week. “We are living through the gravest hour of the pandemic,” he said, speaking after record levels of fatalities on seven of the previous eight days.
While Portugal has suffered fewer deaths in total since the beginning of the pandemic relative to its 10.2m population than many other countries — including the UK, the US, Spain, Italy and France — it recorded on Monday the third highest seven-day average of Covid-19 fatalities, behind the UK and the Czech Republic (per 100,000 inhabitants). In total, Portugal has recorded 566,958 infections and 9,246 deaths since March.
Ricardo Mexia, an epidemiologist and head of an association of public health doctors, attributes the recent surge in cases to a “perfect storm” of conditions, including a failure to flatten the growth curve of infections sufficiently in the autumn, winter respiratory illnesses and a cold spell. Psychological factors are also playing an important role, he said, as positive messaging around Portugal’s Covid-19 vaccination programme, which began in late December, led people to drop their guard.
Health experts criticised the government for relaxing confinement measures at Christmas too far, lifting travel restraints and allowing families to decide for themselves how many households and people could gather.
“An increase in cases was inevitable after the holiday and this was not properly planned for,” said Mr Mexia.
Doctors and nurses across the country have given dramatic accounts of the pressures they face. “I saw a colleague crying after leaving a Covid ward physically and psychologically exhausted five hours after her shift should have ended,” Ricardo Baptista Leite wrote on social media this week. “As one patient is stabilised, three or four more patients needing stabilisation arrive.” Mr Baptista Leite, health spokesman for the opposition Social Democrats, volunteers as a hospital doctor at weekends.
“We’ve already seen patients being triaged in lines of ambulances waiting outside [overcrowded] hospitals,” Mr Mexia said. Portugal’s track and trace system for identifying chains of infection was also struggling to cope, he said, with thousands of people who should be in isolation not being monitored.
“We haven’t yet reached the kind of catastrophic collapse [of the health system] that we saw in Spain and Italy, but we are close to it,” said João Gouveia, a doctor who heads Portugal’s intensive care association. But if infections continued to increase at the current rate for another week or so, the health service could suffer a similar breakdown he said: “The next six or eight weeks will be very tough.”
Under fire from doctors and epidemiologists for not imposing more restrictive measures sooner and not enforcing them effectively, the government is appealing to people to stay at home. “We succeeded in defeating the virus in an exemplary fashion during the first wave . . . and now we have to do it again,” Mr Costa said.
Portugal on Friday moved from a tiered regional system of confinement to a full national lockdown intended to mirror the successful restrictions of last spring. Mr Costa, however, was forced to tighten the measures on Monday after large numbers of people filled parks and strolled beaches at the weekend. The doctor’s professional body criticised his government for “half measures that serve neither the health sector nor the economy”.
The government has ruled out closing schools or universities, which were shut during the first lockdown. Some epidemiologists argue this is only postponing their inevitable closure as the pandemic worsens. But Mr Costa said interrupting a generation’s education for a second year “cannot be justified in health or social terms”. He told parliament on Tuesday, however, that the government would consider closing schools if the fast-spreading variant of the virus first identified in the UK became dominant in Portugal.