Preparation and unified action across sectors is saving Portugal
PORTUGAL is not a rich country. It doesn’t have Germany’s advanced pharmaceutical and manufacturing system, South Korea’s prior experience with Mers or the UK’S elite higher education system.
As the coronavirus ripped through Italy and neighbouring Spain, there was genuine concern the Iberian nation with the fewest critical care beds in Europe would be next.
So how does one of the eurozone’s poorer countries have a Covid-19 testing rate more than double almost every other nation in the world? Medical experts say immense efforts from the private and university sector, and a government that allowed them to act, tell a big part of the story. Portugal shares many similarities with Italy and Spain. It has the third-highest percentage of people over 65 after Japan and Italy, according to The World Bank Group, and grandparents are much more likely to live with their children and grandchildren than in the UK.
Inês Fronteira, professor of public health at the institute of hygiene and tropical medicine at NOVA University Lisbon, said reports from Spain and Italy were a motivation to abide by social distancing restrictions. That, and the knowledge that Portugal has few intensive care beds. “I believe that there was some kind of – I wouldn’t say fear – but thinking that we should be careful because we might not get the response we need if we don’t stay home,” Prof Fronteira said.
The virus arrived in Portugal on March 2, almost a month after it hit Italy and Spain. The government closed schools on March 16, with 331 cases confirmed, and declared a state of emergency on March with 785 cases – five days after Spain did the same with more than 6,000. But none of that explains how Portugal is managing to test more of its population than almost every country in the world.
In the UK, government labs dominated testing, but in Portugal scientists and private firms stepped up. As recently as the first two weeks in May, non-state labs were still responsible for more than half the near 14,000 tests conducted each day.
Prof Maria Manuel Mota, director of the Institute of Molecular Medicine at the University of Lisbon, was one of those who realised early on that decisive action was needed. On March 11, she reasoned that her institute’s experience with Pcr-based tests for malaria could be leveraged to test for Covid-19. “The test we do all the time in our institute is PCR,” she said. “Instead of relying on expensive kits from abroad [I thought] we could design something.” To lead the project, she called on researcher Vanessa Zuzarte Luís, who had a potential testing protocol in mind within a few hours. The next day, they were speaking to a Portuguese firm about manufacturing the reagents needed for the tests, one factor UK authorities blamed for testing difficulties. They were ready and working within a week, leaving only accreditation from the Dr Ricardo Jorge National Institute of Health left to secure.
“The authorities were fantastic,” Prof Mota said. “As soon as I called the right people, they told us, ‘OK, let’s validate this together’.” The accreditation process ran smoothly, and tests were being rolled out to nursing homes by the end of March. Within three weeks, university labs and private institutes across Portugal were using the protocol developed at the IMM, or developing their own. In the UK, independent labs trying to take similar steps were still saying that their offers to help were being ignored as late as April 10, well after Matt Hancock, the Health Secretary, set a target of 100,000 tests a day.
But even in Portugal, the picture is not all rosy. Almost 1,289 people have died, fewer than many European countries but more than Austria, Denmark and Greece to name a few.
Filipe Froes, one of Portugal’s leading pulmonologist, said the effort had hinged not just on the rapid government response but on the wider community, from citizens staying at home or making PPE for doctors, to the winemakers making disinfectant “In the end, this is not a miracle,” he said. “This is work and organisation. We follow a strategy. In Portuguese, we say, ‘If you don’t know where to go, no wind is favourable’. We knew where to go, and took advantage of the two weeks ahead of us to prepare.”