Ricoca Peixoto Vasco, Vieira André, Aguiar Pedro, Carvalho Carlos, Rhys Thomas Daniel, Abrantes Alexandre
Public Health Research Centre. NOVA National School of Public Health. Universidade NOVA de Lisboa. Lisboa; Public Health Unit. North Lisbon Health Centers. Lisbon; European Programme for Intervention Epidemiology Training (EPIET). European Centre for Disease Prevention and Control (ECDC). Stockholm. Sweden. Portugal.
Public Health Research Centre. NOVA National School of Public Health. Universidade NOVA de Lisboa. Lisboa. Portugal.
Acta Med Port. 2020 Nov 2;33(11):733-741. doi: 10.20344/amp.14129.
Portugal took early action to control the COVID-19 epidemic, initiating lockdown measures on March 16th when it recorded only 62 cases of COVID-19 per million inhabitants and reported no deaths. The Portuguese public complied quickly, reducing their overall mobility by 80%. The aim of this study was to estimate the initial impact of the lockdown in Portugal in terms of the reduction of the burden on the healthcare system.
We forecasted epidemic curves for: Cases, hospital inpatients (overall and in intensive care), and deaths without lockdown, assuming that the impact of containment measures would start 14 days after initial lockdown was implemented. We used exponential smoothing models for deaths, intensive care and hospitalizations and an ARIMA model for number of cases. Models were selected considering fitness to the observed data up to the 31st March 2020. We then compared observed (with intervention) and forecasted curves (without intervention).
Between April 1st and April 15th, there were 146 fewer deaths (-25%), 5568 fewer cases (-23%) and, as of April 15th, there were 519 fewer intensive care inpatients (-69%) than forecasted without the lockdown. On April 15th, the number of intensive care inpatients could have reached 748, three times higher than the observed value (229) if the intervention had been delayed.
If the lockdown had not been implemented in mid-March, Portugal intensive care capacity (528 beds) would have likely been breached during the first half of April. The lockdown seems to have been effective in reducing transmission of SARS-CoV-2, serious COVID-19 disease, and associated mortality, thus decreasing demand on health services.
An early lockdown allowed time for the National Health Service to mobilize resources and acquire personal protective equipment, increase testing, contact tracing and hospital and intensive care capacity and to promote broad prevention and control measures. When lifting more stringent measures, strong surveillance and communication strategies that mobilize individual prevention efforts are necessary.
葡萄牙较早采取行动控制新冠疫情，于3月16日启动封锁措施，当时每百万居民中仅记录到62例新冠病例且无死亡报告。葡萄牙民众迅速响应，整体出行减少了80%。本研究的目的是评估葡萄牙封锁措施在减轻医疗系统负担方面的初步影响。
我们预测了在不实施封锁情况下的病例、住院患者（总体及重症监护）和死亡的流行曲线，假设防控措施的影响将在首次实施封锁14天后开始显现。我们对死亡、重症监护和住院情况使用指数平滑模型，对病例数使用自回归积分移动平均模型（ARIMA）。根据截至2020年3月31日的观测数据拟合情况来选择模型。然后我们比较了观测到的（有干预）和预测的曲线（无干预）。
4月1日至4月15日期间，死亡人数比未实施封锁时预测的少146例（-25%），病例数少5568例（-23%），截至4月15日，重症监护住院患者比未实施封锁时预测的少519例（-69%）。4月15日，如果干预措施推迟，重症监护住院患者数量可能达到748例，是观测值（229例）的三倍。
如果3月中旬未实施封锁，葡萄牙的重症监护能力（528张床位）可能在4月上半月就会被突破。封锁似乎有效地减少了新冠病毒2的传播、严重的新冠疾病及相关死亡率，从而降低了对医疗服务的需求。
早期封锁为国营医疗服务体系争取了时间来调动资源、获取个人防护装备、增加检测、进行接触者追踪以及提升医院和重症监护能力，并推动广泛的防控措施。在解除更严格的措施时，需要强有力的监测和沟通策略来调动个人的预防努力。
