Mortality until March of this year, in the territory covered by the ARS Norte, was at the average of the last five years, in some weeks it was even below that average. Until, with the first wave of covid-19 in the country, the scenario changed, the mortality curve rose and has remained high since that time. The districts that make up Minho, Braga and Viana do Castelo, follow this trend of increasing mortality.
None of this would be surprising if it were possible to explain this increase with the deaths caused by covid-19. But it’s not like that. In May-July there was a peak of mortality that the Directorate-General for Health (DGS) says that it coincides “with periods when there were higher temperatures in Portugal”. DGS states that it was in the period between July 6 and August 2 that the “ÍCARO system (instrument of epidemiological observation coordinated by INSA, which measures the effect of heat on health) early identified a period of extreme heat, predicting significant impacts in mortality ”.
Data from the Portuguese Institute of the Sea and the Atmosphere (IPMA) reveal that July 2020 was the warmest month since 1931. The heat waves of July reached mainly the central region and the northern interior of the country. Here may be part of the explanation for the increase in mortality in the North.
As for the first sudden rise in mortality, in March, DGS can only be explained in covid-19. In the absence of “another robust explanation, it is hypothesized that the covid-19 pandemic was the most likely cause of the increase in mortality in this period”.
Source: SNS
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Continuing to follow the graph, however, it appears that mortality peaked again in September and October and that it reaches November on the rise. Regarding this last phase, an assessment by the DGS is not yet known, but it is likely that the explanation lies in the reduction of the “non-covid” activity of the SNS.
“In primary care we lost seven million face-to-face contacts, between nursing and medical consultations, in hospitals we are talking about more than one million consultations, more than 100 thousand surgeries, this until July this year, which can have effects on health , mainly for chronically ill and older patients ”, says Alexandre Lourenço, president of the Portuguese Association of Hospital Administrators. “In these scheduled activities – in surgeries, in consultations – we are now seeing some recovery, but we continue to have less activity than in the pre-covid era”, he adds.
Like MY previously reported, in July of this year, there were 31% less diabetic patients with the foot exam performed and 29% less hypertensive patients with blood pressure below 150/90, in the last six months, in the ARS Norte. These two indicators represent the proportion of diabetic and hypertensive populations that the system has under control. In both cases, the reduction was very large.
In the ARS Norte, 31,267 people died in 2020, until October 31, 2,688 more than in 2019 and 3,254 more than the average of the last five years. If we look at October 25, for example, in 2020, in the ARS Norte, 115 people died, on the same day, in 2019, 80 died and, in the worst year of the last five, 2018, they died on that same day , 94.
There is an increase of 1,577 deaths that cannot be explained by the covid-19
We know that 1,111 of these deaths were due to covid-19, with 1,577 remaining that will have to be attributed to other causes. This was at a time when the government again authorized health units to suspend “non-covid” activity, to direct resources to fight the pandemic. The Senhora da Oliveira Hospital, in Guimarães, is an example of this resource management. In this hospital, one of the rooms in the operating room was transformed into an extension of the Covid Multipurpose Intensive Care Unit, allowing the placement of three additional beds. Two other operating rooms may soon follow suit. This allocation of resources is done with natural prejudice to non-urgent surgeries.
The increase in mortality was greater in the district of Braga than in the district of Viana do Castelo
The increase in mortality was more noticeable in Baixo Minho, with the district of Braga registering a rise in mortality, from 2019 to 2020, of 10.4%. The increase in the number of deaths, compared to the previous year, in the district of Viana do Castelo, stood at 6.3%.
Source: SNS
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Among the counties in the district of Braga, only three registered a lower mortality in 2020 than in 2019: Terras de Bouro, Vieira do Minho and Vizela. The first is part of the short list of Minho municipalities that are not included in the list of municipalities with a high risk of transmission. In any case, the reductions are slight, within what could be expected within a normal framework. In Terras de Bouro it dropped from 69 dead in 2019 to 67 this year. Vieira do Minho, who joined the list of high-risk territories after the revaluation by the Government, on October 12, registered a decrease from 136 to 122 deaths. In Vizela, there was a reduction of four deaths compared to the same period last year, but the municipality is surrounded by some of the most affected by the pandemic and, for this reason, it is included in the list of “high risk”, from the first moment.
The criteria defined by the Government to consider a municipality as “high risk” are two: the first is the existence of 240 cases per 100 thousand inhabitants in the last 14 days, the second is the proximity of other municipalities that fit this criterion.
In the municipalities of Viana do Castelo and Ponte de Lima, mortality decreased
In the district of Viana do Castelo, there are two municipalities that did not keep up with the increase in mortality figures in 2020: the municipality of Viana and that of Ponte de Lima. In Vila Nova de Cerveira, mortality until October, in 2020, was exactly the same as the previous year. The fact that the municipality of Viana do Castelo does not register an increase in mortality ends up contributing to the behavior of the district as a whole, there were only 161 more deaths in this territory, this year. Although there are counties, such as Arcos de Valdevez (another of the counties that have been part of the high-risk group since the 12th) and Monção, where there were significant increases in mortality, plus 36 and 57 deaths respectively.
Source: SNS
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In Braga there were 133 more deaths, only 80 were attributed to covid-19
Looking at just one municipality, the difference between the total number of deaths and deaths by covid is not as obvious as when the analysis is extended to the district or the Health Region. In the municipality of Guimarães, the number of deaths by covid-19 , announced by ACES do Alto Ave, is 33. In this municipality, there were 31 more deaths in 2020, meaning that, here, the pandemic completely explains the increase in mortality.
In Braga, the increase in mortality was 133 records, of which only 80 are attributed to covid-19. A scenario similar to what happens in Arcos de Valdevez, where there were 36 more deaths than in the same period of 2019, although there were only ten deaths by covid-19. The same happens in Monção, where there was an increase of 57 deaths, but only 33 of them are attributed to the new coronavirus.
Source: SNS
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DGS has not yet begun to investigate the causes of this excess mortality and it is not known when it will do so. What is certain is that, for almost the entire Minho region (similarly to what happens in the country), the Portuguese are dying more in 2020 than in previous years and the covid-19 only explains a portion of these deaths.
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