Month: December 2020

It is “with gratitude, solidarity and hope that I wish you all a Merry Christmas and a promising year of 2021”, said Prime Minister António Costa in his Christmas message last night

António Costa added that “in such a hard and demanding time, it is an enormous honour for me to be here at your service, at the service of Portugal”.

Hope

“The day after tomorrow the vaccination process against Covid-19 begins, which, even though it is a phased and prolonged process over time, gives us renewed confidence that thanks to science it is even possible to quell this pandemic”, said António Costa.

And the “reinforced solidarity of the European Union” will “support the national effort to initiate a sustained recovery”, which will allow “to overcome the difficulties we currently live in”, but to face “the structural problems that historically limit the development potential of our Country”, he added.

“We defined a strategic vision for the future of Portugal, and we now have the means to be able to make it happen, thus opening new horizons for a fairer, more prosperous and more modern country to new generations”, he said.

Gratitude

The Prime Minister affirmed his gratitude “to all Portuguese for their capacity for adaptation and sacrifice, for their determination and discipline, for the civic responsibility with which they have collectively faced this pandemic”.

Gratitude, “in particular, to those who provide assistance to those who need it most”, “to the mobilization of the scientific community or to teachers”, “to all those who, since March, have kept the country running”.

“But in a very, very special way, I want to express my gratitude – I am sure that the gratitude of all Portuguese people – to health professionals who, day and night, do their best to treat those who are sick, so often with sacrifice of breaks , time for rest and contact with your own family ”, he said.

Solidarity

António Costa expressed his solidarity with the families of victims or patients of Covid-19, of those who live outside Portugal and are unable to come and miss them.

Solidarity still with “all families, because, in truth, none could join as usual, and in the home of all of us, this Christmas had to be celebrated in a different way”.

But, above all, “to all – and so many are – who suffer the serious economic and social consequences of this pandemic”.

 

The Prime Minister said he was aware “of the harshness of many of the measures that we had to take throughout this year”, and “of the profound impact of these measures on the lives of all of us” to “contain the transmission of the virus, guarantee the responsiveness of health services and, fundamentally, save lives ”.

 

«Faced with an unexpected and unknown virus, the Government has tried to respond in the best way, with balance and common sense». “We certainly did not do everything well”, “but we have not bargained or bargained for efforts,” he said.

 

The SNS 24 Call Centre answered over 3.67 million calls so far this year over double that of 2019.

But how has it evolved? What is it like for those working there? What pressures are they under? How does it affect their lives?

Nine months on from the start of Covid-19 this excellent article outlines in operators own words the work that they undertake and how they deal with people’s fears and anxieties.

“We are the first line”. Beating the pandemic and tiredness with one call at a time

The covid-19 marks a before and after in the life of the SNS24 line and its health professionals, who, in addition to the struggle to overcome the pandemic, also try to overcome the fatigue of nine months of unrelenting calls.

In the ‘call-centre’ located in the centre of Lisbon, a few dozen professionals distributed throughout an ‘open space’ seek to respond to people’s concerns, while a monitor is charging the numbers of the service in real time. Calls do not stop, but you cannot hear phones ringing incessantly with the demand for an answer; everything is digital, fast and repeated by professionals to the point of seeming mechanized.

José Gouveia

At the age of 51 and since 2003 in the contact centre of the National Health Service, the nurse José Gouveia, who also works in the general surgery service of Hospital Garcia de Orta, in Almada, admits to Lusa that this was “a very complicated year” and that the first wave of the pandemic confronted the SNS24 with “total despair”.

“We are the first line in serving and meeting people’s doubts, since there were limitations for health centres and emergency rooms. We were almost the only possible help, albeit with difficulties”, he says, calmly, in contrast to the busy days due to the impossibility of responding to all problems.

And it was not just on the other end of the line that changes took place. José Gouveia responds to calls over the course of the shift with his mask on, in the image of all his colleagues, now a few meters away from security and with many in teleworking situations. When you leave, it will be time to head to the hospital to continue the fight and be replaced by another colleague, who does not sit down before disinfecting the work area.

New procedures were instituted, new guidelines were defined and everything had to be assimilated without wasting time, in a context in which information about the new coronavirus challenged even the most experienced professionals and generalized uncertainty about the future.

“It is necessary to have some experience, which counts here, but sometimes it is difficult with some tricks. It means having the experience of screening and trying to understand what it really is: if they are symptoms related to covid-19, anxiety, etc. It is the experience that gives us this ‘feeling’, this proficiency”, explains José Gouveia, guaranteeing to have “the same principles and the same dedication, but with more effort”.

Manuel Mourão

In the workspace next door, Manuel Mourão, a 52-year-old nurse with almost 30 professional experience, reviews in the days lived with this pandemic its beginning in the SNS24, in 2009, with the flu epidemic A. However, even with the accumulation of work in the emergency department of Hospital de São José, in Lisbon, refuses to let down.

“As I am in an emergency, the burden has been enormous and obviously health professionals are a little exhausted, but that is no excuse for us. As I usually say, every day I take my shower, wear my nurse’s uniform and go to the fight”, he summarizes, naming knowledge as a weapon to“ calmly clarify and give some very assertive guidelines” so that the pandemic is under control.

Unlike most days in the past few months, Manuel Mourão is in the building providing service instead of doing it from home. Although he misses living with friends created over 11 years, this nurse specialized in the field of psychiatry assumes the comfort of the option and recognizes the advantages in reducing the risks of contagion.

“The teleworking experience has been very positive. The pandemic has hurt many people, but for us it has also brought some benefits; we were already talking about it: ‘why not be at home with a computer doing this?’ There was never that opportunity, but the pandemic ended up pushing us more quickly towards that”, he says, before completing another journey and leaving his post.

Catarina Rebelo

Catarina Rebelo, a 25-year-old nurse, arrives to fill the position. After disinfecting the table, the computer and the kit, she puts his rubbers on the headphones to start answering calls. This is the routine he embraced about a month ago, after deciding to reply to an email from the Ordem dos Enfermeiros asking for applications for the SNS24.

“I felt that there was a need to want to participate in helping the front line of the pandemic and that I was unable to exercise at my workplace. So, I opted for this place, being a place where we are very in contact and we help people, despite not being directly cared for”, confesses the young woman, who still lives in her parents’ house and also works in a private clinic.

Without hiding that coming to SNS24 was a purely “personal” choice and driven by the desire for a “new adventure”, Catarina Rebelo already recognizes the tiredness in her colleagues after a “scary” November that she marked in her early days the peak of the second wave of the pandemic in the country.

“In fact, there were a lot of calls on hold when I joined and it was a completely new thing. It was quite scary”, he recalls, although later of “loving” the experience: “ It is very motivating that we are here to help people and they show even during the calls that they are satisfied with our help and our support. And this is gratifying”

Carla Miguel

A few lines ahead, Carla Miguel continues to answer calls beyond the end of the shift. In this case, a father asks on the other end of the line how to deal with the fever of the 12-month-old baby and the nurse, 56, punctuates each question with his left hand, as his right hand clicks on the mouse to enter data on the computer. “If you run your hand over her neck, you feel ganglia,” she asks, while she herself runs a hand over her neck.

Already with two children also involved in the “front line” of the fight against covid-19, Carla Miguel highlights the impact that the pandemic had on people’s feeling of security in relation to their own existence, both individually and collectively.

“The human being has become very weak in this context, all the certainties that we had … There is nothing acquired, we are all very afraid and the instability of insecurity is what concerns me the most. It is a ‘bug’ that nobody sees, a micro-organism with statistical data that leaves us completely defenceless”, she says.

Before going on to another phone call, she introduces some more information into the system, in a process that he fears to increase again from January, because of the easing of the restrictions on the Christmas season.

“We were able to control and keep a lot of people at home, but this is a time when there are people who think from the outset that with a negative test it is all safe and this will cause hospitalizations to increase in this third phase in January. I’m scared out there”, she confides, in a 2020 that was “very hard” and left her in service “from eight in the morning to ten at night” in several days.

Maria Cortes Director of SNS 24

“It is a permanent effort”, completes the director of SNS24, Maria Cortes, for whom the expectation of “light at the end of the tunnel” launched by the start of vaccination against covid-19 reinforced the determination.

“We have to consider that the effort was worth it and that we are motivated to continue until there is a time when we will live our lives again in a free and more relaxed way”, notes the official, who has been at SNS24 since 2017. Until when that moment arrives, it highlights the fact that “no outbreak occurred in the ‘call centres’” and that the system resisted the changes introduced throughout the year.

From a capacity for 200 calls simultaneously up to 2,000 in just nine months, the SNS24 has also grown in the number of professionals and in its automation of service processes, with the entry of two ‘bots’ to collect responses and which, according to Maria Cortes, allowed significant efficiency gains in call times, not only in the present, but also for the future: with or without covid-19.

“SNS24 started in 1998 with a line called ‘Dói Dói Trim Trim’, evolved to Saúde 24 and has a whole tradition of telephone screening in the most diverse areas. It has not yet emerged for the covid”, he stresses, envisioning a positive horizon for the service: “Due to the role it had in the management of the pandemic, the visibility it gained and the trust it generated in the population, the SNS24 will continue to have a determining role at the level access to health care”.

SNS24 already answered more than 3.670 million calls in 2020

The president of the Shared Services of the Ministry of Health (SPMS), Luís Goes Pinheiro, highlighted the responsiveness of the SNS24 line in a 2020 marked by the covid-19 pandemic, with a number of answered calls exceeding 3.670 million.

“More than 3,670 million calls have already been answered in the SNS24. It is, in fact, an especially significant number, considering that last year 1.5 million calls were not even answered. Therefore, more than we have already doubled the number of calls answered in the past year and, as we know, in a context that was not regular throughout the year” said Luís Goes Pinheiro in an interview with Lusa.

Stressing the year with the “greatest demand ever” of SNS24 by citizens, the president of the SPMS did not fail to admit the problems recorded in the first peak of the pandemic, in March, but emphasized the adaptability of the service, which in November surpassed all the records, with more than 816 thousand calls answered, including more than 38 thousand in a single day.

“We have more than 5,600 health professionals providing care on the SNS24 line. Some residents in the seven ‘call-centres’ that currently exist throughout the country and others at a distance, with equipment that allows them to provide this support to the line from their homes or from other locations. This is the big difference: at the beginning of the pandemic, the number of health professionals would not reach 1,000 and today there will be more than 5,600”, he noted.

“We have diversified the professions that currently provide services on the line; they continue to be mostly nurses, but we also have psychologists – namely within the scope of the psychological counselling line and about 55 thousand people have already been assisted who could benefit from this service -, dentists, pharmacists and also sixth year medical students ” , he said.

Between the recognition of covid-19 as “a fatality that caught everyone with a lot of violence” and the effect of change for the better that the pandemic had on SNS24 and that provided “a very special year”, Luís Goes Pinheiro insisted on noting the new perception of the Portuguese about the service.

“They were able throughout this year – in a context as difficult for all of us as was the context of the covid-19 pandemic – to count on this line and the support of the more than 5,600 health professionals who today provide services and who were throughout these various hard months of pandemic an ever-present voice and an open door for all those who felt that, in some way, they needed the attention of the NHS”.

Written by: João Godinho 

https://24.sapo.pt/atualidade/artigos/somos-a-primeira-linha-vencer-a-pandemia-e-o-cansaco-com-uma-chamada-de-cada-vez

 

 

 

 

 

 

 

 

 

 

 

 

Fighters scattered on the western line are said to have played “friendly matches” with those on the opposite barricade. Friendly matches played in no-man’s-land, which is like saying on neutral ground. Between the trenches of some and the trenches of others

There are reports that on December 25, 1914 (precisely 106 years ago), several football matches were played between enemy lines, in what was the first major pause in one of the most bloody and brutal confrontations that man had on a global scale.

We were in the middle of World War I.

Although on that day there were records of the deaths of hundreds of English soldiers (in the trenches of France and Flanders), the truth is that football worked there as a kind of pause button. Messenger of peace.

“It is important that we never forget these examples. They make us believe that nothing is impossible because humanity, all humanity, speaks the same language and responds to the same impulses, feelings and appeals. Sport is one of the ones that most contributed to add them”.

The story refers to that rare and unique moment as “The Christmas truce”.

Fighters scattered on the western line are said to have played “friendly matches” with those on the opposite barricade. Friendly matches played in no-man’s-land, which is like saying on neutral ground. Between the trenches of some and the trenches of others.

It is important to bear in mind that, at that time, almost all healthy adults (and others) were required by their countries to be in the first line of combat. Many of them were football players at the time.

Herbert Smart (then Aston Villa’s spearhead in the service of the British army) said he had walked across to exchange cigarettes for cigars with a German soldier. He learned that he spoke English well because before the war started he worked as a waiter in a London restaurant. And he also learned that he and most of his companions did not want to be there, fighting. They were afraid to die. They wanted everything to end quickly, to get back to their lives, with their families. He said that the handshake, as a farewell, was emotional. Both knew that they would never see each other again and that, a few hours later, they would be back on the battlefield to confront each other as enemies. Enemies who, hours before, talked like friends.

This little piece of history illustrates the healing power that sport has.

It was like that, with the truce decreed by the Olympic Games of Antiquity, with Jesse Owens (who defied the Nazi ideology by winning in Berlin), with the message sent by Mandela through the brilliant selection of South African rugby and with hundreds of others examples from various moments in history. From all sides.

It is important that we never forget these examples. They make us believe that nothing is impossible because humanity, all humanity, speaks the same language and responds to the same impulses, feelings and appeals. Sport is one of the ones that most contributed to add them.

To make it a battlefield is to betray the memory and honour of all those who, in 1914, realized that it was the exact opposite. If we don’t learn from the present, we learn from the past.

I wish you a very happy Christmas, full of special moments and with those who are most important.

 

The President of the Republic left a Christmas message in which he calls for a “broad consensus” and for “strengthening social cohesion” to face the economic and social pandemic that will dominate 2021, when the pandemic “If it’s fading”.

In the Christmas message, released through the Jornal de Notícias, Marcelo Rebelo de Sousa talks about the challenges that the country has been experiencing and those it has to face in 2021, stating “there is and must be another look at Christmas 2020”, which implies a medium-term vision.

“Christmas 2020 is experienced with two simultaneous pandemics and with a dramatic experience of aggravated social gaps. And this combination of crises turns this Christmas into a never-before-seen terrain ”, he stresses.

In his opinion, “the most urgent thing is to look at Christmas 2020 with a shorter term vision – to prevent it from creating objective conditions for a negative or very negative start in 2021”.

“Everything we can do to protect the coming weeks and months, must be done”, he explains.

For the head of state, “the broad consensus to create conditions for a better start in 2021, in terms of the health pandemic, should extend to what will be months of an outbreak and its prevention, while the vaccination progresses”.

It should also extend “to the concern about the economic and social pandemic that will dominate 2021, especially when the health pandemic is fading”.

“Broad consensus, stability, reinforcement of social cohesion, existence of reliable references. This is what Christmas 2020 demands from all of us, Portuguese, it continues to demand now and will continue to demand for some time ”, he stresses, in the message.

Marcelo Rebelo de Sousa recalls that, since March, the country has shown itself to live up to this demand: “We will not fade, these days, amid the responsible joy of the reunion and the rediscovery of the value of hope in resisting difficulties”.

“We have already travelled so much together and with unwavering determination, that nothing can lead us to lie down to lose what has been accomplished”, he stresses.

At the beginning of the message, the head of state begins by recalling difficult historical moments that marked other Christmases.

“Portugal knew, in the lives of less young people, Christmases at war. Those over 90 years old, the end of their childhood or the beginning of adolescence, reminds him. A war outside, but with constraints inside, for example in terms of the supply of certain goods or even a start in the early forties ”.

It also recalls the “Christmases in financial and economic and, consequently, social crisis” experienced by the “less young and young people”, recalling the emigration of “one million Portuguese, between the beginning of the 1960s and 1974, and continuing in crises in the 70s, 80s and second decade of the 21st century, different from each other, but all determining international interventions ”.

Alluding to Christmas 2020, he says that “it is a substantially new reality”: “It is a pandemic. The pandemic hit us ten months ago. Despite the hope of vaccines, it is to stay weeks and months, nobody knowing or being able to predict how many”.

The President also warns of the “psychological consequences of pandemics, in changing social behaviors, in changing community relations”.

“In the absence of comparative standards to measure the scope and depth of what has changed, what has changed, what will remain, what will leave as the pandemic eases and the economic recovery and recreation and correction of inequalities becomes visible ”, he says.

But, he points out, “with hesitations, discontinuities, quarrels, all of them dispensable and even counterproductive, the challenge is too important and the time too pressing, too, to behave other than to continue the feat and accelerate what, in the same line, we have to do it ”.

As has been the case since the second year of the presidential term, in 2017, Marcelo Rebelo de Sousa addresses a Christmas message to the Portuguese through the pages of “Jornal de Notícias”. This year, the head of state makes a historical review of the difficulties that the country has gone through at other times to leave some warnings about what still awaits us, in the complex context of a pandemic that forced us to be far from those we love most. Appealing to the resilience of citizens and the need to accelerate the pace along the path that we have been tracing.

Read the message in full:

A pandemic Christmas

Portugal knew, in the lives of the less young, Christmases at war. Those over 90 years old, the end of their childhood or the beginning of adolescence, reminds him. A war outside, but with constraints inside, for example in the supply of certain goods or even a start in the early forties. Above all, those who are over 60 years old remember it, in particular those who came from Africa after 1974 and those who fought in Angola , Guinea and Mozambique . These memories remain impressive, even for those who only followed those times through censored television and messages from our military over Christmas.

Portugal experienced, in the lives of less young people and younger people, Christmases in financial and economic crisis and, consequently, social. It reminds him of less young people and more young people of several generations. Beginning in what appeared to be economic growth but would translate into the emigration of one million Portuguese, between the beginning of the 60s and 1974, and continuing in the crises in the 70s, 80s and second decade of the 21st century, different from each other, but all determining international interventions.

At different times, Portugal has known Christmases with very vast poverty, or with permanence of incompressible structural poverty – that is, very difficult reduction – or with this poverty amplified by the economic and financial crises. Portugal knew Christmases with epidemic outbreaks before Democracy and already in Democracy, but of limited duration, in addition to these Christmases.

Christmas 2020 is a substantially new reality. It is spent in a pandemic. The pandemic hit us ten months ago. Despite hope for vaccines, it is about to stay for weeks and months, no one knowing or being able to predict how many. With the health pandemic, an economic and social pandemic has emerged – in addition to the fundamental problems of our economy and our society. The increase in poverty and inequality was an immediate effect of the two pandemics. In a word, Christmas 2020 is experienced with two simultaneous pandemics and with a dramatic experience of aggravated social gaps. And this junction of crises turns this Christmas into an unprecedented terrain.

On the psychological consequences of pandemics. Changing social behaviours. Changing community relations. In the absence of comparative standards to measure the scope and depth of what has changed, what has changed, what will remain, what will leave as the pandemic eases, and economic recovery and recreation and correction inequalities become visible.

Of course, the most urgent thing is to look at Christmas 2020 with a shorter term vision – to prevent it from creating objective conditions for a negative or very negative start in 2021. And all we can do to protect the more weeks and months nearby, must be done. But there is and must be another look at Christmas 2020. Which implies a medium-term vision. The broad consensus to create the conditions for a better start in 2021, in terms of the health pandemic, should extend to what will still be months of the outbreak and its prevention, while vaccination progresses.

How to extend concern about the economic and social pandemic. That it will dominate 2021, especially when the health pandemic is fading. Broad consensus, stability, strengthening of social cohesion, existence of trust references. This is what Christmas 2020 demands from all of us Portuguese, it continues to demand now and will continue to demand for some time to come.

Since March, we have demonstrated that we can live up to this requirement. In these days, we will not be lost among the responsible joy of the reunion and the rediscovery of the value of hope in resisting difficulties. We have already traveled so much together and with unwavering determination, that nothing can lead us to lie down to lose what has been accomplished.

With hesitations, discontinuities, quibbles. All of them expendable and even counterproductive. The challenge is too important and time too pressing, too, to behave anything other than to continue the feat and accelerate what, along the same lines, must be done.

 

Covid-19 marks a before and after in the life of the SNS24 line and its health professionals, who in addition to the struggle to win the pandemic also try to overcome the fatigue of nine months of unrelenting calls .

In the ‘call-center’ located in the center of Lisbon, a few dozen professionals distributed throughout an ‘open space’ seek to respond to people’s concerns, while a monitor is charging the numbers of the service in real time. Calls do not stop, but you cannot hear phones ringing incessantly with the demand for an answer; everything is digital, fast and repeated by professionals to the point of seeming mechanized.

At the age of 51 and since 2003 in the contact center of the National Health Service, the nurse José Gouveia, who also works in the general surgery service of Hospital Garcia de Orta, in Almada, admits to Lusa that this was “a very complicated year” and that the first wave of the pandemic confronted the SNS24 with “total despair”.

“We are the first line in serving and meeting people’s doubts, since there were limitations for health centers and emergency rooms. We were almost the only possible help, albeit with difficulties ”, he says, calmly, in contrast to the busy days due to the impossibility of responding to all problems.

And it was not just on the other end of the line that changes took place. José Gouveia responds to calls over the course of the shift with his mask on, in the image of all his colleagues, now a few meters away from security and with many in teleworking situations. When you leave, it will be time to head to the hospital to continue the fight and be replaced by another colleague, who does not sit down before disinfecting the work area.

New procedures were instituted, new guidelines were defined and everything had to be assimilated without wasting time, in a context in which information about the new coronavirus challenged even the most experienced professionals and generalized uncertainty about the future.

“It is necessary to have some experience, which counts here, but sometimes it is difficult with some tricks. It means having the experience of screening and trying to understand what it really is: if they are symptoms related to covid-19, anxiety, etc. It is the experience that gives us this ‘feeling’, this proficiency ”, explains José Gouveia, guaranteeing to have“ the same principles and the same dedication, but with more effort ”.

In the workspace next door, Manuel Mourão, a 52-year-old nurse with almost 30 professional experience, reviews in the days lived with this pandemic its beginning in the SNS24, in 2009, with the flu epidemic A. However, even with the accumulation of work in the emergency department of Hospital de São José, in Lisbon, refuses to let down.

“As I am in an emergency, the burden has been enormous and obviously health professionals are a little exhausted, but that is no excuse for us. As I usually say, every day I take my shower, wear my nurse’s uniform and go to the fight ”, he summarizes, naming knowledge as a weapon to“ calmly clarify and give some very assertive guidelines ”so that the pandemic is under control.

Unlike most days in the past few months, Manuel Mourão is in the building providing service instead of doing it from home. Although he misses living with friends created over 11 years, this nurse specialized in the field of psychiatry assumes the comfort of the option and recognizes the advantages in reducing the risks of contagion.

“The teleworking experience has been very positive. The pandemic has hurt many people, but for us it has also brought some benefits; we were already talking about it: ‘why not be at home with a computer doing this?’ There was never that opportunity, but the pandemic ended up pushing us more quickly towards that ”, he says, before completing another journey and leaving his post.

Catarina Rebelo, a 25-year-old nurse, arrives to fill the position. After disinfecting the table, the computer and the kit, he puts his rubbers on the headphones to start answering calls. This is the routine he embraced about a month ago, after deciding to reply to an email from the Ordem dos Enfermeiros asking for applications for the SNS24.

“I felt that there was a need to want to participate in helping the front line of the pandemic and that I was unable to exercise at my workplace. So, I opted for this place, being a place where we are very in contact and we help people, despite not being directly cared for ”, confesses the young woman, who still lives in her parents’ house and also works in a private clinic.

Without hiding that coming to SNS24 was a purely “personal” choice and driven by the desire for a “new adventure”, Catarina Rebelo already recognizes the tiredness in her colleagues after a “scary” November that she marked in her early days the peak of the second wave of the pandemic in the country.

“In fact, there were a lot of calls on hold when I joined and it was a completely new thing. It was quite scary ”, he recalls, although later on“ loving ”the experience:“ It is very motivating that we are here to help people and they show even during the calls that they are satisfied with our help and our support. And this is gratifying ”.

A few lines ahead, Carla Miguel continues to answer calls beyond the end of the shift. In this case, a father asks on the other end of the line how to deal with the fever of the 12-month-old baby and the nurse, 56, punctuates each question with his left hand, as his right hand clicks on the mouse to enter data on the computer. “If you run your hand over her neck, you feel ganglia,” she asks, while she herself runs a hand over her neck.

Already with two children also involved in the “front line” of the fight against covid-19, Carla Miguel highlights the impact that the pandemic had on people’s feeling of security in relation to their own existence, both individually and collectively.

“The human being has become very weak in this context, all the certainties that we had … There is nothing acquired, we are all very afraid and the instability of insecurity is what concerns me the most. It is a ‘bug’ that nobody sees, a micro-organism with statistical data that leaves us completely defenseless ”, he says.

Before going on to another phone call, he introduces some more information into the system, in a process that he fears to increase again from January, because of the easing of the restrictions on the Christmas season.

“We were able to control and keep a lot of people at home, but this is a time when there are people who think from the outset that with a negative test it is all safe and this will cause hospitalizations to increase in this third phase in January. I’m scared out there ”, she confides, in a 2020 that was“ very hard ”and left her in service“ from eight in the morning to ten at night ”in several days.

“It is a permanent effort”, completes the director of SNS24, Maria Cortes, for whom the expectation of “light at the end of the tunnel” launched by the start of vaccination against covid-19 reinforced the determination.

“We have to consider that the effort was worth it and that we are motivated to continue until there is a time when we will live our lives again in a free and more relaxed way”, notes the official, who has been at SNS24 since 2017. Until When that moment arrives, it highlights the fact that “no outbreak occurred in the ‘call centers’” and that the system resisted the changes introduced throughout the year.

From a capacity for 200 calls simultaneously up to 2,000 in just nine months, the SNS24 has also grown in the number of professionals and in its automation of service processes, with the entry of two ‘bots’ to collect responses and which, according to Maria Cortes , allowed significant efficiency gains in call times, not only in the present, but also for the future: with or without covid-19.

“SNS24 started in 1998 with a line called ‘Dói Dói Trim Trim’, evolved to Saúde 24 and has a whole tradition of telephone screening in the most diverse areas. It has not yet emerged for the covid ”, he stresses, envisioning a positive horizon for the service:“ Due to the role it had in the management of the pandemic, the visibility it gained and the trust it generated in the population, the SNS24 will continue to have a determining role at the level access to health care ”.

Article from Expresso

New Measures for New Year Period

In recent days a consensus has begun to emerge that the rules for the New Year should be tightened. And in the end that is what the government decided. Christmas will continue with the rules that were set but the New Year’s Eve will be much more restricted. The Council of Ministers, meeting this Thursday, decided that movement on public roads would be banned from 23h00 on the 31st – when it was previously allowed until 02h00 – thus limiting the festivities at the end of the year.

The signs that had emerged were in this direction: of a tightening of restrictions after Christmas, in order to contain as many contagions as possible, in part because experts considered the plan “risky”. Thus, in addition to the New Year’s limitation, there will also be a curfew on days 1, 2 and 3 from 13h00. As had been defined, the ban on movement between municipalities is maintained between 00h00 on 31 December and 05h00 on 4 January.

The pressure for something to change in the next 15 days has grown stronger not because of the number of cases, which has been falling, but because of the deaths associated with the disease, a number that is stubbornly not decreasing: for eight days they have remained above 80 and have already reached record numbers of 98 people in one day. This is what Marcelo Rebelo de Sousa noted in the new state of emergency decree: “The number of deaths are still very high, and the experts confirm the clear risks of a further worsening of the pandemic if the measures taken to deal with it are reduced”.

On the political side, the President of the Republic is appealing to the “common sense, civic maturity and just restraint” of the Portuguese at Christmas, asking them for a “contract of trust”, in a message he left after the approval of the new state of emergency – which lasts until January 7.

Decisions in other European countries have also been assessed with a magnifying glass. Germany, France, Italy, the Netherlands and the United Kingdom tightened the rules for this period, going back on what had been decided. All this happens as the Prime Minister is, for the first time in 10 months, in prophylactic isolation after having lunch with the French President, Emmanuel Macron – who tested positive for the virus. Costa’s first test, done this Thursday, was negative. The Prime Minister has no symptoms and has continued work from a distance.

 

Christmas, a poisoned gift

What will happen at Christmas will depend more on all of us and less on what the government says, experts believe, but nevertheless they consider it “risky to keep the restrictions open at Christmas,” says Expresso Manuel Carmo Gomes, professor of Epidemiology at the Faculty of Sciences of the University of Lisbon. According to the expert, it is not possible to anticipate the size of the increase in cases in January, but it should not be “as high as in October or November. Everything depends on the behaviour of the population: “We have never experienced a Christmas season like this and we know that it is a time very much influenced by a social behaviour factor that is difficult to anticipate”.

In order for it to depend on each one, “more information should be given so that people clearly know what to do”, suggests the head of the crisis office for covid-19 of the Order of Physicians (OM), Filipe Froes. “More restrictions should be advised in a pedagogical way, as a civic duty, and this should be a continuum”, he adds.

The diagnosis is shared by infectiologist Margarida Tavares at São João Hospital. “I have always been very critical of the restrictive measures imposed because they do not prevent people from doing what they want. What makes a difference are the awareness messages, but in this case what people have retained is ‘alleviating'”. A few days before Christmas, lung specialist Filipe Froes believes that it will be difficult to get families to change their plans. However, there are some cautions that need to be taken: “I advise you to avoid travel, crowds when shopping and more than two households gathered at home”.

António Diniz, also a member of the OM office, warns that the greater freedom during this season is a poisoned gift. “The number of new daily cases is high and there was little appreciation for the fact that they came after two exceptional periods with many people at home and a sharp drop in the volume of tests performed. It will be very difficult that in the following 15 days there will not be a significant resurgence of infections”.

The greater freedom of movement will have consequences: “It will be very costly in January. As nothing has changed, we will return to the number of cases from a few weeks ago, with the aggravating factor that we already have full intensive care units,” warns the former Secretary of State for Health, Raquel Duarte.

“The siege should have been tightened as early as October to bring the numbers down further during the festive period,” adds António Diniz. Now it is necessary to contain damage, “to have tables or places per household when there is more than one household or to keep children away from family members at risk”. And be very careful with false senses of security. “The rapid test is above all to evaluate the infectivity, that is, whether we can transmit the infection. A negative result only ensures that the virus does not spread within 18 to 24 hours at most”. The times are of battle against the virus and the speech must be at the same level. “A broad national mobilisation was lacking, almost as if for war. To tell the Portuguese that we will have to sacrifice a little of our social and affective freedom for a greater value,” he says.

For José Artur Paiva, president of the College of Intensive Care Medicine of OM, “we have a tangible goal and this vision must be given. With one million vaccinated in the first phase and nearly one million who have already had the disease, we can achieve group immunity in six months and that will be all the better if our behaviour is adequate. For that we need social restriction this Christmas and New Year”, he explains. “People are very tired, very lonely, and the emotional argument is far superior to the scientific one. Therefore, the only way is to use a little emotion in science”, he prescribes to the Government.

Source: EXPRESSO

Fátima Ventura, director of the Scientific Evaluation Unit at Infarmed, explains to Expresso how new scientific techniques and new verification procedures came together to produce what for many people seems like a miracle: vaccines obtained in record times. The expert tells how researchers and regulators managed to save time in each phase

Vaccines against covid-19 have already started to be administered in several countries, and are almost arriving in Portugal, less than a year after the start of the pandemic. The relative speed of its appearance, compared to the long periods associated with other vaccines of the past, generate suspicion in many people. In order to get treatment for the disease, aren’t dangerous shortcuts taken? Will the vaccine be effective? Won’t it have dangerous side effects?

To answer these questions, it is important to understand what this vaccine has new, in relation to others that we have been used to since childhood. Expresso spoke with Fátima Ventura, a pharmacist, director of the Scientific Evaluation Unit at Infarmed, and an evaluator herself. Ventura is also an alternate member of Portugal of the Committee for Medicinal Products for Human Use (CHMP), the last EU body that will give an opinion on vaccines in the EU before the European Commission.

Anticipating something said at the end of the conversation, it is not expected that life will return to what it was, or something like that, before the second half of 2021. Fátima Ventura refers to the prospect of a relatively normal winter, if all goes well. For the time being, he notes that, despite what the headlines suggest, the vaccines already approved in certain countries were for emergency use. “They have not yet been authorized for introduction to the market, either in the United Kingdom, the United States or Canada,” he says.

A NEW TECHNIQUE

To understand what makes many of the vaccines now developed different, it is essential to understand what distinguishes them from traditional vaccines. While an attenuated version of the pathogen in question, whether a virus or any other, is used, fragments of a genetic code are now involved. Specifically, that of the protein that appears in the images of the virus with the characteristic spike, or “peak”.

“When we administer this genetic code in a vaccine, our cells will translate that code into the virus protein”, explains Ventura. “As there is no genetic code behind the virus, this protein is not infectious. We are not going to get sick. What happens is something else. We have special cells, called antigen-presenting cells, that present this protein to other cells and will trigger the immune response: the production of antibodies that are expected to be neutralizing. That is, when the virus itself appears, they look at the protein that it brings and say: oh, it’s strange, I’m going to kill it. Basically, that’s it This protein is the way that the virus has to enter our cells. If the antibodies attack it, the virus does not bind to them and does not infect “.

Fátima Ventura refers to the six vaccines acquired by the EU – “or rather, with a proposal for acquisition, as they will only be effectively acquired if they are authorized”; two with messenger RNA, that of Moderna and that of BioNTech / Pfizer; that of the German company CureVac, which uses the same technique; one from SanofiPasteur-GSK; that of AstraZeneca and Johnson and Johnson, which use other viruses, the so-called adenoviruses, modified to not multiply in other cells and which also have the genetic code of the SARS-CoV2 ‘peak’ protein. “None of the vaccines acquired jointly by the European Union is the virus itself”, summarizes Ventura. “All of them lead, in one way or another, to the production of this ‘peak'”.

BASIC INVESTIGATION WAS ADVANCED

Why was the process so fast compared to normal vaccines? The reasons were several, according to the same expert. Right from the start, the public health emergency situation. “Certain phases took place as usual, but took less time”, he explains. The companies were already developing vaccines of the same type for SARS-CoV1 and MERS. “As the SARS-CoV1 pandemic has since disappeared, there is no longer any possibility of conducting clinical trials. There is no possibility of verifying whether the virus is effective in the environment. All this research was in the drawer.” This is the case with SARS-CoV, because in relation to MERS (still a problem in the Middle East today), the case is different. Pfizer and BioNTech also had a partner for a flu vaccine with this messenger RNA technology. “That is, basic research was already very advanced. This saved some years in advance “, says Ventura.

Another difference has to do with clinical trials. “They have four phases, three before approval and one last after. In phase 1, with lower numbers and a younger population. Phase 2 is dose selection. Then phase 3 begins, which in the case of vaccines should cover tens of thousands of volunteers, to be sure of the vaccine’s effectiveness. Normally, the phases are sequential. In the traditional process, each phase is expected to start before the next one. the next one started.

“When it was already known that it was safe to move to a larger number of individuals or to an older population, it went ahead. The phases have not been shorter, they are overlapping”, he says. “Nowadays, even in relation to Pfizer vaccines, which we are almost ready to have in our market, if all goes well, studies of phase 2 are still going on, at the same time as those of phase 3”.

NORMAL SIDE EFFECTS

Some unknowns remain. It is not known how long the protection lasts, how many times it will be necessary to get the vaccine, or if it only prevents those who take it from contracting the disease or also from spreading it to other people (the first signs of this seem positive, but it is too early for drawing conclusions).

The side effects, too, are still not entirely clear. Fátima Ventura notes that the tests are carried out in a controlled manner. “When we move to the global population, it is natural that side effects will appear. Those effects that only appear when millions are vaccinated. This is normal. It is nothing that does not happen with any medicine. When we read the leaflet that comes in the medicine boxes, we see the frequency of side effects indicated there: if they are common, rare, very rare … “.

“The effects mentioned so far in the studies are the usual ones: the tough guy on the arm, the discomfort on the body … In general, they are very similar to those of the flu”, he says. Even anaphylactic reactions, like those seen in two health professionals in the UK, are far from being unheard of, he says.

THE ROLLING REVIEW AND OTHER NEWS

Another relevant difference is that the industrial production of the vaccine was anticipated. “How can we say that, a few days after the European Commission approves the vaccines, we will already have them to give to people? This is because companies, at risk, started to produce even before being authorized. They achieved this with many support from governments and foundations that support research. There were incentives for companies to go as far as they could “, explains Ventura, giving the example of BioNtech, which will commercialize the Pfizer vaccine in Europe and has everything ready.

Also, the way the authorities are carrying out the assessment was different now. “We usually have more time. The normal process for approving a drug is 210 days in the European Union. For certain diseases that have no therapeutic alternative, that time can be shortened. It is already part of our legislation. It is called accelerated evaluation.” This time, at Europe level, a new mechanism was created. As the evaluation is made, the company submits this data to the agency and they are evaluated. “This is called ‘rolling review’, that is, continuous review”, says Ventura. “We are receiving the book in chapters, so to speak, and we evaluate each chapter. When we have all the chapters evaluated, the company formally submits the marketing authorization request. Usually,

PRECEDENTS IN CANCER TREATMENT

The Portuguese specialist also mentions, as another determining factor, the commitment of many teams, the reinforcement of evaluators that the agencies made. And he notes that the authorization will be conditional, as the clinical trials have not yet ended. “Companies are subject to a series of conditions, with deadlines to meet. The assessment therefore does not stop. If things are not going well, the authorization is withdrawn.”

If the new technique is much faster than the traditional one, there are objective reasons for this. In the traditional technique, “a virus had to be cultivated, cells were needed, etc. It took a long time. In the RNA technique, the first stage is the production of the mold from cells. But from then on, you don’t depend on the cells grow “, he explains.

From the moment the SARS-CoV2 genetic code was published, “it was very easy”, he adds. “The information was removed from the genetic code, the mold was made, and based on that, it was possible to produce a lot of messenger RNA. Otherwise, very small amounts are needed. A thousand times smaller than usual. With very little product , many people can be vaccinated. A quick technique, easy to industrialize, but of course, as it is new, it is more expensive than the others. ”

Covid-19 is not the first disease whose treatment uses these techniques. “Against the protein of a tumor, the approach is the same,” says Fátima Ventura. “Cancer drugs nowadays often have antibodies – so-called monoclonal antibodies. Immuno-oncology is one of the most effective ways to treat cancer. It is using our immune system to treat what is strange. viruses, whether they are cancer cells. ” The Moderna company, he recalls, was already developing this type of approach for a cancer vaccine.

THERE WERE NO SHORTCUTS

With the much greater openness of the scientific community that took place this year, including the appearance of pre-print platforms (ie, where study results can be shared almost instantly, without the months of waiting that the publication process in reputable scientific journals entails ), it could be nothing less than a real scientific revolution.

Even so, it was a terrible year. When we read that, two days after the publication of the genetic code of covid-19, Moderna’s vaccine was already invented, that all mortality happened after that, some raise ethical questions. The truth is that it could not have been otherwise. In science, there are indispensable safety criteria, and not having met them to the letter, in addition to other effects, could compromise the public’s confidence in approved treatments.

If the dramas of 2020, by giving enormous incentive to a new technique to fight diseases, lead to advances against scourges that have long afflicted humanity, the covid-19 may end up, at a certain level, a blessing for humanity . In any case, for now, there are reasons to be confident.
“Yes, we walked faster but we had conditions for that and there were no shortcuts”, sums up Ventura.

The coordinator of the ‘task-force’ created by the Government to manage the vaccination plan against covid-19, Francisco Ramos, replied today in parliament that it would be “a huge mistake” to make the vaccine mandatory for the Portuguese population.

“This vaccination is voluntary and I think it would be a huge mistake to make it mandatory. We have 40 years of experience in the vaccination plan, which is a crown jewel of the National Health Service, ”he said, relativizing the estimates of people who do not want to be vaccinated:“ Whoever refuses to receive the vaccine must be respected. The reports say that less than 10% of the population refuses to take the vaccine and these numbers are encouraging ”.

Heard at a joint hearing by the Health Commission and the Eventual Committee to monitor the implementation of measures to respond to the pandemic, the head of the task force stressed that “trust is essential” in this process and that there must be “clarity and ease of communication ”.

“We have to win people’s confidence to adhere to the vaccination process. If we don’t win it, vaccines will serve little purpose. We must be able to manage the uncertainty, ensuring that the vaccine is safe, that the Portuguese should adhere to it and that the plan is being prepared with great caution ”, he noted, devaluing the concern that may exist with allergic reactions for that being“ a common issue ”in vaccine administration.

As such, Francisco Ramos anticipated a communication campaign in which, in addition to local contacts, the creation of “a completely dedicated ‘website’ where people can find all the information” and “two telephone contact lines, in which the infrastructure will be supported by the SNS24 ”, with professionals able to answer questions, and the possibility of scheduling vaccines is still open.

Despite recognizing a “reduction of about 20% in vaccines” by Pfizer in the first quarter of 2021 for “a failure by the company in this matter” at European level, the coordinator of the task force, guaranteed the readiness of the NHS.

“Even if this distribution occurs on Christmas Day, we will have people qualified to receive vaccines on the spot. We are available to start vaccinating as soon as the vaccines arrive, it would be intolerable to have vaccines in Portugal and not use them right away. The worst that could happen would be to set fixed dates for a person to be vaccinated in a day at X hours and then not vaccinate ”, he noted.

Faced with the capacity for an eventual anticipation of the vaccine administration until the end of December and not only in January, Francisco Ramos was not concerned, preferring to highlight the “very high hope” that this step means in combating the pandemic caused by the new coronavirus.

“The less time we have to prepare this process, the better, because it means that vaccines will arrive earlier,” he said.

For the first phase of the vaccination plan, scheduled between January and March 2021, vaccination points were defined taking into account the priority groups in accessing the vaccine: people over 50 with associated pathologies, residents and workers in homes , and essential health and service professionals.

For this reason, the vaccine will be administered in the approximately 1,200 vaccination points usual in health centers, in homes and long-term care units and within the scope of occupational medicine for professionals in essential services.

Portugal accounts for at least 5,733 deaths associated with covid-19 in 353,576 confirmed cases of infection, according to the latest bulletin from the Directorate-General for Health (DGS).

Respect restrictions

Rui Portugal, Deputy Director-General for Health, said that it was crucial for people to comply with restrictions in each municipality, especially travel and gatherings.

Care if you are sick

If you are infected or have symptoms of covid-19, you must comply with the health issued by the health authorities. During Christmas, families must support the sick. “Physical leave does not mean family leave”,

Contact reduction

Before and during the festive season, contacts should be reduced, for example, if you usually celebrated Christmas with ten or more people, you should consider reducing the number of family members or friends, in order to decrease the potential spread of the new coronavirus.

Exposure time

The same goes for the hours spending with family or friends on Christmas days: instead of spending five hours with several people, DGS advises to cut down on time and spend only an hour or two in a group.

Family nucleus

Although Christmas is, for many, spending the festive season with the extended family, in times of pandemic it is recommended to party only within the household.

Visits to other relatives safely

If you do visit other family members, you should consider doing it outside area and for a short time.

Avoid spaces such as kitchens

The kitchens are, as a rule, a place where several people gather in the same house. Such gatherings increase risk of spread of the disease and should be avoided. Traditional greetings (hugs, kisses and handshakes) must be avoided. The physical distance of one meter to two meters must also be maintained.

Airing houses

Whenever possible, houses should be ventilated and interior surfaces disinfected regularly.

Objects

Avoid as far as possible sharing objects and cutlery with other people. If unavoidable clean your hands afterwards.

The Deputy Director-General of Health also said that care should be taken with the consumption of alcohol which may reduce the sense of the need of safety among family members and friends.

 

 

This year, different police stations in the country assisted 12 elderly people lost on public roads. A simple bracelet made it possible to take them back home or to family members, through the I’m Here Adults program, which results from a partnership between PSP and Santa Casa da Misericórdia.

In the right hand or in the left? More or less tight? At the door of an odd number on Rua Diário de Notícias, in Lisbon, the PSP agent Lopes da Silva delicately puts a bracelet on the thin and wrinkled skin wrist of Maria Fernanda, 87 years old and resident in Bairro Alto for 60. ” great “, she guarantees. And the agent continues. “Look, you know what this is for, don’t you?” “I’ve heard of it.” It is better to repeat. “This has a little number here, in which your [family members] contacts will stay, in case you get lost, if you have a problem on the public road, and don’t bring anything with you.” Then, Maria Fernanda shoots her conclusion: “I mean, from now on, I am a protected woman. Good!”. He skips his feet lightly on the building’s doorstep and claps his hands.

Age does not forgive, the popular sayings already warn. Over the years, the number of pathologies and the limitation of autonomy tend to increase. These are not nice accounts for those who have become accustomed to making their living in the city and, one day, find themselves on the verge of not being able to leave the house alone without getting lost along the way. Can a bracelet and a number change the safety of the elderly? That’s the purpose of the national program I’m Here Adults, a partnership between the Public Security Police (PSP) and Santa Casa da Misericórdia.

The initiative proposes to distribute a bracelet, which is assigned an identification number, to a more vulnerable population such as the elderly, who will help passers-by or police officers to help them and identify them if these people are lost on the public road. After the success of the I’m Here Children program, created in 2012, in 2015 PSP launched a pilot project for the older version. “We are talking about all the elderly, but it is more aimed at people who, due to a pathology or old age, may momentarily become unbalanced and lose track of time and space on the public road, without any contact or identification .

Artur Serafim explains that if a citizen or agent reports that a person is lost, he can call the national emergency number, 112, indicate that he has a bracelet under this program and dictate the number inscribed on it, so that the National Directorate of PSP can access this user’s profile and contact people nearby. Therefore, the bracelet does not have an integrated GPS tracking system. It works only as a “tool” of work, a means to cut a path.

About a thousand active bracelets

Elderly people lost in the streets of the city “does not happen daily and thankfully, but it is happening”, warns the PSP spokesman in Lisbon. As an example, he recalls that, this year, there were 12 cases at national level in which it was necessary to “make the connection between people and people’s families”. Reducing the geographical scale for the Lisbon Metropolitan Area, there have been four cases since January. Figures that, in his perspective, justify the extension of the program to more and more people. “What we want is for there to be more adherence and we can thus safeguard the lives of many people.”

At the national level, the distribution of bracelets in the scope of I’m Here Adults has reached thousands since 2016. In all, 1388 bracelets were delivered, of which only 961 are active in the system. And Lisbon represents a large share of this total: there are currently 441 active. According to the PSP, the Campo Grande and Odivelas police stations are the ones that aggregate the largest number of deliveries to date.

The distribution process, explains representative Artur Serafim, “is very simple”. It can be requested by the carrier himself, if he is aware of his condition and feels that he wants to be safer every time he leaves his home. Or even by a caregiver, family member or friend, as well as by an institution that the elderly person is in charge of. To apply, simply fill out a form on the internet or go to a police station, so that PSP agents can help with the process. After an identification number is generated, the bracelet is activated and will be given to the elderly.

With the covid-19 pandemic, the challenges have changed. “We note that there is greater adherence and we welcome this behavior, because it is ideal for us,” says the spokesman. In response to the increased interest on the part of family members and the elderly to join the program, PSP now offers a wider range of police stations where the bracelets can be distributed. So far, this service is not available in all police stations, “because we do not have this capacity in terms of the number of bracelets”, explains Artur Serafim. However, the medium term objective “is that a large slice of the squares in the Metropolitan Area of ​​Lisbon have the bracelets”.