Notícias e Eventos

Excess of mortality, colateral mortality and Portuguese health services response in COVID-19

Publicado a 03/11/2020

The research group from COVID-19 Barometer of NOVA National School of Public Health analyzed deaths between March 16 2020 and September 30, concluding that there was an excess of mortality of 12% (7,529 more deaths than those that would be expected based on the average mortality of the last five years). 68% of these deaths were not caused by COVID-19.

Between March 16, 2020, the day Portugal reported the first death from COVID-19, and September 30, 2020, there were 7,529 more deaths than those that would be expected based on the average mortality of the last five years , that is, there was an excess of mortality (MS) of 12%. The excess of mortality mainly affected people over 85 years old (+ 18%). Sixty-eight percent of excess mortality (MS) due to natural causes corresponds to collateral mortality, that is, it is associated with deaths that were not identified as COVID-19.

Since the beginning of the Pandemic, there has been a very significant drop in the number of services provided by Portuguese health services. In 2020, there was a reduction in face-to-face and home based consultations in primary health care (-53% and- 49% respectively), consultations in hospitals (-11%), complementary means of diagnosis and therapy (-50%) , outpatient surgical interventions and inpatient surgical interventions (-21%), considering the averages of previous years. Even urgent surgical interventions were reduced by 9 percent.

Primary health care has significantly changed its delivery model, replacing its traditional consultations with non-face-to-face and non-specific consultations that have increased by 116%. On balance, total , the total number of medical consultations in primary health care dropped by about 4% . It will be worth studying the impact of this change on the quality of care provided. In 2020, there was also a drop of around 8% in the demand for pre-hospital care (high end ambulance service), more pronounced for high-priority care.

This suggests that patients with severe symptoms, which would justify triggering pre-hospital care facilities for immediate or advanced life support, would have been reluctant to do so, for fear of becoming infected with COVID-19. During this period, cases classified as low priority and, therefore, referred to the national health service phone help line – Health 24 without activating pre-hospital ambulance service) increased by 41%. This suggests that in times of COVID-19, patients request urgent ambulance services for more trivial reasons than before, or that the algorithm that decides who will get the urgent ambulance service has become more strict.


About COVID-19 Barometer 

A 30 people strong group of faculty, researchers and students from NOVA National School of Public Health dedicated to monitoring and analyzing the available data, to support the Ministry of Health and feed the media with quality information. The group is organized around four themes (social opinion, policies and interventions, occupational health and epidemiology) and launched an ongoing social media survey on COVID-19 related perceptions and behaviors.

The Portuguese Government invited the Dean to integrate the restricted and high-level advisory board that briefed the President, the Prime Minister, political and civil society leaders on a biweekly basis on the evolution of the pandemic. Until now (novembre 2020), the work produced by the NOVA NSPH COVID-19 Barometer resulted in 8 scientific papers, 40 working papers and scientific analysis and resulted in more than 1.000 news articles in national and international media. [in portuguese]