Covid-19 ICU admissions continue to outperform in seasonal flu season

Portugal passed for the first time the barrier of 250,000 known active covid-19 cases for the first time: in other words, 2.5% of Portuguese are infected – but among asymptomatic and people who are never diagnosed, the number will be higher. Over the winter, the projection is that 30% of the Portuguese population will be infected, in line with what is projected for the Northern hemisphere. Figures that at the beginning of the pandemic would have triggered all alerts and now, with vaccination in the booster phase and an apparently less virulent variant, gain another meaning, but have been putting pressure on SNS24, family doctors, public health teams – that they will stop doing all the screenings with the infected and receiving an sms with a survey to fill out. Is it already a situation comparable to the flu? Is that where you walk? It’s possible, but it still doesn’t seem to be the case this winter – and even the flu has more severe years.

Attack rate remains higher than seasonal flu

The University of Washington was the first to come forward two weeks ago with the projection that the contagions could this winter outweigh the infections of the entire pandemic, predicting 3 billion infections, particularly in the northern hemisphere, as SARS-Cov- 2, like other coronaviruses, appears to have seasonal dynamics.

The numbers that seemed high began to materialize in different countries, starting with the USA, which surpassed one million diagnoses in one day. The projections for Portugal are not far from the modeling made at the National Institute of Health Dr. Ricardo Jorge, which this week presented at the Infarmed meeting a model that, in the most conservative scenario, predicts a maximum of 42,000 contagions between this week and next , if containment is effective, followed in the medium term by an increase in contagion with the opening of schools, but with less force than during the festive period.

Each model is based on its premises and that of the Institute for the Assessment of Metrics in Health (IHME) at the University of Washington, which we publish alongside, does not incorporate specific local measures but takes into account the mobility of the population, which at the end of the year was already closer to the pre-pandemic and now suffered in Portugal and in many European countries another brake – a new update is expected next week. But the restrictions are not those of the last winter and with more contacts and, with a more transmissible variant, it is expected that there will be more infections. Carlos Antunes, from the Faculty of Sciences of the University of Lisbon, estimates 3.5 million cases by the end of March. By way of comparison, seasonal flu has an attack rate of 5% to 15% of the population, so it is projected that the SARS-Cov-2 attack rate this winter could still be double what would be normal at one time. of seasonal flu. But these are not the only numbers that can be used as a benchmark: currently, even with lower inpatient ratios per covid-19 than before the vaccines, this Thursday there were 161 patients inpatients with covid-19 in intensive care in the National Health Service. In the last seasonal flu season before covid-19, in the winter of 2019/2020, 121 flu patients underwent intensive care during the five months of influenza monitoring carried out by the Dr. Ricardo National Health Institute Jorge, less than those who are hospitalized at the same time as covid-19. It was a moderate time, but the years with the greatest impact reach 150 to 200.

Data from bulletins that don’t show everything

In terms of hospitalizations, a study released last year concluded that in ten years, between 2008 and 2018, a total of 13,629 hospitalizations were identified due to the flu. How many hospitalizations did covid-19 lead to? Nascer do SOL has been trying for several weeks to obtain current data from the General Directorate of Health and the Central Administration of the Health System, without success, but a survey until August that it was possible to have access to indicated that they had been hospitalized until then more than 60,000 patients diagnosed with covid-19 in NHS hospitals (note that some may have covid-19 as the main or secondary diagnosis, that is, it was not covid-19 that took them to the hospital). This movement of patients, some being discharged, others remaining for several days in the hospital and others ending up dying, does not show up in the DGS bulletins, which only show hospitalized patients at any given time. What, even in the current situation where hospital pressure is substantially lower than a year ago on the covid-19 side but higher on the non-covid side, may not give an idea of ​​the movement in hospitals, which started to be growing in the region of Lisbon and also extends to the North of the country.

An example from last Thursday: yesterday, in the DGS bulletin, it could be read that within 24 hours there were 42 more inpatients with covid-19 in NHS hospitals, bringing the total to 1353.

Data to which Nascer do SOL had access allow us to conclude that in the Lisbon region, in 24 hours, the number of patients admitted with covid-19 in the different hospitals in the region rose from 622 to 650, therefore 28 more inpatients than on the day previous. But in those same 24 hours, 60 patients were found to have been recovered, that is, they will have been discharged, and 13 ended up dying. Doing the math, there will have been around a hundred new patients hospitalized in the Lisbon region alone on Thursday.

What to Expect Over the Winter: The rise in infections now in the older population suggests that even with greater protection from vaccines, there will be a greater impact on health services and an increase in mortality: globally, the IHME predicts they may come More than one million deaths were recorded this winter associated with covid-19, with close to 6.5 million deaths associated with covid-19 at the end of the second winter of the pandemic in the northern hemisphere. In one year, globally, it is estimated that seasonal flu causes 650,000 deaths and the most stressful season will only start in the southern hemisphere in our summer.

The increase in natural immunity against high levels of infection, reinforcing the immunity conferred by vaccines, is one of the hypotheses for winter to be important in the transition from pandemic to endemic, but in contrast there is the risk of new variants and uncertainty about the impact of Omicron on unvaccinated, older people and sequelae. “We hope that after March there won’t be much transmission of Omicron anymore. However, we must wait for the emergence of new variants, some with the ability to escape immunity and maintain transmission,” says Christopher Murray, director of the IHME, to Sunrise. Whether this is the last winter of the pandemic is anyone’s guess, but the trend will be to become more of a disease. “We believe that there will continue to be transmission especially in winter due to the emergence of variants. However, with increased immunity from previous infections, access to regular vaccine boosters and antivirals, covid-19 could have an impact equivalent to or less than that of seasonal flu,” he concludes.

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Source: Jornal i by ionline.sapo.pt.

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