Not all measures contained in this 2022-2023 winter seasonal response plan are new. The Secretary of State for Health Promotion, Margarida Tavares, referred to the DN after the plan was announced. “There are measures that have already been used in previous years”, but what is intended now is for them to be more effective. Or rather, that there be greater articulation between services, Regional Health Administrations and ACes and between these and the SNS24 Line.
O The objective, as stated in the document, is to improve user response. “Give better health to all”, refers to the document as a slogan, “taking advantage of the scientific knowledge acquired for decision-making”, since “an effective response to covid-19 and other respiratory infections will affect the least possible the provision of of care for other health needs, which will be fundamental to preserve the capacities of health and public health institutions in relation to other needs and emergencies”.
In the same document it can also be read that “this strategy will be continuously evaluated and adapted to the evolution of the epidemiological situation and the capacity to respond”, considering also fundamental for this response to be able to “ensure high levels of coverage and vaccination reinforcement – to promote the use of masks – adequately ventilate environments – implement therapeutic protocols based on scientific evidence”.
1 – Epidemiological surveillance of respiratory infections and monitoring of the health system.
Reinforcement and consolidation of the population-based sentinel epidemiological surveillance system for SARS-CoV-2, influenza and other respiratory viruses; Surveillance of outbreaks in ERPI, RNCCI and other contexts of more vulnerable populations; Indicators of demand, access, response throughout services and levels of health, vaccination coverage, morbidity and mortality; Monitoring and Intervention Team in the Seasonal Response in Health, in permanent operation in the Ministry of Health and of multi-institutional constitution.
2 – Prevention and Control
Seasonal vaccination campaign; Public health measures to prevent the transmission of covid-19, flu and other respiratory infections, according to epidemiological developments, contexts and locations.
3 – Health care to be provided before the Emergency Service
SNS line 24 flowcharts adapted to the epidemiological situation; Use and orientation of users through the SNS24 line; Articulation and response of the SNS 24 line, primary health care (activation of units with extended opening hours and complementary services) and hospital emergency services, according to demand monitoring; Daily update on the SNS Portal of information on ACES units, with extended/complementary working hours; Telehealth to support reference professionals at the RNCCI, RNCP and ERPI units; Specific teams of professionals from ACES and Hospitals to support ERPI.
4 – Identify and mitigate situations of vulnerability of elderly people
Surveillance of outbreaks in ERPI, RNCCI and other contexts of more vulnerable populations; Prioritization of seasonal vaccination of people at greater risk and who live in a vulnerable situation, particularly users of RNCCI and ERPI; Telehealth to support RNCCI, RNCP and ERPI reference professionals; Specific teams of professionals from ACES and Hospitals to support ERPI; Update of daily rates at RNCCI (Ordinance No. 272/2022, of November 10); Availability of vacancies and articulation with the RNCCI; – Transition program between hospital discharge and social response.
5- Communication
Use of the SNS Line 24 as preferred contact; Use of the appropriate level of care; Reduction of barriers, inequality and stigma in accessing health care; Involvement of users, families and caregivers in the response to winter respiratory infections.
6 – Creation of the Monitoring and Intervention Team in the Seasonal Health Response
It will be in permanent operation in the Ministry of Health and with a multi-institutional constitution (DGS, DE-SNS, ACSS, INFARMED, INEM, IPST, INSA, ARS, SPMS, SUCH and NCAMS) for the collection and analysis of information related to epidemiological surveillance, monitoring of demand and response from health services, and other relevant information and alerts with capacity for monitoring, analysis and rapid communication, with the participation and collaboration of specialists and scientists external to the Ministry of Health whenever justified, who provide consultancy in areas specific.
7 – Joint
Reinforcement of articulation with Social Security through a transition program between hospital discharge and social response.
Regarding health units, the document reveals that there must be:
1 – Review and adequacy of the contingency plans so that they are operational and feasible, foreseeing a functioning for situations of baseline demand, of intermediate or high intensity and with commitment to evaluation and improvement at the end of the 2023 winter season.
two – Inclusion in the contingency plans of articulation measures with municipalities, associative, cultural and recreational entities, community-based/non-governmental organizations, patient associations, security forces in proximity.
3 – Implementation of checklists for preparing for winter in the 4 levels of care: pre-hospital, primary, hospital and continuous.
4 – Availability and daily update on the SNS portal, in the “Seasonal Response in Health” area, of information on the locations in the various ACES, with extended/complementary timetable regimes.
5 – Implementation of vacancy coordination teams in hospital establishments, managing in an integrated way and making available all available beds in the hospital in real time, to reduce the length of stay in the Emergency Service (SU) and avoid “hospitalizations” in the SU.
Balance of the Situation
SARS-COV-2
In the last balance sheet released by the DGS, last Thursday, the incidence values, based on the mandatory notification of cases, remained stable. However, the increase in the number of hospitalizations due to SARS-CoV-2 and the prevalence of sublines with potential interest indicated that there was an increasing transmissibility. The report revealed an increase in the number of admissions to the ward in the age groups above 20 years old, and in intensive care above 80 years old. Although with a reduced impact of the disease on health services and on general mortality, this translated into general mortality in line with expectations for the time of year.
Vaccination
By November 15, more than 2 million people had been vaccinated with a booster. 100% of Residential Structures for the Elderly (ERPI) are covered by vaccination; 94.7% of the population has started primary vaccination (9,333,329); 80.1% of the population already has the 1st booster dose (6,650,209); 71.6% of those over 80 years old have a 2nd booster dose (454,079); 60% of those over 60 who have the fall dose (4th dose), (2,147,783)
Prevention
INSA estimates that the impact of vaccination against covid-19 made it possible to prevent 1,200,000 infections; 2,000,000 hospitalization days; 130,000 days of hospitalization in the ICU; 12,000 deaths prevented.
Citizens
The ENSP barometer also reveals that citizens are available to wear a mask (80%), but little or not at all available (62%) for protective measures that condition relationships with family and friends.
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