# Covid in Portugal as of 2020/07/26

## Case fatality rate
Case fatality rate (CFR), meaning the number of deaths per detected case, is among the lowest by median age of the population.
_Portugal is in the bottom right_

While it is not an accurate measure of the true number of deaths to be expected per infection, which is much lower, a low CFR may reflect, among other things:
* broad testing that identifies even mild cases
* good coping capacity of the healthcare system
* lower susceptibility of the population to serious disease

... all of which are good. Let's look at what testing and mortality can tell us.

## Testing
### Testing policies
Portugal was the first country in Europe to do screenings to find asymptomatic cases among high exposure groups, as early as April 10th.

Even as of now not many countries in Europe do it ...

### Testing capacity
Portugal has been among the countries that run most tests per capita since April and the testing capacity is increasing.
* The network of labs performing SARS-Cov-2 tests has been recently expanded from around 30 to around 90 labs nationwide for faster turnover of results.
* Government is expanding testing capacity, which is planned to increase by more than 50% (possibly more) before the end of the year.
* There is reserve capacity for testing in a network of scientific research labs that could augment testing in case it becomes necessary.

## All cause excess mortality

All deaths in Portugal from patients without a positive test but result of disease compatible with COVID-19 or a setting with suspected infection are required to undergo postmortem testing and counted as a COVID-19 related death. This is not necessarily the case in all countries.

_All cause mortality in units of statistical significance vs week of the year. Values above red line are considered excess mortality based on what should be expected based on historical data._

Many countries are very likely under-reporting COVID-19 deaths. Example: compare trace for the Netherlands with Italy... and consider the fact that the Netherlands has reported 358 COVID-19 deaths per 1 million inhabitants while Italy has reported 581 deaths per 1 million inhabitants.

Given that in Portugal we haven't experienced an all cause mortality increase and given current mandatory testing policies pre and post-mortem I believe our COVID-19 death data is probably trustworthy.

### Mortality by age group in Portugal

| Age group | % of all deaths |
| --------- | ------------------------ |
| >80 | 67% |
| 60-80 | 28% |
| <60 | 5% |

In the following plots which I have made using official data, the last data point corresponds to the reports as of today, July 26th 2020.

Deaths among people older than 80 are likely to reflect outbreaks in elderly homes or small countryside villages with very old population:

That doesn't necessarily reflect the risk of community transmission.

The mortality among people that are less than 60 years old suggests small limited outbreaks
... some of which might have taken place at wards in hospitals, especially earlier ones (my speculation).

Deaths among 60-70 year olds reveal a robust trend in decreasing deaths by COVID-19. This age group is less likely to live in institutionalized settings and get infected from relatives or in work settings. I believe it is a better reflection of the state of the epidemic.

# Other positive signs
* On April 20th the government has inititated a research project in partnership with university research centers to use waste water testing for early detection of outbreaks: (https://www.portugal.gov.pt/pt/gc22/comunicacao/comunicado?i=investigacao-em-aguas-residuais-pretende-criar-sistema-de-alerta-precoce-do-virus-sars-cov-2)
* There's a program for sequencing virus samples collected in Portugal which may assist in understanding major sources of transmission and public policy (https://insaflu.insa.pt/covid19/)
* Weekly reports with analysis of recent infection data by region to assist public health policy (http://www.insa.min-saude.pt/category/areas-de-atuacao/epidemiologia/covid-19-curva-epidemica-e-parametros-de-transmissibilidade/)

## Self sufficiency
Due to swift development initiatives during the pandemic we already have a few things made in Portugal:
* Validated testing kits with swabs, reagents, etc., (pending final approval for clinical use but already in use in asymptomatic screening)
* Certified medical ventilators
* (starting August) Medical grade FFP2/N95 filtering masks (respirators)
* Disposable and reusable masks with efficicacy certification by independent testing body
* Face shields

# How some health specialists cope with COVID-19 risk in their lives
https://www.washingtonpost.com/health/how-fauci-5-other-health-specialists-deal-with-covid-19-risks-in-their-everyday-lives/2020/07/02/d4665ed6-b6fb-11ea-a510-55bf26485c93_story.html

# FFP2/N95 filtering masks for use on the airplane
Good comfortable models which I have used:
- 9322 aura 3m (with valve)
- 9332 aura 3m (with valve); this one is slightly harder to breath with and shouldn't offer much if any additional protection. 9322 is preferable

I would wear this with another simple surgical mask on top, in case someone complains because of the valve.

In addition I would also wear a face shield like this
(without the suit)

or goggles like these: