James Melville continues his series comparing international responses to COVID-19 and the example of Portugal shines out despite an ageing population and a frail health service.

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É melhor prevenir do que remediar. “It is better to prevent than to mend.” Portuguese proverb 

Portugal, with more of its population aged over 80 than anywhere else in Europe except Italy and Greece, combined with a health service that’s poorly equipped, were at risk of a comparable Coronavirus tragedy to its Iberian neighbour, Spain. Portugal has just 4.2 critical care beds per 100,000 people, the lowest in the EU. Spain has over nine such beds per 100,000 and Germany now has 34 per 100,000. Due to the fragility of their health system, Portugal could have faced a worse health crisis than in Italy or Spain. 

But remarkably, Portugal appears to have avoided a disaster. It did so by shutting down the country early and much earlier than many European countries. They acted fast and it appears to have worked.

Portugal registered its first coronavirus cases on March 2, a month after the disease first appeared in Spain and Italy. This bought Portugal extra time. It allowed the Portuguese government to gather knowledge from countries who had already reported weeks of the virus, learn from their mistakes and introduce aggressive measures before the virus could overwhelm the country. 

Portugal shut down their schools and social gatherings when there were just 112 cases and no fatalities in the entire country. Spain already had 2,140 infections by the time the schools were closed.

Six days after the country’s schools and universities were shut, Portugal declared a national state of emergency and went into full lockdown after recording 448 cases. Spain went into lockdown on 14 March after recording more than 6,000 cases.

Unlike Spain, Portugal’s almost immediate response to combating COVID-19, has resulted in minimising the spread and fatalities of the pandemic. Portugal, as of the 26th April, has recorded 23,864 COVID-19 cases and registered 903 deaths. Compare and contrast to other Mediterranean countries, France, Spain and Italy, who all have over 160,000 cases per country and over 20,000 hospital deaths per country. 

Like the fast response examples set by Greece, Denmark, Norway and Austria, early implementation of lockdown measures can help explain the slower pace of the infection in Portugal. A consistent theme is now emerging during the Coronavirus crisis – countries that lockdown early manage to minimise the spread of the disease and minimise their overall mortality rates.

Although the spread of the virus was largely clustered around Porto, Portugal’s government implemented immediate nationwide lockdown measures, which prevented the disease from spreading to other parts of the country.

Another consequence of Portugal enforcing social distancing and lockdown measures early and therefore being able to restrict the spread of the virus, was that they were able to enforce lockdown measures that were less strict than in many European countries. Many businesses are still open, such as factories and construction sites. Now, over a million people are due to return to work in May. President Marcelo recently stated that, “what we’re aiming for is to announce the programme of progressive deconfinement after the meeting of the Council of Ministers on April 30”. 

Since the first cases in Portugal were confirmed, a network of primary care facilities were utilised to offer home care to patients. 82% of coronavirus patients in Portugal recovered at home, so their healthcare system never reached the stage where it was under severe pressure.

The miracle of Portugal happened because their government took swift and decisive action to combat the Coronavirus. They acted earlier than the examples of Spain, France, Italy and also the UK. The results so far, speak for themselves. 


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