Portugal, a nation with a population of just over 10 million, like most countries in Europe, has suffered badly in the pandemic. One in ten of the population have been infected with the SARS-Cov-2 virus, and over 18,000 have died. That is 1,773 deaths per million people. In Australia, although we are in the middle of our third Covid-19 wave, we have only had one in 210 people infected by the virus and 1,389 killed by it; that is 54 deaths per million people1, far fewer per capita than Portugal.
Perhaps because of this extreme suffering, Portugal was fairly quick off the mark in vaccinating its population, having started in December, 20202. Currently, it has the highest vaccination rate in Europe, with just under 86% of its entire population (not just over 16s or over 12s) having had two doses3. Despite this exceptional vaccination rate, Portugal is only now coming out of its fourth wave of infection, which kicked off in the middle of June4, when only 27% of its population had been fully vaccinated and 19% had been partially vaccinated3. That wave reached a peak of about 3,300 new cases per day in late July, and 15 deaths per day in early August. Currently, Portugal is still recording 570 new cases and 6 deaths per day on the tail of this fourth wave4.
Portugal has recently relaxed most of its Covid-19 restrictions, with no further capacity restrictions, curfews or limitations on alcohol sales. Bars, clubs and restaurants are open and have no capacity limits. However, on public transport, masks are mandatory and a European Union Covid Digital Certificate must be presented for access to major cultural and sporting events, bars, clubs, health facilities and for travel by air or sea. Physical distancing is also recommended, as is frequent hand washing, and respiratory etiquette (not coughing, sneezing or breathing on anyone)5.
Currently, Australia has 48.4% of the entire population fully vaccinated, with another 17.0% having had one dose. New South Wales and the Australian Capital Territory have the highest vaccination rate, with 57.5% and 56.6% fully vaccinated respectively6. New NSW premier Dominic Perrottet this week announced major changes to NSW’s way out of Covid-19 lockdowns which will come into effect on Monday October 11. Among these are:
Schools for many year groups will reopen; fully vaccinated people will be allowed to go to gyms and restaurants; increasing the number of adults allowed to gather in homes from 5 to 10; increasing the number of adults allowed to gather in public spaces from 20 to 30; increasing the cap on people at weddings and funerals from 50 to 100; and reopening indoor pools7
During his press conference, Perrottet stated that this was based on medical advice. However, it wasn’t. The NSW Chief Health Officer, Kerry Chant did not endorse this and warned Perrottet that these changes come with risk8. The “scope and breadth” of changes to the NSW roadmap out of lockdown caught the Australian Medical Association by surprise, and may lead to “skyrocketing cases”, its NSW president, Danielle McMullen, has said. She added: “We were happy with the roadmap as it was. We thought it was a careful and sustainable reopening. It’s really important that everyone is vaccinated and that’s why we’re still pushing so hard to really get to that 90-to-93% vaccination target9.
Epidemiologist Prof Mary-Louise McLaws said she was worried about how the new roadmap would impact the most vulnerable, including those who are immunocompromised and for whom the vaccines are not as effective, and those who can’t get vaccinated for medical reasons. She is also concerned about the impact on young people, since they are driving infections, and that having schools open up near the end of the October will not allow enough time for all the under 40s to be fully vaccinated9.
Professor Alexandra Martinuik, said she believes masks need to stay for the time being, that indoor ventilation needs greater attention, and that capacity limits in venues and households need to be lower. She said: “Now is not the time for accelerating NSW reopening. We are sitting at about 59% of the total population of NSW having two doses of a Covid-19 vaccine. Countries which have re-opened gradually have typically been at 70-80% total population vaccinated”9. That is where Portugal was when it opened up, and still cases and deaths are occurring, although the rate is declining. If Perrottet opens up before New South Wales reaches a similar level of vaccination as Portugal, it could be disastrous. However, he is beholden to his donors and they are so inconvenienced by lockdowns.