Three perspectives on the impact of the COVID-19 pandemic in Portugal

Abstract

The COVID-19 pandemic was the most profound health crisis of the 21st century, leading to over 6 million fatalities globally. It tested health systems worldwide, revealing their weaknesses and resilience. Health systems' ability to maintain essential operations, quickly regain optimal performance and undergo structural and functional transformations to improve their overall strength is essential to improve the response to future external health shocks. However, the full impact of the COVID-19 pandemic still needs to be better understood in economic and health system terms. We applied time series analysis methods to the case of Portugal, a high-income European country, to assess three different aspects of the impact of COVID-19. In Chapter two, we present evidence of the economic impact of the two government COVID-19 mitigation lockdowns. The first lockdown had a more significant impact, resulting in a 21% decrease in spending, whereas the second lockdown resulted in a 16% decrease in spending. Our findings also reveal a rise in spending in the pharmaceutical sector during the first lockdown, which could put pressure on supply chains and result in disruptions within and across countries. In contrast, the health services sector did not see a decrease in spending during the second lockdown, likely indicating adaptations during the period between lockdowns (the inter-lockdown period). Lastly, our research adds to the growing body of literature demonstrating lockdowns' effectiveness in reducing SARS-CoV-2 cases and COVID-19 deaths. In Chapter three we illustrate the effects of the governmental lockdowns on routine health service utilization. We found that the lockdowns resulted in moderate to severe disruptions in health services across different sectors of the health system (including outpatient care, surgical care, and emergency department visits). A more significant decrease was observed during the first lockdown compared to the second. An increase in telemedicine consultations partially offset this decrease. While hospitals were able to return to pre-pandemic levels of operation quickly after the second lockdown, they did not increase their production to make up for the lost visits. On the other hand, the impact on primary care was even more severe, and even a year after the end of the second lockdown, primary care had not yet recovered to pre-pandemic levels. The pandemic resulted in millions of missed hospital and primary care visits, increasing unmet need on a population level. In Chapter four, we observed a general decrease in inpatient care for non-COVID related conditions, followed by an increase in case fatality rates. During the first lockdown, there was an immediate 17% increase in case fatality rates, while the second lockdown saw a 62% increase. The rise in case fatality rates was not uniform across age groups, with higher increases being observed in older age groups, particularly in conditions related to the circulatory and digestive systems. Despite the increase in case fatality rates, our analysis showed that the expected number of deaths did not rise during the pandemic period, suggesting that the frailest patients may have been selectively admitted during this time.