Portugal and Spain: same peninsula, very different coronavirus impact

Early action by Portuguese authorities is being credited for the country’s low death and infection figures

A care home in the Portuguese city of Figueira da Foz.
A care home in the Portuguese city of Figueira da Foz.CARLOS COSTA (AFP)

Spain, with its high coronavirus death toll and ongoing confinement, regards neighboring Portugal with a combination of envy and perplexity. Located in the same peninsula, Portugal has had a little over 1,000 deaths for a population of 10.2 million, compared with Spain’s more than 26,000 deaths for a population of 47 million. Portugal, with around five times fewer deaths per million inhabitants (111 versus 569), did not impose a mandatory quarantine, instead framing it as a civic duty that was widely observed. And although bars and restaurants did close, the economy did not grind to a halt.

What is Portugal’s secret? Experts from both sides of the border point to several factors, including less travel between Italy and Portugal than between Italy and Spain. But above all, Portugal acted faster. After seeing events unfold in Italy and Spain, Portuguese authorities declared a state of emergency when the country only had 100 coronavirus cases and no deaths. In Spain, that decision was made after registering 4,209 cases and 120 fatalities.

For the epidemiologist Rita Sá Machado, the fundamental issue was “the early application of public health measures, such as school closures.” This measure went into effect on March 16, when the first death was recorded.

If we don’t keep up good social conduct, we run the risk of losing everything that we’ve gained
Graça Freitas, Portuguese director of health

The state of emergency began a week later, with 1,200 infections and 12 deaths. “The variety of measures that were applied was also very important, because they made it possible to control the expansion of the epidemic,” said Sá Machado.

Alberto Infante, an expert in public health, agrees: “How you act at the beginning determines everything that happens later. Although we didn’t know it until late February or early March, asymptomatic people have played a really important role. Portugal had the good fortune to see what was happening in Spain and Italy and the good sense to introduce early measures when the epidemic was getting started.”

Besides this early action, Infante notes three elements that might have made a difference with regard to Spain. “Portugal does not have a system of devolved powers to the regions that makes decision-making more complicated; the [Socialist] government and the opposition worked as one and sent out the same message from the beginning; and maybe because of this and because they could see what was happening abroad, the people showed great awareness,” he says. Only the Communist Party of Portugal (PCP) opposed the declaration of a state of emergency, alleging it would violate constitutional rights.

António Pires de Lima, a former economy minister who served with the conservative government of Passos Coelho between 2011 and 2015, praises the speed at which decisions were made.

“The virus arrived a few weeks later than Italy and Spain,” he recalls. “We saw the chaotic situation in Italy, and when the first infection was detected [on March 2], the government took quick decisions. It was essential for the Portuguese people to understand the risk of exponential growth of transmission and the danger to public services. People acted with a great sense of responsibility and stayed home. This helped flatten the curve of contagion and the national healthcare service did not collapse, it responded very well.”

Ninth place

Although Portugal has done much better than Spain in terms of deaths and infections per 100,000 people, it still ranks ninth on the list of EU-27 countries for most deaths per one million people, and sixth for number of infections per million. Spain holds second spot on both counts behind Belgium.

Some regions of Spain have better figures than Portugal, such as Murcia and the Canary Islands. “It’s not that these regions have done anything particularly well compared with the others, it’s just that the quarantine began when there was still low incidence,” says Jesús Molina Cabrillana, a member of the Spanish Society of Preventive Medicine, Public Health and Hygiene.

Despite the early measures, there was also a shortage of protective gear in Portugal. “That was the negative side,” says Pires de Lima. “Just like in most other countries. I think we all regarded China complacently, thinking that the virus would not come here. January and February were not used to buy gowns and masks, and we underestimated their role in the personal protection of citizens.”

Portugal has recorded a few spikes in recent days. “Where things get too relaxed, new clusters emerge,” says the director of health, Graça Freitas. “A very small percentage was infected, the rest of us are at risk. If we don’t keep up good social conduct, we run the risk of losing everything that we’ve gained.”

Experts warn that until the epidemic is over, no solid conclusions can be made. Nobody knows how long the virus will keep infecting people, what new outbreaks might look like, or how much damage they could inflict.

English version by Susana Urra.

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