Policy responses for Portugal - HSRM


Policy responses for Portugal

1.3 Isolation and quarantine

On October 14, he Directorate-General of Health has changed the period of isolation for confirmed cases (https://covid19.min-saude.pt/wp-content/uploads/2020/10/Norma_004_2020_act_14_10_2020.pdf):
• from 14 to 10 days, for asymptomatic cases, counting from the day of the positive result;
• from 14 to 10 days from the onset of symptoms, for mild or moderate disease, if no fever for 3 consecutive days and significative improvement of symptoms;
• from 14 to 20 days from the onset of symptoms, for serious or critical disease, if no fever for 3 consecutive days and significative improvement of symptoms;
• from 14 to 20 days from the onset of symptoms, for serious immunosuppression, irrespective of the disease severity, if no fever for 3 consecutive days and significative improvement of symptoms.
The period of quarantine for close contacts of confirmed COVID-19 cases remains 14 days.

On 19 February, the Directorate-General of Health updated its guidance for the end of isolation of close contacts (https://covid19.min-saude.pt/wp-content/uploads/2021/02/i027197.pdf): the isolation can end if the person tests negative 10 days after the last exposure.

All suspected cases are advised to remain isolated at home and avoid going to health care facilities. Instead, they should call the SNS 24 Contact Centre and follow instructions. Initially, the Contact Centre validated clinical and epidemiological criteria using a second line, the Medical Support Line, where doctors were called to clinically evaluate the symptoms reported by the suspected case. In case of validation, an ambulance from the Medical Emergency Institute was activated to transport the suspected case to a designated reference hospital in order to collect samples to be tested. For confirmed cases, hospitalization in isolation beds was the procedure.

As the epidemic evolved, only confirmed COVID-19 cases with clinical criteria for hospitalization are currently being treated in hospital. Cases with mild symptoms are sent home and regularly contacted by health care workers for monitoring. They are subject to mandatory confinement (https://dre.pt/application/conteudo/130473161), and the police is informed by the health authorities in order to ensure compliance.

The definition of suspected case has changed with the evolution of the pandemic, but it included symptomatic travellers returning from areas with active community transmission. With the evolution of the outbreak across the globe, those areas were also expanded: initially they included China, South Korea, Japan and Singapore; then, Iran and four regions in Northern Italy (Emiglia-Romagna, Lombardia, Piemonte and Veneto) were added, finally three States in Germany (Bavaria, Baden-Württemberg and North Rhine-Westphalia), two regions in France (Regions of Grand Est and Île-de-France) and four autonomous communities in Spain (Catalonia, La Rioja, Madrid and Basque Country) were added. Social distancing, hand hygiene and respiratory etiquette were recommended for travellers returning from those areas. They should monitor their symptoms and, in case of symptom onset, self-isolate and call SNS 24. Contacts of confirmed cases are traced by public health authorities and, according to exposure, they can be ordered to self-isolate at home for 14 days. During this period, they are monitored by health authorities.

Mandatory quarantine for public health emergencies is not foreseen in the Portuguese Constitution, but after the State of Emergency came into force, restrictions on citizens’ movements were put in place. As mentioned, mandatory quarantine is only applied to confirmed cases who are recovering at home and all those isolated by determination of the public health authorities. The rest of the population is strongly advised to stay at home and only leave under special circumstances, with more limited circumstances for those aged 70 years and older, immunocompromised patients and people with chronic conditions (see Section 1.2).