2. Ensuring sufficient physical infrastructure and workforce capacity
ENSURING SUFFICIENT PHYSICAL INFRASTRUCTURE AND WORKFORCE CAPACITY is crucial for dealing with the COVID-19 outbreak, as there may be both a surge in demand and a decreased availability of health workers. The section considers the physical infrastructure available in a country and where there are shortages, it describes any measures being implemented or planned to address them. It also considers the health workforce, including what countries are doing to maintain or enhance capacity, the responsibilities and skill-mix of the workforce, and any initiatives to train or otherwise support health workers.
2.1 Physical infrastructure
There are 107 public hospitals in Portugal, including 3 hospitals in Public-Private Partnership and 6 military or prison hospitals. There are microbiology laboratories in major hospitals across the seven health regions, including Azores and Madeira. The National Institute of Health validated the methodology used in each hospital lab to diagnose SARS-CoV-2 infection, according to WHO guidelines. Currently, the National Institute of Health, the Military Laboratory, 38 public hospital laboratories, 22 University labs and 27 groups of private laboratories are processing samples for COVID-19 diagnosis. The national laboratory capacity was perceived to be sufficient but was further expanded in April by including University lab facilities. The government has acquired regularly both swabs and testing kits.
The initial capacity assessment undertaken in the Ministry of Health concluded that, as of February 2020, hospitals belonging to the National Health Service (excluding the Autonomous Regions) had:
• 1,142 mechanic invasive ventilators, including ICUs and operating rooms;
• 528 general level 3 ICU beds for adults and 59 paediatric level 3 ICU beds (excluding other types of ICUs: burn, coronary, neonatal);
• 218 adult isolation beds with negative pressure and 25 paediatric isolation beds with negative pressure.
Either by the acquisition or through donations, the country aimed to double its ventilators’ capacity in the short-term. The Ministry of Health acquired new 996 ventilators, 119 were recovered, 522 were donated to the NHS and 156 were loaned. Overall, the country’s ventilatory capacity was strengthen with 1,793 ventilators, being 1,226 of them invasive ventilators. Of those new ventilators, by the end of August, 686 invasive ventilators and 338 non-invasive ventilators had already been delivered and installed in NHS hospitals.
Hospitals were also able to optimize resources and create additional ICU beds. By the end of April, the NHS had further increased general level 3 ICU beds for adults by 25%. The occupation rate of general level 3 ICU beds for adults was 66%, as of June 30. The occupation rate of COVID-19 patients was around 14% of all general level 3 ICU beds for adults in the NHS.
In the beginning of the pandemic, shortages of personal protective equipment (PPE) have been reported, but the government has decided to create a National Strategic Reserve of PPE. Donations of PPE and other equipment have also taken place. Overall, as of 30 September, more than 23 million surgical masks, 5.3 million P2/P3 masks, 930,000 PCR testing kits and 857,000 extraction kits are stocked in the National Strategic Reserve. The private sector has around 250 mechanic invasive ventilators and, if needed, beds from the private or social sector will be used. However, health care for COVID-19 has been provided in public hospitals.