Following the publication of the Plan for Fall/Winter 2020/2021, the Directorate-General of Health has updated its guidance on case management. Essentially, given the similarity of symptoms, patients with respiratory symptoms have separated circuits like those described for COVID-19. Patients with symptoms can be advised by phone and be assessed in Respiratory Diseases Dedicated Areas both in primary care and hospitals. Testing for COVID-19 and flu is available.
Initially, symptomatic or asymptomatic suspected cases were asked to call SNS 24 Contact Centre (808 24 24 24) and provide information on their symptoms and epidemiological links. Those cases were then validated by a doctor (from the Medical Support Line) and, in case of being validated as a suspected case, public health authorities and a COVID-19 reference hospital were activated to organize collection of samples, laboratory testing and eventual hospitalization. As the number of cases increased, the Medical Support Line was discontinued.
On 26 March, a new model for managing patients suspected to be infected of COVID-19 in health care units was implemented (https://www.dgs.pt/directrizes-da-dgs/normas-e-circulares-normativas/norma-n-0042020-de-23032020-pdf.aspx). The Directorate-General of Health defined the pathway of COVID-19 patients within the health system according to their clinical condition.
Although SNS 24 Contact Centre is still the preferable way of entering the pathway of identification of cases, new phone lines were created locally to manage suspected cases. A suspected case can be firstly assessed at dedicated areas in primary care (COVID-19 Dedicated Area in the Community). Testing can take place in hospital laboratories, private laboratories or even in drive-through testing centres. Patients with mild symptoms are sent home for self-care and are contacted by health care services regularly. Patients with more severe clinical presentation are referred to dedicated areas in emergency services (COVID-19 Dedicated Area in Emergency Services). There, the patient can be assessed and hospitalized, either in dedicated wards for COVID-19 or, for those in serious condition, in dedicated ICU.
Health care workers in ambulatory care register the regular follow-up of COVID-19 patients who are recovering at home or their contacts who are being monitored using a newly created platform: TRACE-COVID (http://tracecovid19.min-saude.pt) (https://www.dgs.pt/directrizes-da-dgs/normas-e-circulares-normativas/norma-n-0042020-de-23032020-pdf.aspx).
The Directorate-General of Health regularly updates the guidance for health care providers. ICU were reorganized to accommodate the increasing number of COVID-19 patients: suspected and confirmed COVID-19 patients have separated areas, and those are also separated from other patients (https://www.dgs.pt/directrizes-da-dgs/normas-e-circulares-normativas/norma-n-0052020-de-26032020-pdf.aspx).