27 November 2020
New cases: 5444
New deaths: 67
Critical: 526 		ICU beds Ventilators
Estimated capacity for adult patients
Days until full capacity
Estimated number of days until full capacity is reached at current allocation to COVID-19 patients of ICU beds (51% in the public sector and 55% in the private sector) and ventilators (55% in the private sector and 60% in the public sector) considering current 3-day average of new daily cases.
0 3
Variation in number of days before full capacity is reached relative to previous day 0 0
Estimated number of days until full capacity is reached if resource allocation to COVID-19 patients is increased from current levels to 80% of ICU beds and ventilators considering current 3-day average of new daily cases.
0 5
Estimated number of days until full capacity is reached at current allocation to COVID-19 patients of ICU beds (51% in the public sector and 55% in the private sector) and ventilators (55% in the private sector and 60% in the public sector) if 3-day average of new daily cases changes from currentl level to 500 new daily cases.
Non-applicable at the moment due to over occupancy in this scenario. 36
Estimated number of days until full capacity is reached at current allocation to COVID-19 patients of ICU beds (51% in the public sector and 55% in the private sector) and ventilators (55% in the private sector and 60% in the public sector) if 3-day average of new daily cases changes from current level to 7 497 new daily cases (same value as the daily peak of new cases registered on 4 November 2020).
0 2
Estimated number of days until full capacity is reached if resource allocation to COVID-19 patients is increased from current levels to 80% of ICU beds and ventilators if 3-day average of new daily cases changes from current level to 7 497 new daily cases (same value as the daily peak of new cases registered on 4 November 2020).
0 4
Resources
Estimated free capacity considering current resource alocation to COVID-19 patients -82 1038
Estimated free capacity considering total available resources 331 2110
Current occupancy for adult patients
Current number of COVID-19 ICU patients 526
Estimated number of COVID-19 patients in mechanical ventilation (75% of COVID-19 patients in ICU need mechanical ventilation: see Assumption #8 below) 395
Other key indicators
Average number of new cases in the last 3 days: 5706
Peak of new daily cases: 7 497 registered 4 Novembro 2020
Current capacity for adult patients
Total current capacity reserved for adult COVID-19 patients 444 1432
Total current capacity for adult patients 857 2504
Public sector
Total public sector capacity allocated to adult COVID-19 patients 364 1352
Total public sector capacity 2254
Initial public sector capacity (March 2020)
Newly developed public sector capacity 90 1112
Newly installed (ICU beds) / Purchased (ventilators)
Donations
Loan
Private sector
Total capacity private sector capacity allocated to adult COVID-19 patients 80
Total private sector capacity
Initial private sector capacity (March 2020)
Newly developed private sector capacity
Capacity history
No history available yet
Announced future capacity for adult patients
Pending delivery of ordered items
Pending delivery of announced donations 0
Total when all ordered items are delivered 3283
Assumptions Reference Time of data collection Sample size Date of reference
General assumptions
The average number of new cases from the last three days is used for forecasting. ALERT's approach. 5 May 2020 5 May 2020
Mechanical ventilation is normally only provided in ICUs. However, if total ICU capacity is reached, temporary ICUs can be created to accommodate additional ventilators.
In Portugal, COVID-19 patients are also accepted in the private sector. https://observador.pt/2020/03/24/hospitais-privados-prontos-a-receber-e-tratar-doentes-e-aliviar-sns/ 24 March 2020 24 March 2020
http://aphp-pt.org/covid-19-hospitais-privados-tem-2-200-casos-suspeitos-e-112-doentes-internados/ 4 April 2020 24 March 2020
https://www.publico.pt/2020/03/21/sociedade/noticia/hospitais-privados-vao-receber-doentes-covid19-1908809 21 March 2020 21 March 2020
https://www.cuf.pt/noticias/acompanhamento-de-doentes-covid-19-nos-hospitais-da-rede-cuf 13 April 2020 13 April 2020
http://aphp-pt.org/hospitais-privados-e-multicare-fidelidade-chegam-a-acordo-para-tratar-doentes-com-covid-19/ 15 April 2020 15 April 2020
https://www.publico.pt/2020/04/16/sociedade/noticia/covid19-hospitais-privados-disponiveis-acordos-seguradoras-1912636 16 April 2020 16 April 2020
ICU beds assumptions
Criteria for admission of COVID-19 patients to Intensive Care in Portugal according to DGS (General Directorate for Heatlh).
Major:
1. Septic shock with the need for vasopressors;
2. Respiratory failure requiring invasive mechanical ventilation.
Minor:
1. Respiratory rate ≥ 30cpm;
2. PaO2/FiO2 ≤ 250;
3. Pneumonia with multilobar involvement;
4. Change in the state of consciousness;
5. Urea ≥ 42mg/dL (BUN ≥ 20mg/dL);
6. Leukopenia (< 4000/mm3), in the absence of any other cause;
7. Thrombocytopenia (< 100000/mm3), in the absence of any other cause;
8. Hypothermia (< 36ºC);
9. Hypotension requiring intensive fluid therapy. 		https://www.dgs.pt/directrizes-da-dgs/normas-e-circulares-normativas/norma-n-0042020-de-23032020-pdf.aspx 26 April 2020 25 April 2020
Allocation of 51% of ICU beds to COVID-19 patients in the public sector.
As of 5 May 2020, 51% of occupied ICU beds were with COVID-19 patients.
Allocation of 80 ICU beds to COVID-19 patients in the private sector, belonging to 5 private hospitals from Lisbon, Porto and Algarve (Hospital Boa Hora in Matosinhos, CUF Porto, CUF Lisboa, Hospital da Luz Lisboa, H. S. Gonçalo in Lagos).
Assumption #1
8% of total COVID-19 patients (not just hospitalized patients) will need to be admitted to ICU. 		Comment this assumption
7% of hospitalized patients were admitted to ICU in a hospital (Wuhan Jin Yin-tan hospital) in Wuhan study, China https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(20)30079-5/fulltext 24 December 2019 - 26 January 2020 710 24 February 2020
9% of people who tested positive for SARS-CoV-2 were admitted to ICU in Lombardy study, Italy https://jamanetwork.com/journals/jama/fullarticle/2764365?resultClick=1 20 February 2020 - 18 March 2020 17713 6 April 2020
8.7% of people who tested positive for SARS-CoV-2 were admitted to the ICU, California study, USA https://jamanetwork.com/journals/jama/fullarticle/2765303 1 March 2020 - 31 March 2020 1299 24 April 2020
14,2% of hospitalized patients were admitted to ICU in New York study, USA https://jamanetwork.com/journals/jama/fullarticle/2765184?guestAccessKey=906e474e-0b94-4e0e-8eaa-606ddf0224f5&utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_content=tfl&utm_term=042220 1 March 2020 - 4 April 2020 2634 22 April 2020
22% of hospitalized patients were admitted to ICU in New York study, USA https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(20)31189-2.pdf 2 March 2020 - 1 April 2020 1150 19 May 2020
26% of hospitalized patients were admitted to ICU (135 patients from Jinyintan Hospital and 56 patients from Wuhan Pulmonary Hospital) in Wuhan study, China https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(20)30566-3.pdf 29 December 2019 - 31 January 2020 191 9 March 2020
30% of hospitalized patients were admitted to ICU, California study, USA https://jamanetwork.com/journals/jama/fullarticle/2765303 1 March 2020 - 31 March 2020 377 24 April 2020
Assumption #2
11-day average length of stay in ICU. 		Comment this assumption
8 days ICU average length of stay, Wuhan study, China https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(20)30566-3.pdf 29 December 2019 - 31 January 2020 191 9 March 2020
9 days in Seattle study, USA https://www.nejm.org/doi/pdf/10.1056/NEJMoa2004500?articleTools=true 24 February - 9 March 2020 24 30 March 2020
9 days in Lombardy study, Italy https://jamanetwork.com/journals/jama/fullarticle/2764365?resultClick=1 20 February 2020 - 18 March 2020 1591 6 April 2020
14 days in Danish study https://ugeskriftet.dk/files/scientific_article_files/2020-04/a04200232.pdf 11 March 2020 - 1 April 2020 16 27 April 2020
18-day average stay under invasive mechanical ventilation, New York study, USA https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(20)31189-2.pdf 2 March 2020 - 1 April 2020 203 19 May 2020
Assumption #3
14-day average length of stay in ICU for all ICU-admitted surviving patients.		 Comment this assumption
7 days ICU average length of stay for surviving patients, Wuhan study, China https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(20)30566-3.pdf 29 December 2019 - 31 January 2020 137 9 March 2020
8 days ICU average length of stay for surviving patients, Lombardy study, Italy https://jamanetwork.com/journals/jama/fullarticle/2764365?resultClick=1 20 February 20020 - 18 March 2020 256 6 April 2020
8 days ICU average length of stay for surviving patients UK study (patients from England, Wales and Northern Ireland) https://www.icnarc.org/Our-Audit/Audits/Cmp/Reports March 2020 - 7 May 2020 3271 8 May 2020
14 days ICU average length of stay for surviving patients, Seattle study, USA https://www.nejm.org/doi/pdf/10.1056/NEJMoa2004500?articleTools=true 24 February 2020 - 9 March 2020 24 30 March 2020
18-day average stay under invasive mechanical ventilation, New York study, USA. https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(20)31189-2.pdf 2 March 2020 - 1 April 2020 203 19 May 2020
Assumption #4
8-day average length of stay in ICU for all ICU-admitted non-surviving patients.		 Comment this assumption
7 days ICU average length of stay for non-surviving patients, Wuhan study, China https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(20)30079-5/fulltext 24 December 2019 - 26 January 2020 31 24 February 2020
7 days ICU average length of stay for non-surviving patients, Lombardy study, Italy https://jamanetwork.com/journals/jama/fullarticle/2764365?resultClick=1 20 February 2020 - 18 March 2020 405 6 April 2020
8 days ICU average length of stay for non-surviving patients UK study (patients from England, Wales and Northern Ireland) https://www.icnarc.org/Our-Audit/Audits/Cmp/Reports March 2020 - 7 May 2020 2872 8 May 2020
8 days ICU average length of stay for non-surviving patients, Wuhan study, China https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(20)30566-3.pdf 29 December 2019 - 31 January 2020 54 9 March 2020
9-day average of hospitalization prior to death, New York study, USA https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(20)31189-2.pdf 2 March 2020 - 1 April 2020 101 19 May 2020
Assumption #5
20-day average duration of stay in ICU for all surviving patients who undergo mechanical ventilation. 		Comment this assumption
This assumption considers 1 day of stay in ICU before mechanical ventilation is initiated and another for recovery from the same.
15 days in UK study (patients from England, Wales and Northern Ireland) - also includes ECMO patients https://www.icnarc.org/Our-Audit/Audits/Cmp/Reports March 2020 - 7 May 2020 1768 8 May 2020
27-day average stay under invasive mechanical ventilation, New York study, USA https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(20)31189-2.pdf 2 March 2020 - 1 April 2020 19 May 2020
Assumption #6
10 days average length of stay in ICU for non-surviving patients from mechanical ventilation, ECMO and other advanced life support systems. 		Comment this assumption
This assumption considers 1 day of stay in ICU before mechanical ventilation is initiated.
9 days in UK study (patients from England, Wales and Northern Ireland) - also includes ECMO patients https://www.icnarc.org/Our-Audit/Audits/Cmp/Reports March 2020 - 7 May 2020 2519 8 May 2020
10-day average stay under invasive mechanical ventilation for non-surviving patients, New York study, USA https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(20)31189-2.pdf 2 March 2020 - 1 April 2020 83 19 May 2020
Assumption #7
45% of surviving COVID-19 patients admitted to ICU.		 Comment this assumption
23% in New York City study, USA (these were discharged patients). Some survivors were still in ICU at the time data collection ended (1 April 2020); the latter were not included in the percentage of survivors mentioned earlier. https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(20)31189-2.pdf 2 March 2020 - 1 April 2020 257 19 May 2020
38% in Wuhan study, China https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(20)30079-5/fulltext 24 December 2019 - 26 January 2020 52 24 February 2020
50% in Seattle study, Washington https://www.nejm.org/doi/pdf/10.1056/NEJMoa2004500?articleTools=true 24 February - 9 March 2020 24 30 March 2020
50% in California study, USA https://jamanetwork.com/journals/jama/fullarticle/2765303 1 March 2020 - 31 March 2020 68 24 April 2020
53,2% in UK study (patients from England, Wales and Northern Ireland) https://www.icnarc.org/Our-Audit/Audits/Cmp/Reports March 2020 - 7 May 2020 6143 8 May 2020
Assumption #15
85% of COVID-19 patients admitted to ICU who do not receive mechanical ventilation will survive.		 Comment this assumption
11% of COVID-19 patients admitted to ICU who did not receive mechanical ventilation died, New York study, USA. Some of the ICU admitted patients remained in ICU at the time data collection ended (4 April 2020). https://jamanetwork.com/journals/jama/fullarticle/2765184?guestAccessKey=906e474e-0b94-4e0e-8eaa-606ddf0224f5&utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_content=tfl&utm_term=042220 1 March 2020 - 4 April 2020 2314 22 April 2020
Assumption #16
Average length of stay in ICU for patients who did not undergo mechanical ventilation		 Comment this assumption
8 days ALERT assumption
Ventilator assumptions
Criteria for mechanical ventilation in Portugal according to DGS (General Directorate for Heatlh):
Respiratory failure type 2 in acute COPD, syndrome hypoventilation-obesity and pathology restrictive pulmonary, among others;
Acute pulmonary edema;
Therapeutic limitation for intubation, in selected cases after discussion with Intermediate/Intensive Care Unit. 		https://www.chporto.pt/pdf/2020/COVID-19_Manual_Clinico_CHUPorto.pdf 2020 2020
Allocation of 70% of ventilators to COVID-19 patients in the public sector.
Allocation of 56% of ventilators to COVID-19 patients in the private sector.
Assumption #8
75% of COVID-19 patients in ICU will need mechanical ventilation.		 Comment this assumption
43% in Wuhan study, China https://www.bmj.com/content/368/bmj.m1091 13 January 2020 - 12 February 2020 274 17 March 2020
71% in Washington study, USA https://jamanetwork.com/journals/jama/fullarticle/2763485 20 February 2020 - 5 March 2020 21 19 March 2020
71% in Wuhan study, China https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(20)30079-5/fulltext 24 December 2019 - 26 January 2020 52 24 February 2020
75% in Seattle study, USA https://www.nejm.org/doi/pdf/10.1056/NEJMoa2004500?articleTools=true 24 February - 9 March 2020 24 30 March 2020
79% in New York study, USA https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(20)31189-2.pdf 2 March 2020 - 1 April 2020 257 19 May 2020
94% in Vitoria study, Spain https://www.sciencedirect.com/science/article/pii/S2352556820300643?via%3Dihub 4 March 2020 - 31 March 2020 48 9 April 2020
100% in Denmark study https://ugeskriftet.dk/files/scientific_article_files/2020-04/a04200232.pdf 11 March 2020 - 1 April 2020 16 27 April 2020
Assumption #9
6% of COVID-19 patients will need mechanical ventilation (8% of total patients will go to ICU; 75% of ICU patients will require mechanical ventilation).		 Comment this assumption
12% of hospitalized patients in New York study, USA https://jamanetwork.com/journals/jama/fullarticle/2765184?guestAccessKey=906e474e-0b94-4e0e-8eaa-606ddf0224f5&utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_content=tfl&utm_term=042220 1 March 2020 - 4 April 2020 2634 22 April 2020
17% of hospitalized patients in Wuhan study, China https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(20)30566-3.pdf 29 December 2019 - 31 January 2020 191 9 March 2020
Assumption #10
50% of patients who would benefit from mechanical ventilation either do not qualify for it by medical criteria or have not reached medical care centers on time (does not interfere with estimates provided above).		 Comment this assumption
According to news from 9 May 2020, nearly 40% of deaths took place in elderly homes (450 deaths out of 1135 total deaths, as of 9 May 2020); another 10% may not have reached the hospital in time or have not qualified for mechanical ventilation. https://rr.sapo.pt/2020/05/09/pais/lares-contam-450-obitos-por-covid-19/noticia/192304/ February / March - 9 May 2020 1135 09 May 2020
According to news from 23 April 2020, almost 50% of those who died with COVID-19 were residents of long-term care facilities. https://www.publico.pt/2020/04/23/mundo/noticia/metade-mortes-europeias-lares-idosos-tragedia-humana-inimaginavel-oms-1913614 February / March - 23 April 2020 23 April 2020
Assumption #11
15 days on average in mechanical ventilation. 		Comment this assumption
10 days in Seattle study, Washington https://www.nejm.org/doi/pdf/10.1056/NEJMoa2004500?articleTools=true 24 February 2020 - 9 March 2020 24 30 March 2020
10 days in UK study (patients from England, Wales and Northern Ireland) - also includes ECMO patients https://www.icnarc.org/Our-Audit/Audits/Cmp/Reports March 2020 - 7 May 2020 4287 8 May 2020
18 days in New York study, USA https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(20)31189-2.pdf 2 March 2020 - 1 April 2020 203 19 May 2020
Assumption #12
32% of surviving patients from mechanical ventilation.		 Comment this assumption
19% of patients on mechanical ventilators survived in Wuhan study, China https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(20)30079-5/fulltext 24 December 2019 - 26 January 2020 52 24 February 2020
22% of patients on mechanical ventilators survived in Wuhan study, China https://www.bmj.com/content/368/bmj.m1091 13 January 2020 - 12 February 2020 119 17 March 2020
41.2% of patients on mechanical ventilators survived in UK study (patients from England, Wales and Northern Ireland) https://www.icnarc.org/Our-Audit/Audits/Cmp/Reports March 2020 - 7 May 2020 3508 8 May 2020
56% of patients on mechanical ventilators survived in Danish study https://ugeskriftet.dk/files/scientific_article_files/2020-04/a04200232.pdf 11 March 2020 - 1 April 2020 16 27 April 2020
Assumption #13
18 days on average in mechanical ventilation for surviving patients from the same		 Comment this assumption
Assuming 1-day stay in ICU before mechanical ventilation was initiated and another 2-days in ICU after removal from mechanical ventilation.
15-day average stay in ICU for surviving patients from mechanical ventilation in UK study (patients from England, Wales and Northern Ireland) - also includes ECMO patients https://www.icnarc.org/Our-Audit/Audits/Cmp/Reports March 2020 - 7 May 2020 1768 8 May 2020
27-day average stay under invasive mechanical ventilation, New York study, USA https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(20)31189-2.pdf 2 March 2020 - 1 April 2020 19 May 2020
Assumption #14
9 days on average in mechanical ventilation for non-surviving patients from the same. 		Comment this assumption
Assuming 1-day stay in ICU before mechanical ventilation was initiated.
9-day average stay in ICU for non-surviving patients from mechanical ventilation in UK study (patients from England, Wales and Northern Ireland) - also includes ECMO patients https://www.icnarc.org/Our-Audit/Audits/Cmp/Reports March 2020 - 7 May 2020 2519 8 May 2020
10-day average in mechanical ventilation for non-surviving patients, New York study, USA https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(20)31189-2.pdf 2 March 2020 - 1 April 2020 84 19 May 2020
Assumptions history Reference Time of data collection Sample size Date of change
Assumption #2
CHANGED TO: 11 days average length of stay in ICU.
EARLIER VERSION: 9 days average length of stay in ICU. 		https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(20)31189-2.pdf 2 March 2020 - 1 April 2020 Changed 22 May 2020
Assumption #3
CHANGED TO: 14 days average length of stay in ICU for all ICU-admitted surviving patients.
EARLIER VERSION: 10 days average length of stay in ICU for all ICU-admitted surviving patients. 		https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(20)31189-2.pdf 2 March 2020 - 1 April 2020 Changed 22 May 2020
Assumption #5
CHANGED TO: 20 days average length of stay in ICU for surviving patients from mechanical ventilation, ECMO and other advanced life support systems.
EARLIER VERSION: 15 days average length of stay in ICU for surviving patients from mechanical ventilation, ECMO and other advanced life support systems. 		https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(20)31189-2.pdf 2 March 2020 - 1 April 2020 Changed 22 May 2020
Assumption #6
CHANGED TO: 10 days average length of stay in ICU for non-surviving patients from mechanical ventilation, ECMO and other advanced life support systems.
EARLIER VERSION: 9 days average length of stay in ICU for non-surviving patients from mechanical ventilation, ECMO and other advanced life support systems. 		https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(20)31189-2.pdf 2 March 2020 - 1 April 2020 Changed 22 May 2020
Assumption #11
CHANGED TO: 15 days on average in mechanical ventilation.
EARLIER VERSION: 10 days average duration of stay in mechanical ventilation. 		https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(20)31189-2.pdf 2 March 2020 - 1 April 2020 203 Changed 22 May 2020
Assumption #13
CHANGED TO: 18 days on average in mechanical ventilation for surviving patients from the same.
EARLIER VERSION: 13-day average in mechanical ventilation for surviving patients from the same. 		https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(20)31189-2.pdf 2 March 2020 - 1 April 2020 Changed 22 May 2020
Assumption #14
CHANGED TO: 9 days on average in mechanical ventilation for non-surviving patients from the same.
EARLIER VERSION: 8-day average duration of mechanical ventilation in non-surviving patients from the same. 		Following New York study, USA (https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(20)31189-2.pdf). 2 March 2020 - 1 April 2020 83 Changed 22 May 2020