Search

Background: On March 16, 2020, the first death from CO­VID-19 was recorded in Portugal. Since then, there has been a reorganization of health services, changing the normal approach for the different cases of public health. Excess deaths recorded without a COVID-19 diagnosis are called excess mortality without COVID-19 (EM non-COVID-19). This study aims to estimate the EM non-COVID in the 7-month period after the first registered Covid-19 death. Methods: The following 2 methods were used to estimate the excess mortality in this period: the daily historical average of reported deaths and an adapted auto regressive integrated moving average (ARIMA) model, considering the previous 5 years of records until October 16. For this model, after March 16, data was replaced with the daily historical average deaths from the previous 5 years, simulating the closest scenario possible as there was no pandemic. Only deaths from natural causes were selected for these estimations. For EM non-COVID-19 estimation, we subtracted the COVID-19 deaths from the overall excess mortality. Results: Between March 16, 2020, and October 16, 2020, there was an excess of 6,330 deaths from natural causes, i.e., nearly 12% more than expected. Both methods estimated an EM non-COVID-19 of around 66–67% in this period, with a greater relevance in mid-July and mid-September. Conclusions: Excess mortality was present almost every day during the study period. EM non-COVID-19 seemed to vary over time, showing some inadequacy of healthcare services in management of other patients free of COVID-19 in Portugal during periods with a greater patient volume. It is necessary to take care and monitor COVID-19 cases but also non-COVID-19 cases.

Microcomputers and decision support software could help management information systems do what they are expected to support management decision-making. The same software tools which business and industry use for planning and analysis could be used in primary health care (PHC). Commercially available software uses simulation optimization sensitivity analysis forecasting projection "what if" models linear programming and project management scheduling and resource allocation. Such software could help define and resolve problems in PHC programs even though they are not specifically designed for PHC. The authors discuss the Microcomputer Simulation of PHC developed by the Aga Khan University as an example of the approach. They describe decision support at the local level and offer conclusions and investment recommendations on hardware software training and technical support.