• Ricoca Peixoto Vasco V Public Health Research Centre. NOVA National School of Public Health. Universidade NOVA de Lisboa. Lisboa; Public Health Unit. North Lisbon Health , André Vieira, Pedro Aguiar, Carlos Carvalho, Daniel Rhys Thomas, and Alexandre Abrantes.
• Public Health Research Centre. NOVA National School of Public Health. Universidade NOVA de Lisboa. Lisboa; Public Health Unit. North Lisbon Health Centers. Lisbon; European Programme for Intervention Epidemiology Training (EPIET). European Centre for Disease Prevention and Control (ECDC). Stockholm. Sweden. Portugal.
• Acta Medica Port. 2020 Nov 2; 33 (11): 733-741.

IntroductionPortugal took early action to control the COVID-19 epidemic, initiating lockdown measures on March 16th when it recorded only 62 cases of COVID-19 per million inhabitants and reported no deaths. The Portuguese public complied quickly, reducing their overall mobility by 80%. The aim of this study was to estimate the initial impact of the lockdown in Portugal in terms of the reduction of the burden on the healthcare system.Material And MethodsWe forecasted epidemic curves for: Cases, hospital inpatients (overall and in intensive care), and deaths without lockdown, assuming that the impact of containment measures would start 14 days after initial lockdown was implemented. We used exponential smoothing models for deaths, intensive care and hospitalizations and an ARIMA model for number of cases. Models were selected considering fitness to the observed data up to the 31st March 2020. We then compared observed (with intervention) and forecasted curves (without intervention).ResultsBetween April 1st and April 15th, there were 146 fewer deaths (-25%), 5568 fewer cases (-23%) and, as of April 15th, there were 519 fewer intensive care inpatients (-69%) than forecasted without the lockdown. On April 15th, the number of intensive care inpatients could have reached 748, three times higher than the observed value (229) if the intervention had been delayed.DiscussionIf the lockdown had not been implemented in mid-March, Portugal intensive care capacity (528 beds) would have likely been breached during the first half of April. The lockdown seems to have been effective in reducing transmission of SARS-CoV-2, serious COVID-19 disease, and associated mortality, thus decreasing demand on health services.ConclusionAn early lockdown allowed time for the National Health Service to mobilize resources and acquire personal protective equipment, increase testing, contact tracing and hospital and intensive care capacity and to promote broad prevention and control measures. When lifting more stringent measures, strong surveillance and communication strategies that mobilize individual prevention efforts are necessary.

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