As current times demand, it was by email, and after 14 hours of uninterrupted combat against the SARS-Cov-2 virus, that Professor Melo Cristino generously answered some questions about the COVID-19 infection. Professor José Melo Cristino, among many other functions and positions, is Full Professor of Microbiology at FMUL and Director of the Clinical Pathology Service at the Northern Lisbon University Hospital. We take the opportunity to thank him here, not only for the time spent responding to this short interview, but also for his performance in the fight against COVID-19. We also emphasize that he answered on 19 March 2020, and, therefore, his answers are based on the data available until that date.
Taking into account your knowledge, we would like to know your opinion on the current state of the spread of the COVID-19 virus in Portugal.
J. Melo Cristino: The virus is called SARS-CoV-2. COVID-19 is the name of the infection caused by the virus. We are at the beginning of the exponential growth phase of infection cases. If we have an evolutionary pattern identical to several other European countries, there will be a worsening of the situation in the coming weeks to months.
In your opinion, what will be the measures that can and should be taken in Portugal taking into account the natural progression in epidemiological terms of the disease and what can we do to delay or even reverse it?
J. Melo Cristino: In a Western democracy such as ours, I believe that the main measures are individual protection and social isolation, since we do not have others available, such as vaccination or chemoprophylaxis (administration of a drug to prevent the acquisition of infection). The population is susceptible and there will be a spread of the virus.
There are several studies that show that if protective measures are not taken and the infection is allowed to run its normal course, the duration of the most critical period will be shorter, but there will be a very high number of people infected in a shorter period of time. This will bring great difficulties to the health services, with possible depletion of resources and inability to respond effectively.
With the implementation of effective isolation measures, if they are carried out by all, the aim is to extend the period of transmission of the virus so that the number of people who get sick is more distributed over time. I think that this is the best scenario for our country, taking into account the health services offer in Portugal, namely the National Health Service, which will be faced with the overwhelming majority of cases.
Internationally, we see several countries using different, and often seemingly contradictory, strategies regarding their approach to COVID-19, such as Macau or the United Kingdom. Which ones do you think are the most appropriate that could be implemented in Portugal?
J. Melo Cristino: As I understand it, the strategy initially followed by the United Kingdom had the advantage of treating mostly infected patients at home, with health professionals moving there. In this aspect, it was excellent. However, recommendations for isolation were scarce and made at an almost individual level, assuming that the population would become infected and thus create immunity. The UK radically changed its strategy a few days ago because projections of the evolution of the infection showed an explosive increase in transmission and the likelihood that there would be many thousands of cases of infection quickly, impossible to be effectively addressed by the health services. This prediction led to a change in approach, which is now the one followed by other Western countries.
In Macau, very strict isolation measures were imposed as soon as the first cases arose and the territory remained with a dozen patients diagnosed for several weeks, all of whom were considered cured. It was an exemplary case of success, but this is now threatened because in the last few days seven new cases have emerged. It will be interesting to follow developments in Macau.
As an expert and professional with great experience in these areas, we would like to know if you have been approached by the competent entities, and what role you can play at this moment, in order to create short and medium term strategies to limit the consequences and impacts of this pandemic at the health and social level.
J. Melo Cristino: I am part of some working groups dedicated to addressing the COVID-19 infection in Portugal. Since last week, I have spent most of my time doing the laboratory diagnosis of the infection because the request made to the Microbiology Laboratory of the Northern Lisbon University Hospital Centre has been very big. I coordinate a group of absolutely exceptional professionals who have worked 24/24 hours to allow an effective response in terms of quality and time. I believe that we are the national hospital laboratory with the highest demand and that more tests have done daily (about 200), following a relatively slow and not yet automated methodology (RT-PCR) that requires training, a lot of concentration and resilience. Making the diagnosis (as quickly as possible) of people suspected of infection is essential at this stage in order to be able to implement effective isolation strategies, reducing the possibility of being a vehicle of transmission to others.