Csaba Makó (Centre for Social Sciences of the Hungarian Academy of Sciences): How would you explain that Covid-19 produced high casualties in Italy and Spain but not in Portugal and Greece?

Nuno Boavida (Observatório de Avaliação de Tecnologia do CICS.NOVA): 

The first argument to explain those differences is the level of interconnectedness of Portugal and Greece when compared to Spain, Italy (and others). Both Portugal and Greece are less interconnected with the rest of Europe and the world, in geographic, economic and demographic terms.

Another important factor is the high level of expertise still present in the bureaucracy of the Portuguese health ministry. The main experts are well known, the retired ones are very loud and vocal and, to some extent, even admired. Importantly, these people are still the same ones who were involved in building the Portuguese health system after our revolution in 1974 into the 1980-90s. The leader of DG Health and many influential commentators were WHO experts in the 1980,90 and 00s. There is also a past-dependency argument as Portugal faced previous epidemics with harsh consequences to the population. An example of this harsh past is the fact that the only health national research laboratory is famously named after an important figure of the fight of Spanish influenza.

A relevant line of argumentation is the political consensus created in the country. The minority government found wide support in an unusually popular president and in the fractious parliament (99% of the parliamentarians fully supported the government).

Another factor can also be the ability to control and manage a small country with fewer borders than Italy and Spain. A country with less population and fewer diversities in their voters tend to be easier to manage and to shut down immediately (I still remember that economic pressures of the tourism industry led to a crazy reopening of the Milan cathedral a few days after the initial lockdowns).

Perhaps one of the most important arguments is pure fear, as the population knows the health system is poor and weaker than in Italy or Spain. And last and perhaps the best argument is simple luck because the first patients arrived later in Portugal than in Italy and in Spain, allowing us to get ready with more time.

Nevertheless, most of these arguments might not be valid for the next wave of Covid-91. We can be in a worse situation in the next wave because we will probably import new cases from countries with which we have historical ties and share our language in Africa and Brazil. Let's hope not!

Csaba Makó: Many thanks for the detailed diagnosis of your COVID-19 situation.