First, I would like to explain how the response to the pandemic was thought, prepared, organised, debated and implemented in a region that, as an island, has and had its own particularities and which we believe helped addressing and controlling the Covid-19 pandemic during the first wave and also during the second wave.

Since the beginning of the pandemic, we developed and implemented a command, coordination and control structure, involving healthcare and civil protection, articulating with public and private entities and preparing the response in accordance with PREPCRAM – Emergency Response Plan for Civil Protection of Madeira.

We have not neglected the pandemic and we believe that this attitude has made a difference.

We were pioneers in many of the measures that I will cover below and which provided also a positive contribution as they were proactive, anticipatory and preventive, focusing always on the protection of public health in the Autonomous Region of Madeira (ARM).

We carefully followed the evolution of the pandemic in the world, in Europe and in the rest of Portugal, the measures that were adopted and the resulting impact on the population and on the control of the pandemic. We were particularly attentive to the manner how Asian countries managed to control its evolution, with preventive measures whose outcome relied to a great extent on the responsibility of citizens.

The right to life is the most important thing to preserve, and one cannot speak of loss of rights, freedoms and guarantees when people’s lives are at stake.

Madeira has always respected its population and that is why in those cases where the measures were not complied with the end-result was always new outbreaks.

We were right

And as regards Government decisions supported by the Regional Health Authorities (ARS), the only major concern was the public health of the ARM.

Madeira followed the disaster methodology – MRMI (Medical Response to Major Incidents), and this region played the leading role in the dissemination of this methodology since 2010, in the Azores and in the country and hosted 20 courses and trained more 1500 professionals so far in the medical, nursing and civil protection fields, targeted also to polices forces, regional guard forces, military forces, managers, psychologists, operational assistants and forensic staff.

Over the past ten years, this model has always been effective and efficient when it comes to respond to accidents that plagued the region, such as floods, fires, the fall of a tree or the fall of the bus down a cliff.

This calamity is very particular – it can reach those in charge of providing a response – healthcare and civil protection professionals and depends now more than ever on the responsibility of citizens. We had to take into account the protection of these professionals and the need to call for the civic responsibility of each and every one of us.

The success of the response depends primarily on the citizens and their behaviour.

We all have to be aware of the calamity we are going through and, after almost a year, we are still surprised by certain refusal to comply with measures aimed at protecting the population and enabling our economy to recover – as is was the case of masks, initially recommended for closed spaces and later mandatory in all public spaces, a decision taken first by the Regional Government in April 2020 and adopted by the rest of the country in November 2020, eight months later.

The decisions being made are of a sanitary and not of political nature, as many intend to makes us believe, and this has been an insurmountable obstacle for those who have to lead the fight against the pandemic and whose main concern is public health of the population.

We always feel a worrying lack of follow-up and a great mismatch between our decisions and the judicial system and its laws in a pandemic context. Habeas corpus was a difficult example to accept, and the current deaths in the ARM which are a sad reality prove that we were right in trying to protect the most vulnerable citizens.

Madeira started its response by monitoring the evolution of Wuhan’s pneumonia since December 2019 and followed the guidelines issued by the WHO and, later, by the Portuguese General Health Directorate.

We announced our emergency line on the 27th of January, (SRS24) and later the plan which included the articulation between all the entities of the public-private-military-security-maritime actors in the ARM – establishing our response framework under PREPCRAM.

During the month of February, we trained all professionals and the entire public administration in Madeira on how to design contingency plans, while reorganizing the Regional Health Service (SRS) implementing changes in the response mechanisms in terms of Healthcare, Primary Healthcare (CSP) and Hospital Care (CH).

A COVIDRAM commission was created to lead the response plan at the level of the healthcare units, emergency services were closed in Primary Healthcare and we increased our response at the level of Hospital Care, creating areas for both screening and advanced screening in order to sort the arrival of suspected cases to be tested.

On March 12, the “State of Alert” was declared in the ARM, the day before the WHO declared the pandemic after which we introduced temperature control and did an epidemiological survey in order to control air and sea inflows of people.

Subsequently, we closed ports and marinas in March 2020 and established controls in terms of the number of weekly flights arriving in Madeira.

We protected our professionals and vulnerable groups, closing schools and homes and also preventing the mobility of healthcare professionals between the public system and the contractual, private and social systems.

In the initial phase, the response was articulated with the ARM military forces, with the collaboration of the Madeira Operational Command (COM) and the Madeira Military Zone (ZMM) for the transportation of material and for the implementation of screening tents for testing by SESARAM, the Madeira regional healthcare system.

We have created a public health emergency unit headed by the only public health physician and with the collaboration of more than 40 professionals in the field of General and Family Medicine (FGM), nurses, General Training Interns (IFG) and Specific Training Interns (IFE), who collaborated worked together in trace-tracking and isolation of suspected and confirmed cases and monitoring their evolution.

We privilege the digital means as regards communication with users – telehealthcare, teleappointments, tele-interview, telemedicine, webinar and creating additional support lines for the general citizen, for the elderly, for children, for pregnant woman in the areas of psychology, nutrition, medication support and oncology. We try to reach everyone differently in close connection with the ARM healthcare services.

We met users using new technologies

We also created APP registration platforms such as “Madeira Safe” in order to monitor travellers and “S-ALERT” to monitor positive cases in the ARM until the end of the quarantine, and prophylactic isolation.

We introduced the use of masks in the community in April 2020 – we were pioneers in the country, following the current example in Asian countries and, more recently, in some European countries as regards closed spaces in order to provide greater protection to the population, as well as social distancing, respiratory etiquette and hand disinfection and we believe that we have contributed to curb the spread of the virus in the early stages.

Thanks to these measures on July 1st we had only 92 confirmed cases and only two still active and that is why we decided back then to gradually with lockdown easing, protecting the population and restarting the essential activities in order to allow our economy to recover after the difficult lockdown period.

We were able to stop lockdown because we had the right conditions to comply with the recommendations of WHO-SRS, testing capacity and still few cases in the ARM.

How did we prepare for the second wave?

With the same resolve as in the first wave, with anticipation and proactivity and with perfect articulation between the different entities.

We gradually opened the borders, and we wanted tourists to test at the origin, and as nobody heard us we decided to create a screening centre on arrival at Funchal and Porto Santo airports to test on arrival and we also created testing stations in the country – around 33, for testing before boarding.

A huge investment that cost ARM around EUR 20 million euros – this is yet another investment for the benefit of our population and their safety in this pandemic context.

We opened commercial activities gradually with the requirement of a contingency plan, during the months of April and May and we also resumed the healthcare activity stating the obligation to perform tests in all invasive, surgical, imaging, obstetric, oncological and nephrological procedures in hospitalization admissions in healthcare units and also in the area of mental health.

We established a testing strategy, given our capacity, and after the first stage where suspects were tested and close contacts we created “zero moments” in the healthcare sector, in elderly’s homes, in schools, civil protection units, for inmates, in care homes and shelters and the test results were always negative.

We prepared the Covid and flu response areas with the presentation of the Autumn-Winter plan, anticipating the vaccination, extending vaccination to risk groups, and making inpatient and intensive care beds available in healthcare units.

At the end of 2020, and with the horizon set on the vaccines, we had about 134 beds available and 108 fans in these circuits.

We reorganized the regional healthcare sector again at the level of Primary and Hospital Care with the creation of circuits for respiratory and non-respiratory patients, Covid and non-Covid patients with flu and others.

We implemented more restrictive measures in terms of prevention, with the mandatory use of a masks in all open and closed public spaces and at school level, covering all children from 6 years of age.

Testing procedures were changed compared with its initial strategy and in the areas of health, social, civil protection and education, along with testing upon arrival at the island and test repetition between 5th and the 7th day after travelling.

We also started using quick antigen tests, with the collaboration of the Portuguese Red Cross and on an initial stage 50 000 tests were made available which have been used in outbreaks and screening in the ARM.

We continued collaboration of hoteliers, offering accommodation for positive non-resident and resident cases who were unable to self-isolate at home.

We kept providing training and prepare our professionals to respond to the pandemic.

But the pandemic is still there with more cases, more hospitalizations, more patients in intensive care and unfortunately more deaths.

We must continue to focus on preventive measures and we must comply with them, scrupulously otherwise we will allow it to perpetuate and cause more morbidity and mortality.

We must be true public healthcare agents, we must keep protecting ourselves in order to protect others, especially the most vulnerable.

On December 31st we started the anti-Covid 19 vaccination campaign in Madeira. A process with some complexity, given the characteristics of the vaccine available – that of Pfeizer- which requires important cold storage facilities. We prepared all pharmacy and nursing professionals for this operation and purchased two ultra freezer cabinets for this purpose. We articulated at national level with the SUCH (Service of Common Use of Hospitals) in order stay in tune with the national taskforce.

The vaccination process is similar to that in other countries privileging healthcare professionals, elderly’s homes, care home users, users with comorbidities and people over 50 years of age and also civil protection professionals as being on the front lines of priority.

This process has to be conducted with great deal of rigor and responsibility by the Regional Commission and focuses not only on vaccination but also on its monitoring and on pharmacovigilance.

What have we learned so far?

After 10 months – a lot! And we continue to learn, as this virus is unpredictable as regards its contagion potential.

• It takes leadership, and respect for those leading this fight;
• This is possible and we need to reorganize the healthcare systems response;
• We need to protect professionals and the most vulnerable;
• We need to have personal protection equipment that allows safety in the provision of these services;
• We need to train everyone and to establish contingency plans that should be followed;
• We can boost the assistance activity, with increased precaution and protection of professionals and users – and we have to bear in mind that we will be able to reach full capacity again before the pandemic is over;
• We need to communicate more and more using new ICT-Telehealthcare, telemedicine, teleappointments, tele-interview, webinar;
• We need to increase the responsiveness of healthcare systems – regional healthcare system, hospitalisation and intensive care units;
• We need testing, tracing, tracking and safe isolation capability;
• We need to prepare the response in a timely manner in exceptional situations in conjunction with private parties, whenever necessary;
• We need communication support lines for general users, the elderly, pregnant women, paediatrics, nutrition, psychology and mental health;
• We need to invest more in the healthcare and social areas, and in Madeira this investment was € 117 billion, € 85 billion multi-year in 2020 and will reach € 33 billion in 2021.

I would like to conclude with a final message: the success of the response to the pandemic now that we have the vaccine available, continues to depend on citizens and their behaviour.

While non-pharmaceutical measures were required to control the pandemic, now we need to have a massive adherence to vaccination so that we can have more than 60-70% vaccinated and thus acquire group immunity.

I wish you all a good year 2021, the year of vaccines for all and a year of hugs between citizens.

May this be the year of the return to normality.