After months of being shut as part of government measures to prevent the spread of Covid-19, the doors of Primark flung open on Monday 15 June to interminable queues of starved shoppers. Critics were quick to deride the gathering as a likely hotbed of new infections – a travesty when the death rate from Covid-19 is not yet zero. But while this might appear a description of the UK, it actually refers to events in Lisbon, Portugal.
Portugal and the UK, however, have had radically different experiences of Covid-19 and approaches to the crisis. Shopping centres did indeed open on 15 June for those living in Lisbon’s metropolitan area, but this is one of the latter stages of “phase two” of the lockdown easing. (A spike in infections in the capital has since led to the partial return of the lockdown and the contentious exclusion of Portugal from the UK’s “air bridges”.) Unlike in the UK, many other outlets opened to the Portuguese public before larger shopping areas, among them small shops, restaurants, and museums. The differences in public policy and crisis management between the countries are the result of two inescapable phenomena: history and ideology.
Portugal has recorded an impressively low Covid-19 infection and death rate (with just 159 deaths per million people, compared to 652 in the UK), especially when compared to neighbouring Spain (607 deaths per million people). The impact of the pandemic could have been far more severe in a country where nearly one in three people are aged over 65 and which has the lowest number of intensive care beds per capita in all of Europe. As critical care nurse Diana Pereira told me, Portugal’s “territorial, diplomatic and systemic proximity” to Italy, where in the first fortnight of March Covid-19 deaths spiralled from five to 1,441, left health workers terror-stricken.
But perhaps because of these troubling omens, the Portuguese government grasped the gravity of Covid-19, urging people to isolate early on, closing down schools and other public buildings on 16 March, and implementing a full lockdown two days later (almost a week before the UK). Pereira, who works in one of Lisbon’s public hospitals, added that while there were initial shortages of testing kits, the government swiftly acquired a larger stock. Indeed, as of mid-May, Portugal had tested 32,000 people – more than half the number in the UK, a much wealthier country with six times the population. Following the tests, scrupulous procedures were put in place, as I myself discovered a fortnight after taking one.
In normal years I split my time between London and Lisbon, travelling from one to the other for work and family visits. Portugal and the UK have more in common than one might imagine – not least their peoples’ shared tendency to apologise when someone else barges into them on the underground. But in recent years they have taken diametrically opposed political directions. Last October, Portugal returned the incumbent Socialist Party to power with increased support. Two months later, in the UK, Boris Johnson’s Conservatives won their biggest majority since 1987.
When I decided to pack my bags and exile myself from London to Portugal for the remainder of the pandemic, I had already experienced Covid-19 symptoms and self-isolated for two weeks. Even so, as I arrived in Lisbon, wrapped in protective equipment and doused in antibacterial gel, I went immediately to a lab to be tested. Less than 24 hours later, I was told the result was negative and soon forgot the matter.
One afternoon, a fortnight later, I received a call from the Directorate-General of Health, where a friendly member of staff enquired whether I or anyone in my household had experienced any symptoms since testing negative for Covid-19. As we had not, I was informed they would close the case. After weeks of unabated anxiety due to living under a government that had so neglected public health, it felt immensely soothing to be cared for in this manner – by another government 1,000 miles away. A test, a phone call, and a five-minute survey was all it took.
But perhaps this conscientious approach towards public health should not come as a surprise. The Portuguese national health service was born on 15 September 1979 as a late, but nonetheless legitimate, child of the revolution that liberated the country from far-right dictatorship five years earlier. Its founding document states that access to the service, known by the abbreviation SNS, “is granted to all citizens, independently of their social or economic situation”. Defending and promoting the SNS, it adds, is a “duty, incumbent on all” and protected by the Portuguese constitution. And in turn, the constitution, which was adopted in 1976 and endures to this day, proclaims the resolve of the Portuguese people to “open the way to a socialist society”. Or, as Pereira would have it, “the SNS is synonymous with democracy”.
This symbiotic relationship between the national health service and the legacy of the April Revolution was all the more evident at this year’s commemorations, which fell in the middle of the lockdown. The far right, politically marginalised but now with one MP, demanded a ban on any reference to the anniversary.
In contrast to British MPs who demanded the “depoliticisation” of the pandemic, Portuguese politicians from all sides understood all too well the ideological implications of this move. Proto-fascists and Christian-conservatives, who on the campaign trail last year heralded the encroachment of private enterprise in the SNS, now hoped to silence the memory of the very struggle that made Portugal’s commendable Covid-19 response possible. The Socialists were well aware of the dangers of ignoring such an anniversary at times like this. Commemorations went ahead, though with less pomp than in previous years.
This ideological battle over healthcare has been fought in Portugal and the UK for decades. And in both countries, the Covid-19 crisis might prove decisive in determining which side wins in the coming decade. According to Pereira, while “it was already urgent to have a robust SNS to respond to the needs of the population, it has now become clear that the SNS cannot be reduced to merely a charitable public service for the poorest.” She added: “The private sector, with its management geared towards financial results, is incapable of responding to all the population’s health needs. Within these needs is the answer to Covid-19.”
Doctor André Nóbrega is a general practitioner in the Oporto region, where the first wave of infections hit harder than in southern Portugal. While he did not shy away from criticisms of the “at times patronising” government approach to the crisis, he too agreed that the national health service “made the difference”. He also cited the government’s much-debated decision to legalise migrants with pending visa and asylum applications upon lockdown as a crucial move.
This wasn’t just a political act of solidarity during a global pandemic. By acquiring legal status, migrants were granted full access to the SNS system, which, in Nóbrega’s view, “allowed us to minimise the people who are not diagnosed because they do not seek health services”. This then reduced “the number of cases that continued to infect the community, since – when undiagnosed – they are not isolated from the general population”.
It remains to be seen if the Portuguese government will continue to champion the right to universal healthcare in the manner it has during the pandemic. Staff and resources have been put under unprecedented pressure, energy is running low, and corporate sharks hoping to capture valuable SNS infrastructure are never far away.
“Public health investment depends more on political will and acceptance of prevention and long-term outcomes than on the amount of money,” suggests Nóbrega. For Pereira, greater investment in health workers’ salaries and working conditions is paramount, “so they don’t leave the SNS en masse”. Her call is reminiscent of the days during Portugal’s austerity years (from 2011 to 2015) when entire planes were booked by recruitment groups to charter nurses from the Portuguese health system to the NHS. Among them was a nurse who later looked after Boris Johnson during his Covid-19 treatment.
And while the two nations’ divergent approaches will certainly deliver different social outcomes in the years ahead, it is inside the world of politics that they already bear striking results. A poll published on 1 June found that the Portuguese government’s approval rating had increased by 14 points to a record 74 per cent. The UK government’s approval rating, by contrast, is now a mere 34 per cent.
Joana Ramiro is a freelance journalist who has written for the Independent and Jacobin