The authors state that “it is safe to assume an observed excess mortality of 2400 to 4000 deaths in the period assessed” during the COVID-19 pandemic. This alarming claim is based primarily on increased mortality due to decreased use and access to healthcare (1291), rather than reported COVID-19 related deaths (689), seasonal factors and other effects of the lockdown. Excess mortality due to decreased access to healthcare has been estimated utilising mortality
records from Portuguese 2008 triage admission data. It would be interesting to undertake a sensitivity analyses about this key value. It is possible those who did not attend for emergency care during the lockdown period were at considerably less risk of death than the average attendee. Furthermore, it is possible that investment in the Portuguese Health care system since 2008 has reduced average triage mortality rates per admission in 2020.

Letter to the Editor here (English only).