When Dr Tiago Villanueva arrived at his family medicine clinic in Lisbon on Monday afternoon, it was like a ghost town. The patients had all been sent home, and health workers were bracing for a crisis of unknown duration – almost like the COVID-19 pandemic.
But this time, there was no mobile phone service, no Internet, and no power.
It’s still not clear what caused the massive multi-hour blackout in Spain and Portugal, but its impact was felt immediately across the Iberian Peninsula, which has a combined population of about 60 million people.
Businesses closed, people got stuck in metro tunnels, and workdays were upended.
For health workers, the power outages meant regular services ground to a halt as they prioritised urgent medical care.
Hospitals relied on generators to keep their emergency departments open and proceeded with only the most time-sensitive surgeries. Dialysis patients’ treatments were delayed, resulting in shorter sessions in some cases.
When the outage first hit around midday, Villanueva’s team “still tried for a couple of appointments to do everything manually, writing prescriptions by hand – doing everything like 30 years ago,” the doctor told Euronews Health.
Eventually, they sent patients home and waited for instructions from central health authorities, or for sick patients to show up anyway. They only left the clinic when the Sun started to go down, making visibility a problem, said Villaneuva, who is also president of the European Union of General Practitioners/Family Physicians (UEMO).
Cold-chain storage concerns
Across the two countries, at the forefront of health workers’ minds was the risk to vaccines, which must be stored cold. Any drop in temperature can render them largely ineffective.
Villaneuva’s clinic managed to transport its doses – such as the measles, mumps, and rubella jab and a vaccine that protects young children against tuberculosis (TB) – to a nearby hospital, but it’s not yet clear whether all primary healthcare facilities across Portugal could do the same.
“We are talking about thousands of refrigerators that need to have a generator constantly [running] to preserve the quality of vaccines,” Dr João Paulo Magalhães, vice president of the Portuguese Association of Public Health Doctors, told Euronews Health.
“Probably, there are some vaccines that are no longer viable at this point”.
Meanwhile, in Terrassa, a city outside Barcelona, pharmacist Jordi Nicolás told Euronews Health that hospital-based pharmacies were also able to tap into hospital generators, ensuring their drugs and vaccines were kept cold.
But there was another hurdle: many pharmacies in Spain have been automated, meaning Nicolás’ team had to come up with workarounds to ensure that critical medicines, such as those used in intensive care, were still accessible with the power shut off.
“There are a lot of robots,” said Nicolás, who is also vice president of the Spanish Society of Hospital Pharmacists (SEFH).
Wake-up call on need for contingency plans
Pharmacists were also preparing for the possibility that the energy outage would last for several days, Nicolás said. In that case, they wouldn’t know which patients were prescribed which medicines, because most of that information is stored in an electronic medical record that could be unavailable.
“This situation lets us know it is important to establish contingency plans. At this moment we depend so much on energy,” he said.
Back in Portugal, Magalhães agreed. Outside of hospitals, pharmacists were unable to process prescriptions on Monday, which caused a “lot of disruption,” he said.
“The system was not working, and it was a little bit serious in terms of the potential of the consequences,” Magalhães said.
If the blackout had lasted more than one day, he added, “it would have repercussions for patients”.
Meanwhile, Villaneuva is hoping that emergency plans will be put in place to ensure family medicine clinics can communicate with central health authorities during emergencies.
He is considering buying a radio, which was many people’s only means of information when mobile service went dark.
For now, though, health workers across Portugal and Spain are prioritising getting back to their usual services after a chaotic start to the week.
“In most hospitals in Spain, the energy came back about 9 or 10 in the evening, so it seems like a happy ending,” Nicolás said.
