As little as nine months ago, Portugal was considered a model of success in the battle against COVID-19, particularly in comparison to neighbouring Spain.

But in early 2021, with the country’s rate of new cases reaching the highest in the world in proportion to its population last week, and ambulances queueing outside Lisbon hospitals as its health service buckles under the strain, it is a grimly different story.

“The main hospitals are overcharged with sick people and doctors,” Manuel Carvalho, the director of one of Portugal’s biggest daily newspapers, Público, told Al Jazeera. “It is increasingly impossible to take care of all people that ask for help. Things are really bad and there are no signs of improvement.”

Record death tolls from the pandemic were set each day last week, rising steadily from 152 on January 17 to 275 on January 24, while on Saturday 15,000 new cases were registered in just  24 hours.

All of this is a far cry from early last year, when Portugal was the last country in Europe to register a COVID-19 case, on March 2.

A voter waits to vote in the presidential election, in Lisbon, January 24, 2021 [File: Antonio Cotrim/EPA/EFA]

Having swiftly brought in confinement measures, until May, while Spain’s contagions marked Europe-wide highs, Portugal’s total contagion figures were at times as little as 10 percent of its neighbour.

Record numbers of cases are currently being registered worldwide, and like so many other countries, Portugal is suffering from pandemic fatigue. Authorities are toughening up restrictions after estimating that just 30 percent of the population respect social distancing rules.

However, Francisco Miranda Rodrigues, the president of one of Portugal’s top associations of mental health professionals, Ordem dos Psicólogos Portugueses (OPP), said: “It’s a complicated cocktail of causes, perhaps unique to Portugal.

“Twenty percent of our population lives in poverty or social exclusion, a very significant figure, and after such a long pandemic their limited resources have been used up. As a result, their ability to follow [the lockdown] rules has gone up in smoke.”

Furthermore, compared with the government’s clear instructions last year, he believes some Portuguese people have been baffled by the authorities’ much more mixed messages recently.

“At first it was easy to say ‘stay home’ to everybody, with no exceptions, and that was it. But when restrictions eased, we needed some higher-risk groups to return to work, so we had to tell them they could go back if they were careful,” Miranda Rodrigues said.

“At the same time, when you’re talking to teenagers you want them to be a little bit more afraid. [But] then you’re telling the elderly to stay home, while others they can go to the cinema: it’s confusing.”

Famous cafe ‘A Brasileira’ is closed in downtown Lisbon, Portugal, January 22, 2021 [File: Miguel A Lopes/EPA/EFA]

Another important factor, Miranda Rodrigues argues, is a chronic lack of psychological support networks within the public health system, with just 2.5 mental health professionals per 100,000 people.

“When a tough situation goes on for months and months, more and more people are vulnerable,” he argued.

“When the pandemic started, a special telephone hotline providing nationwide psychological help was created, running 24 hours a day, seven days a week.

“But that was to act as a quick fix, while more much structured psychological support programs were created. Unfortunately, that hasn’t happened.”

Viewed from the other side of the frontier, Guillermo Martínez de Tejada, professor of microbiology and parasitology at the University of Navarra in northern Spain, believes Portugal may have “lowered their guard” after such early success.

“That first victory probably made them too confident and the virus has ended up running wild. They ended up in a trap,” Miranda Rodrigues said.

Maria Antónia Duarte Silva, a teacher and lifelong Lisbon resident, said: “Back in March, people here were really scared, we didn’t know what was happening. We could see the damage COVID-19 was causing close by, first in Italy and then even closer in Spain. So when the government said “stay at home”, people obeyed.

“But people are tired now. When the second lockdown began, I went to the supermarket and it was like COVID didn’t exist. It’s as if the population didn’t want to accept what’s happening.”

Health professionals during a testing in the parish of Ponta Garça, Ponta Delgada, island of Sao Miguel, Azores, Portugal, January 19 2021 [File: Eduardo Costa/EPA/EFA]

The consequences, though, are tragic, as the country’s medical system faces near-collapse in some areas.

As one doctor in one of Portugal’s biggest hospitals told Al Jazeera, “Until recently I was working in a little paradise. But the last three weeks have been terrible.”

Requesting anonymity, she cited recent harrowing cases caused by the medical crisis, like a patient in central Portugal haemorrhaging litres of blood after being forced to wait several hours for an ambulance.

There is talk, too, among colleagues of one hospital running temporarily out of oxygen, another lacking “a minimum of protective equipment”.

“And,” she added, “these are not isolated incidents.”

With roughly a quarter of her medical team now infected with COVID-19, she told Al Jazeera that the internal organisation is badly aggravating the situation, with pathologists, lab doctors and psychologists being roped in to work in overwhelmed intensive care units rather than staff with more appropriate skills.

“We could have been much more prepared for this second time. But there is no full emergency plan,” she said.

On the political front, in Sunday’s presidential elections, Marcelo Rebelo de Sousa was re-elected with a hefty 60.7 percent of the vote.

The elections went ahead despite the pandemic, partly because any change of dates would have required overly complex legal alterations of the country’s constitution.

However, a considerable increase in votes for the hard-right Chega Party, from 1.3 percent in the last general election to 11.9 percent on Sunday, was perhaps a warning sign that Portugal’s population is deeply troubled by the nation’s current predicament.

Asked before the election if he expected a big protest vote on Sunday, Miranda Rodrigues argued: “If I’m feeling very tired, and I need answers, then hate speech that blames third parties as exclusively responsible for everything becomes very interesting. It’s a popular narrative, all over the world, the terrain is more favourable now for it to grow. And here in Portugal, too.”

Beds are ready to receive the first patients at a field hospital set up in a sports hall in Lisbon, January 20, 2021 [File: Armando Franca/AP Photo]