LAST UPDATE | 14 Oct 2022

THE NUMBER OF people in hospital with Covid-19 in recent weeks has been steadily rising, and giving the Government cause for concern for the winter ahead. 

The possibility of mandatory mask wearing on public transport and in health settings in the event of a winter Covid wave was discussed at Cabinet earlier this week when  Minister for Health Stephen Donnelly presented the HSE Winter Plan.

The plan includes an emergency response plan to ensure Ireland can deal with a new Covid variant of concern. It would be implemented if the virus posed a serious risk to public health and would allow for a rapid escalation of testing and tracing measures.

Speaking to reporters beforehand, Donnelly said there has been a “significant” increase in the number of people in hospital with Covid in recent weeks, adding that the Government “hope things will remain calm” over winter.

Professor of Immunology in DCU Christine Loscher told The Journal that we’re potentially entering into a winter surge of the virus, and that we should be “doing everything that minimises risk” in order to prevent further strain on the health service. 

So where are we at with Covid at the moment? Let’s take a look at the data. 

Case numbers

The latest published data shows that Covid cases have been on the rise in the last two weeks.

According to the latest report from the Health Protection and Surveillance Centre (HPSC), 2,337 new cases of Covid-19 were reported between 2 October and 8 October. 

This is a 21% increase from the 1,921 cases reported over the seven-day period from 25 September to 1 October. 

The highest number of new confirmed cases was in the 45-54 age group, with 16.7% of notified cases. The current median age of Covid-positive cases is 52. 
16.2% of cases were among the 35-44 age group, while 11.9% of cases were among 75-84 year olds. Those aged 85 and over accounted for 7.8% of cases. 

The HSPC report states that the incidence rate of confirmed cases per 100,000 population for the week of 2-8 October was 49.1.

As of 10 October, Offaly was the country with the highest incidence rate at 184.7 cases per 100,000 population, followed by Kilkenny at 173.3 and Laois at 148.8.

The latest daily figures, published on Tuesday 11 October, showed 705 PCR-positive tests and 789 registered antigen-positive tests. Compared to two weeks earlier, this is an increase of 51.9% and 34.4%, respectively.

However, PCR testing has reduced in recent months, making it more difficult to get a sense of the true scale of infection in the community.

The HSE no longer carries out PCR tests for people under 55 with symptoms of Covid who are otherwise healthy.

It also does not test people aged 55 or older if they are fully boosted, even if they have symptoms of the virus.

Under new plans published this week, PCR testing will be wound down further from this autumn and will only take place if deemed necessary after a clinical assessment.

Hospitalisations

Over the two-week period of 25 September to 8 October, there were 750 people in hospital with Covid-19, an almost 30% increase on the previous two-week period. 

As of Thursday morning, there were 459 people in hospital with Covid, a 37% increase from 335 people two weeks ago. 15 people were in intensive care with the virus.

However, the Health Minister has said that just 40% of those in hospital are there due to Covid.

Loscher told The Journal that since testing for the virus has been reduced, hospitalisation figures will serve as an indicator of “where we’re at” with Covid.

She said the jump in hospitalisations is a “cause for concern”, meaning it is an indication that Covid is circulating at higher levels in the general population.

We know from previous rounds of Covid that generally, only a small proportion of people would end up in hospital, even if a large number of people get it. So it’s likely that people ending up in hospital now is not because it’s any more severe, or because they’re not protected, but it’s probably more likely to do with the fact that there’s just a higher volume of people with Covid.

“I do think we need to be keeping an eye on the hospital numbers very closely in the next week or two, in terms of what way they might jump and the indications it gives us for circulating Covid in the community.”

Booster stats

Despite NIAC’s recommendation that certain groups receive additional boosters, uptake has been slower for the most recent cohorts when compared to the winter 2021 booster programme.

The Department of Health said that this is likely due to a combination of “vaccination fatigue, the summer holiday period, and a reduction in the public’s perceived risk of Covid-19 infection”.

As of 6 October, over 3 million first booster vaccine doses and over 720,000 second booster doses had been administered by the HSE, including 126,440 doses to people who are immunocompromised.

In a tweet this afternoon, Chief Medical Officer Professor Breda Smyth said 78,600 Covid-19 booster doses were administed last week, up from 15,000 the previous week. 

“This is one of the highest weekly number of vaccines administered this year and is a great testament to all of you topping up your protection,” Smyth tweeted. 

“We know that the effectiveness of #Covid19 vaccines wanes over time,” she said.

“That is why it is important to keep up to date with your vaccine schedule and make sure to receive a booster dose as soon as you are eligible. You are only fully vaccinated when you receive the booster recommended for you,” she added. 

This is one of the highest weekly number of vaccines administered this year and is a great testament to all of you topping up your protection.

We know that the effectiveness of #COVID19 vaccines wanes over time.

— Chief Medical Officer (@CMOIreland) October 14, 2022

According to the latest HSE data, 70% of over 80s, 68% of 70-79-year-olds and 41.7% of 60-69-year-olds had received a second booster dose as of 3 October.

Boosters adapted to protect against the Omicron strain of the virus began being administered on 3 October after NIAC recommended their use for those aged 12 and older who are eligible for a booster vaccination.

The new boosters include components of the original virus strain of Sars-CoV-2 and the Omicron variant.

Loscher said there needs to be a “revitalisation of a very active public health campaign to encourage boosters”.

“Particularly right now, as we’re coming into a surge, boosting is going to give a huge amount of protection to people who are due their boosters,” she said.

‘Twindemic’

As part of the winter vaccination programme, flu vaccines are also being offered alongside booster jabs.

Concern has been raised that the HSE could be facing into a ‘twindemic’ where the annual flu season would see a simultaneous spike in Covid cases, putting the health service under significant strain.

“If you consider the last surge we had, we were nearing 1,000 people in hospital with Covid. That was having an impact on A&E, it was having an impact on staff shortages, and it was having an impact on people not being able to access planned surgeries,” Loscher said.

I think if you consider that potential level of hospitalisation with a severe flu on top of that, I think you’re going to reach very much a tipping point.

The southern hemisphere, where the flu season is from April to October, is usually monitored by experts to predict what might happen in the northern hemisphere. The data so far has not been positive. 

According to Australia’s Department of Health and Aged Care, the country has experienced its worst flu season in five years, with cases peaking about three times higher than the average for that period. 

Donnelly has said that the plan being brought forward by his department would be a “very comprehensive response to what’s going to be a very difficult winter”.

Flu vaccines are currently free for those aged 65 and over, children aged 2-7, healthcare workers and people with long-term health conditions.

#FluVaccine is available for free for the most vulnerable in the population and can be co-administered with the #CovidVaccine #ForUsAll pic.twitter.com/yThkmG247I

— Stephen Donnelly (@DonnellyStephen) October 10, 2022

However, Loscher said she would have liked to have seen them free for all people the way they were in the last few years.

“I think it’s an added encouragement for people, and I think that it will go a long way to minimising the impact of this concern we have about this double season of Covid and flu, particularly on the healthcare system,” she said.

“We should be rolling out the flu vaccine free for everybody who wants us encouraging everyone to get it. We did that the last few years and the flu vaccine uptake has never been higher. I think reverting back to it being free for certain cohorts of people might discourage people.”

New restrictions?

With all of this in mind, the question of whether or not new restrictions will be introduced is being asked. 

Tánaiste Leo Varadkar has said that the Government expects to be able to manage the increase in case numbers and that he does not expect new restrictions will need to be imposed in the winter months.

Meanwhile, Donnelly this week published a report on the Department of Health’s strategy for the management of Covid this autumn and winter, which places a particular emphasis on preparedness and contingency planning. 

The report outlines that preliminary preparations for drafting of contingency legislation for the potential reintroduction of public health measures in certain circumstances is underway.

“This is a precautionary measure to ensure all elements of preparedness are in place. Due diligence and careful consideration of a constellation of indicators will be required before enaction,” the report says.

While there are currently no plans to introduce mandatory mask-wearing in public settings, the report states that “any potential future reintroduction of population-wide mandated [facemasks] will include a point-in-time assessment and take account of all relevant factors and be proportionate to the risk at the time”.

It states that this will take a “risk-based approach” and be guided by advice from the CMO Professor Breda Smyth.

The report recommends that people continue to wear masks on public transport and in healthcare settings.

Loscher said that rather than discussing the possibility of reintroducing mask mandatings, the conversation should focus on why masks are useful.

“I think mask mandates will be met with a lot of resistance, and a lot of controversy, and instead of having the controversy about the mask mandate, I think we should just spend the time talking about why masks are useful and why they help lower the risk,” she said.

We need to give very clear messages that when we get to a certain level of Covid, that we’re very clear with the general public that: ‘Currently, we’re experiencing very high case numbers, it’s impacting on hospitals, and in order to minimise risk of a very significant surge and an overrun of the health care system, we would recommend mask wearing and indoor private settings and public transport’.

She said that people have become very well educated about the usefulness of masks, and believes a lot of people will begin to wear them again “when Covid is circulating at a high level and they’re on crowded public transport and in crowded places with closed windows”.

She also said that we should be doing “everything that minimises risk”.

“The most important thing we can do to minimise the impact of this double whammy that might be coming at us is very clear directions about vaccination, encouragement of vaccination in both regards for the booster, and also for the general flu jab for everybody, making that available freely and telling people what the risks are, and encouraging people to use the mitigation tools that we’ve had before, which is, if you’re going into a crowded setting, you need to be thinking about wearing a mask.”