SLOW AND STEADY, but how slow will it be?

After a devastating Third Wave in late December and January, there was some cause for optimism heading into February. 

Case numbers were declining at a rapid rate, vaccination was picking up and the public were adhering to restrictions. 

The latter is still the case but Covid-19 continues to spread, and case numbers aren’t dropping quite as fast. 

To an extent, this can be explained by the resumption of asymptomatic close contact testing which health officials estimate will contribute between 50-100 extra cases per day over the coming weeks. 

Outbreaks in nursing homes and hospitals also tend to persist for a considerable period of time, a point Chief Medical Officer Dr Tony Holohan illustrated in a letter to Health Minister Stephen Donnelly on 4 February. 

Ireland’s national incidence rate is 299.6 cases per 100,000 of the population on a 14-day rolling average, according to data from the Health Protection Surveillance Centre – compared to 397.1 on this day last week and 621.9 the week previous.

The country reduced its 14-day average by more than 80% between 14 and 28 January. It reduced by a further 40% between 28 January and 5 February. 

It has only reduced by a further 24% since last week. 

Looking at 14-day incidence rates in individual counties, Monaghan has the highest incidence of Covid-19 in Ireland at 578.3 cases per 100,000 – a further 34% reduction since last week. 

Carlow is the second-highest county in Ireland with a 14-day incidence rate of 391.7. Waterford is third-highest with a 14-day incidence rate of 391.6. 

Counties with the current lowest incidence rates include Kilkenny (128), Leitrim (134.2) and Clare (136.3). 

It appears that although incidence continues to decline in all counties, some remain concerningly high. 

Dublin accounted for more than 50% of cases (516) reported on Tuesday when all other counties reported between less than 5 and 60 new cases that day.

Asked last night why this is the case, Deputy Chief Medical Officer Dr Ronan Glynn said there has been a “greater proportion” of cases in Dublin and that is “something we need to watch”. 

Dr Glynn said it is not yet clear what factors are behind the capital’s high incidence – beyond population size – but said it could be due to asymptomatic close contacts being tested again. 

“We need to keep an eye on it and see,” said Dr Glynn, adding that mobility data suggests there has been an uptick in movement across Dublin in recent days. “We will monitor it closely over the coming days and see whether that trend continues in Dublin.”

Testing & Tracing 

Testing had ramped up to almost 25,000 per day on 8 January. 

A lag over Christmas resulted in a spike in demand for tests from 27 December onwards.

Testing was curtailed by demand. Testing of asymptomatic close contacts only recommended on 28 January. 

This could lead to a rise in daily cases by 50-100 per day, and we are likely to see that borne out in cases numbers for the foreseeable. 

On 17 December, approximately 83,000 tests were carried over the previous seven days, an indication that incidence was rising in the lead-up to Christmas. The positivity rate had risen to 3.2%. 

By 7 January, approximately 174,000 tests had been carried out over the previous seven days. The positivity rate then was 22.7%. 

The number of tests per week reduced by about 12,000 each week since that date.

Approximately 121,402 tests have been carried out in the past seven days as of Thursday. The positivity rate is currently 5.8%. 

That is a reduction of just 0.6% in one week, however, a further indication that asymptomatic cases are being counted again and that our rate of decline is slower than in January. 

Modeling 

How will this feed into health officials and Government’s thinking heading towards 5 March?

Taoiseach Micheál Martin has already indicated that Level 5 restrictions will remain largely in place beyond that date until Easter or even May.

He said on Wednesday that the B117 Variant (UK Variant) is keeping incidence of Covid-19 “stubbornly high”. 

NPHET’s modeling from late January – which estimated we are on track to see 200-400 cases per day by 28 February – remains accurate, according to Chair of NPHET’s Irish Epidemiological Modelling Advisory Group Professor Philip Nolan.

Speaking last night, Professor Nolan said, firstly, that NPHET’s estimates were calibrated as if asymptomatic close contacts were already being tested. 

Secondly, we will only hit 200-400 cases per day by the end of February if Ireland’s Reproductive Number stays between 0.5 and 0.9, he said.

It is currently estimated at between 0.6 and 0.8. 

Hospital & ICU

Meanwhile, Ireland’s health system continues to be under strain. 

HSE CEO Paul Reid said yesterday that, although the number of people hospitalised with Covid-19 is decreasing, it is still not a “normal” situation. 

There have been 52 hospital admissions in the last 24 hours and 55 discharges. 

There are – as of this morning – 984 confirmed Covid-19 cases in hospital and 169 people in Intensive Care Units.

There were 1,308 confirmed Covid-19 cases in hospital and 188 people in Intensive Care Units last Friday compared to 1,620 and 216 the previous week. 

Vaccinations 

Finally, 243,353 vaccinations have been administered in Ireland. That is a further 24,000 doses administered since last week. 

Of the vaccines administered so far, 91,548 have been in long-term residential care settings with 150,789 administered to frontline healthcare workers. 

Of those, 154,079 have been given a first dose with 65,748 frontline healthcare workers now fully vaccinated. 

The HSE said yesterday that a further 79,500 vaccines will be administered in 78 long-term residential care settings, to frontline healthcare workers and to GPs next week. 

Healthcare workers with direct patient contact as well as residents at long-term residential care facilities over the age of 65 have been first to receive the vaccine. 

Both vaccines currently being used in the roll-out – the Pfizer vaccine and the Moderna vaccine – are mRNA vaccines that require a two-dose schedule.

The AstraZeneca vaccine – which is easier to store but has suffered well-publicised setbacks – will be administered to 22,000 frontline healthcare workers next week. 

About 12,000 people over the age of 85 given their first dose by next Sunday. 

HSE CEO Reid said this week the aim of the first week of the rollout to this cohort will focus on ensuring the cold-chain transfer to GPs in Ireland is secure before all 72,000 people over 85 are given their first dose. 

It comes after Health Minister Stephen Donnelly confirmed that it will not be until mid-May that all people over 70 will receive their first dose, despite an initial target for this cohort of mid-March. 

Ireland’s vaccination programme continues to experience setbacks – mainly related to supply and a recent decision to recommended that people aged 70 and over should receive mRNA vaccines – from Pfizer/BioNTech or Moderna – not AstraZeneca. 

Covid-19 cases, meanwhile, remain at a higher level than what we experienced in April 2020. 

Health officials will keep a close eye on Covid-19 incidence – and severity of disease – in vaccinated healthcare workers over the coming weeks. 

After a dark winter, it could provide Ireland’s first chink of light.