Covid-19: Facing into another surge in cases, the path ahead is far from clear

Once again in this pandemic, two very contrasting approaches are being taken on either side of the Irish Sea.

The UK on Monday announced it would lift almost all social distancing and mask rules as part of a wholesale reopening from July 19th.

Ireland, meanwhile, deferred the planned reopening of indoor dining because of the threat posed by the Covid-19 Delta variant.

It is the UK, not Ireland, that is suffering a massive surge in virus cases and has recorded a 25 per cent increase in related hospitalisations over the past week. British prime minister Boris Johnson has even factored a possible rise to 50,000 cases a week into his plans, along with an unspecified number of additional deaths.

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Johnson is counting on the virus running into a wall of immunity, thanks to the vaccination of two-thirds of adults. Here, with half the population fully immunised, Ministers are wondering what they should do.

It is worth remembering that predictions of another large surge in cases tell us little about what needs to be done. The number of people hospitalised by the virus, or admitted to intensive care (ICU), are better indicators on which to base policy, as is the number of deaths of people with Covid-19.

With the development late last year of effective vaccines, many assumed the threat posed by the virus would be nullified. Even if people got infected, few would fall seriously ill.

The emergence of the Delta variant, which is at least 50 per cent more infectious than previous strains, is challenging this assumption. Even a small proportion of infections being passed on can quickly lead to a surge when the variant is so transmissible, and the numbers at risk are so large.

This is happening in Israel and the UK, where cases are increasing despite having some of the world's highest vaccination rates. The link between infection and serious illness has been weakened, but not broken by vaccination. The chance of a confirmed case dying from Covid-19 has fallen from about one in 100 to one in 1,000.

The National Public Health Emergency Team (Nphet) believes Ireland is at the start of a surge similar to that happening in Britain, now that the variant has established its dominance.

Virus-weary population

Last week, its gloomy “scenarios” envisaging the size of this surge caused understandable fear and loathing among a virus-weary population. The wide spread in projected scenarios, from the most pessimistic to the most optimistic, only added to the consternation.

The numbers used by Nphet probably overstate the magnitude of the surge, because many of the cases will be asymptomatic and will never come to official attention. The models also need to be adjusted to take account of the decision to delay the resumption of indoor dining, and for the decision to fast-track vaccines to young people.

But while the astronomical estimates of cases over the next three months garnered most attention, it is the models for hospitalisations, ICU admissions and deaths that matter most.

Under the “optimistic” scenario, for example, Nphet foresaw 1,500 hospitalisations, 200 ICU admissions and 250 deaths between now and the end of September. These figures should improve once the model is tweaked this week, but they still give pause for thought.

‘Abundance of caution’

Can our health service cope with this level of admissions? Or to put it another way: is the reopening of society and the return of thousands of people to their jobs to be delayed because the HSE fears it won’t be able to cope?

Since mid-May, about 55 Irish people with Covid-19 have died, a fraction of the levels experienced earlier in the year. Hospitalisations and deaths are currently stable. But it takes weeks for cases to translate into serious illness and death, so we won’t know for some time how many people will end up needing treatment.

There aren't enough straws, as yet, in the wind across Europe to determine how much of an impact another wave would have on the Irish health service. Many of our neighbours, in which the variant has yet to become dominant, are enjoying falling incidence figures. Some – Norway, for example – are hesitating like us about reopening society further.

The Government will have to make difficult decisions without having a full picture.

Does it follow the example set by the UK’s social experiment, about which many scientists have expressed doubts? Or does it act out of the same “abundance of caution” that made Ireland’s lockdown longer but safer than almost any other in Europe?