The first week of the year is traditionally the time when hospitals are most stretched, thanks to a rise in winter respiratory disease along with pent-up demand for services after Christmas.
This year is no different for the Irish health service.
Covid-19 is not flu, of course, but then neither is Covid in January 2022 the same threat as it was in January 2021. Vaccination and, to a lesser extent, the Omicron variant have seen to that.
Due to the variant, case numbers have gone through the roof. Positivity rates have reached an astonishing 50 per cent. This may be because, with services curtailed over the holiday period, most of those going to the bother of accessing a test are pretty sure they are ill already.
Because the testing system cannot cope, we do not know the real level of infection in the community. Neither can we gauge accurately when this wave will peak – current estimates place the moment between January 10th and 15th. It’s not just that Omicron is new, that it moves faster and that it is less severe; we also lack real-time data tracking its movement in the population, across different age-groups, among vaccinated and unvaccinated cohorts and in hospitals.
We can only hope Ministers and health officials have more access to essential data than the rest of us, on which they can base informed decisions. Most surveillance reports haven’t been updated since before Christmas, for example.
The number of patients in hospital with Covid-19 has more than doubled since Christmas Day – to 884 on Tuesday. This figure will continue to rise, thanks to the increase in case numbers, but for how long we don’t yet know.
The good news is that nursing homes have so far been spared large numbers of outbreaks, according to informed sources. In England, which is two weeks ahead of us in this wave, outbreaks in care homes are not translating into hospital admissions, presumably due to recent vaccine boosting.
Even more encouragingly, and mirroring the experience of other countries, the number of Covid-19 patients in intensive care is staying stubbornly steady. There were 90 virus patients in ICU on Tuesday, fewer than on St Stephen’s Day.
The graph tracking deaths in the pandemic has budged even less than for ICU admissions in this latest wave of the pandemic, though they will increase at a remove of several weeks from the rise in cases. There were 22 Covid-19 deaths in the week up to December 29th, in line with figures seen over previous months.
All of this says that, while the health service is in for a rough two months, it should cope with what Omicron will throw at it. It would cope even better if resources were directed to address the long-term challenges posed by winter surges – more hospital and ICU beds, for example, or seven-day operations for all key services.
The picture is complicated by the considerable impact staff being off work is having on the operation of hospitals. In all the big hospitals, hundreds of key staff are out of commission due to infection or being a close contact. Figures to be published later this week are likely to confirm that over 6,000 staff are off work for this reason.
While this leaves already exhausted colleagues to shoulder even more of the burden, these absences are time-limited. Widespread use of derogations and changes that have reduced periods of self-isolation will help reduce the duration of this issue.
Things will get worse before they get better, and then they may improve very quickly. That will be the time when we need to think out longer-term solutions to the pandemic. With early research showing the protection offered by boosters waning after just one month, for example, what role will vaccination play in tackling Covid-19 in the future? Will we all be expected to submit to booster doses every three months, or will vaccination be focused on the most vulnerable?
Finding solutions won’t be easy. Omicron – more transmissible but less severe – may be a way-station for Covid-19 on the path on endemicity. Or it may be a random change that could be followed at some point by a new variant that is both more transmissible and more lethal. There is so much we still don’t understand about this virus.