Fixation on daily tally of Covid cases distracts from what must be done

It is encouraging that deaths remain low, but little progress has been made on key issues

Grafton Street in Dublin. Photograph: Gareth Chaney/Collins

Grafton Street in Dublin. Photograph: Gareth Chaney/Collins

 

To properly assess the current stage of the pandemic, it is more useful to start with the most serious outcome – death – than with case numbers.

In mid-September an average of one person a day with Covid-19 was dying; now, that figure is two a day.

While it would be better if no deaths were recorded, the figure hardly leaps off the page.

Mortality is much lower than it was in spring because those becoming infected now are on average much younger. Earlier intervention and better treatment are also making a difference.

One major caveat: death rates tend to lag behind other indicators by some weeks, so these figures will increase as an inevitable consequence of more hospitalisations. But given case numbers have been rising now since August, it is encouraging that the graph for deaths remains low.

Two-thirds of those dying with the virus are aged 80 or over, and 95 per cent have underlying conditions, according to the Central Statistics Office.

Covid-19 is a brutal disease for some, and the most severe cases may end up in intensive care. In mid-September there were nine cases in ICU; today, that number is 25. With such relatively small numbers, it is difficult to make confident predictions, but inevitably the trend is upwards for the coming weeks.

Here, then, is the first pinch point. On Thursday evening, according to the HSE, 244 critical care beds were occupied, 27 of them with Covid-19 patients, and 34 remained free. It isn’t hard to see this supply being used up quickly on the basis of current trends.

But the health service is used to dealing with surges in demand each winter during flu season, and each hospital has a plan for expanding capacity when this happens. The HSE reckons it can scale up to 350 ICU beds to meet a surge in demand – that’s about 100 more than are currently occupied. When asked this week, officials declined to specify how many weeks’ ICU supply is in the system based on current trends.

Seventeen ICU patients were on ventilators on Thursday. With more than 1,000 ventilators available, supply here does not seem to be an issue.

Demand for beds

The second looming pinch point is the supply of hospital beds. The rate at which patients are hospitalised in September was one-third of what it was last March. But according to National Public Health Emergency Team official Prof Philip Nolan, hospitalisations of Covid-19 patients are growing exponentially, and within a month’s time, we could have up to 450 in hospital.

Demand for hospital beds always starts rising at this time of year as respiratory complaints spread. As of Thursday there were 254 free beds in the hospital system, so this is obviously a problem should current trends continue. One of the challenges is that Covid-19 patients need to be treated for much longer than, say, flu patients – Nphet said this week the average length of stay of a Covid-19 patient is 20 days in hospital and 14 days in ICU.

The health service is likely to react by cancelling elective work to make way for a surge in virus patients, something it does every year during flu season. And given that it struggles to cope during bad flu winters, the same is likely to happen over the coming weeks.

The last indicator to consider, and the most uninformative, is the number of new cases each day. This is actually a count of the number of positive PCR tests, a figure that includes false positives and people who are not infective at the time of the test (though they may have been so in the recent past and could become so in the days that follow).

Case numbers are a useful indicator of the level of transmission of the virus. We need to pay particular heed to levels among older people, among healthcare workers and cases transmitted within health facilities, but the daily announcement of new cases does not deserve its status as a national obsession.

Fruitless fixation

It is true figures are rising exponentially but fixating on this seems to be getting in the way of tackling problems that are nearly as old as the pandemic – dealing with the Border; enforcing rules we have agreed on; providing more ICU beds; speeding up testing; scaling up contact tracing; and providing a framework for travel built around quarantine and testing options.

As this week has gone on, pressure has grown to reimpose a lockdown. Extended closures of schools after midterm seem to be on the cards, despite the lack of scientific evidence and the fact this is not envisaged at any level of the Government’s framework plan. Yet we still haven’t seen a proper cost-benefit analysis of the impact of lockdown on a struggling economy and on non-Covid health.

Neither have officials made clear what the strategy would be after a lockdown. Do we continue to lock down for months, or would restrictions be lifted, possibly sparking yet another surge? Surely this would have to be answered before the country was shut down again.

Some scientists say we should seek to eliminate the virus, though it hard to see how this could be achieved in such a trade- and travel-dependent country as Ireland.

Other scientists espouse shielding of the vulnerable while opening up society. But given the lack of firm evidence for herd immunity, and the very large number in the vulnerable category, this is too big a risk for many to take.

It may be that “muddling through”, perhaps with a little less melodrama than was seen this week, remains our best option. There is a value to keeping schools and businesses open, and morale up, that is not caught in the epidemiologist’s graph, while the risks are managed within the levels of the Government’s framework plan.

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