For the first time in many months, all the main pandemic indicators are stable or improving

Analysis: Omicron has bounced favourably for the world but the next variant might not be so benign

Vaccine being administered to staff at St Vincent’s University Hospital, Dublin.  Ireland will, hopefully, follow the patterns seen in the UK and other countries further along the Omicron curve. File photograph: Alan Betson

Vaccine being administered to staff at St Vincent’s University Hospital, Dublin. Ireland will, hopefully, follow the patterns seen in the UK and other countries further along the Omicron curve. File photograph: Alan Betson

 

The sight this week of public health officials spurning further restrictions even with a record 20,000-plus Covid-19 cases a day told its own story.

For the first time in many months, all the main pandemic indicators are stable or improving. Case numbers have been steady for the last 10 days. The number of Covid-19 patients in hospital, which rose after Christmas Day, has stabilised in the past five days.

ICU numbers had been falling since November, and have remained pretty static since Christmas Day. There are fewer patients in ICU now than there were on November 10th.

Case positivity, which started soaring before Christmas, grew more slowly after it. Over the last five days, this figure has stabilised and even fallen a little.

These trends are subject to all sorts of caveats. The massive Omicron variant surge overloaded testing capacity so the real number of infections is much higher than those confirmed by PCR test. In the first week of the year, up to 500,000 people may have been infected.

The number of Covid-19 patients in hospital has been the main pressure-point over recent weeks, but an increasing number of these patients are in hospital with other conditions, and were then found to be infected with the virus. For some of these patients, Covid-19 will exacerbate their conditions; for others, it will be a sideshow.

Milder symptoms

According to the HSE, 30 per cent of patients diagnosed with Covid-19 are actually in hospital for something else. The fact that this figure has risen from 10 per cent a few months ago is testament to the lack of testing in the community and the milder symptoms linked to Omicron.

A snapshot survey by the Infectious Diseases Society last week found under half of Covid-19 patients showed symptoms of the virus and over 70 per cent were not on oxygen therapy.

GPs are seeing a drop in referrals for testing, which adds to the indications we may have passed the peak of infections

“Even amongst those with Covid illness, only a small proportion have florid Covid pneumonia with associated oxygen-obtaining difficulties,” St James’s Hospital respiratory doctor Brian Kent noted during the week.

Up to 40 per cent of his Covid-positive patients are there “because they have something else going on and happen to have Sars-CoV-2 in their nose, not because they have overt Covid,” he observed.

While some patients are still getting very sick, these are much more likely to be unvaccinated, doctors in Ireland and other countries have pointed out.

Gauging what happens now is hampered by a lack of data. The Health Protection Surveillance Centre hasn’t published a daily incidence report since Christmas Eve. The move to case confirmation based on self-administered and self-submitted antigen tests for many people means that staple of the pandemic over the past two year, the daily case count, will from now on mean less than it ever did.

Drop in referrals

GPs are seeing a drop in referrals for testing, which adds to the indications that we may have passed the peak of infections.

So what happens now? We know that Omicron is completely dominant in Ireland (98 per cent of cases), that it moves quicker than previous variants and that it is less severe.

Ireland will, hopefully, follow the patterns seen in the UK and other countries further along the Omicron curve. Cases should fall sharply from current high peaks, though the new, shorter periods of self-isolation could lead to an increase in still-infectious people at large. The reopening of colleges will also contribute to spread. However, it seems unlikely either of these factors will fundamentally change the direction of travel as spring approaches.

We can’t keep vaccinating people every few months, as this will impair immunity

Looking across the Atlantic, the US is experiencing a surge in hospitalisations that exceeds anything happening in Europe. The mostly likely reasons are low vaccination rates (not applicable here) and the continuing circulation of the Delta variant.

In the UK, meanwhile, admissions of children have risen three-fold since late December. Experts are investigating the trend but think it may be the result of high community transmission affecting an unvaccinated group.

No figures on hospitalisations broken down by age have been published in Ireland this year, so it is not possible to say whether something similar is happening here. There were 22 children with Covid-19 in hospital on Thursday, and two in ICU.

There has been an increase in outbreaks in nursing homes and an increase in cases among older age groups, which needs to be monitored. So far, the size of outbreaks remained small.

No certainty

At this stage, there seems no reason not to lift current hospitality restrictions as planned at the end of the month, or even earlier. The Danish government is about to reopen cinemas and music venues now that their hospital numbers are dropping, even though infections remain high.

Beyond that, there is no certainty. Omicron has bounced favourably for the world but the next variant might not be so benign. We can’t keep vaccinating people every few months, as this will impair immunity and anyway the vaccines we are using were designed for a different strain of Covid-19.

What we really need over the coming months is attention to longer-term thinking and planning , principally to deal with winter surges of infection.

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