How bad can it get as we reopen amid another Covid-19 surge?

Holohan raises concerns about high number of unvaccinated people in young age groups

It’s been 585 days, 83 weeks or 19 months since the Dublin nightclubs opened their doors. Video: Enda O'Dowd

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You would be forgiven for being confused at the contradictory messages delivered this week with reopening of nightclubs when Covid-19 trends have taken a “wrong turn”.

In the same week that the State chief medical officer Tony Holohan said there was a “worrying and concerning” increase in coronavirus infections, hospitalisations and admissions to intensive care units, the Government permitted reopening of nightclubs at full capacity from last night.

Two days after the National Public Health Emergency Team (Nphet) said that increased social contacts and socialising indoors had led to a very rapid increase in Covid-19 cases nationally and across all age groups, the Government said people would not have to wear face masks when they are eating, drinking or dancing in nightclubs. This generally covers much of what people do in clubs.

Ahead of nightclubs reopening, Dr Holohan raised concerns about the high number of unvaccinated people in young age groups . He also criticised businesses that failed to check Covid-19 vaccination certificates.

Hours before the clubs reopened, HSE chief executive Paul Reid warned that the surge in infections should be “a very real rain check for us all” and was already resulting in 1,800 health staff on sick leave and cancellation of surgeries in two of the State’s major hospitals: University Hospital Galway and University Hospital Limerick.

The view in Government, while seeming counter-intuitive in light of the concerns raised, is that the State’s response to the pandemic can change with vaccination rates in excess of 90 per cent and that it is therefore possible to lift more restrictions and reopen the “night economy”.

The Government’s focus in reopening remains on personal responsibility rather than public intervention, with people urged to shun places notable for poor compliance rather than having the State step in. A combination of both may still be required.

As Tánaiste Leo Varadkar noted this week, the Government is grappling with the complicated middle ground between a closed and reopened economy against the backdrop of an unsettling trajectory.

The Government is juggling a virus that will transmit better in the autumn and winter because of increased indoor mixing along with the first winter of the Delta variant and “breakthrough” infections among the vaccinated.

The Government is taking bubble-wrapping measures again to protect the most vulnerable, rolling out third “booster” vaccine shots for older people. It is finally embracing antigen testing for the wider population. The phased return to offices is becoming even more phased. Face-mask use will continue well into 2022.

Mounting pressure

This is in sharp contrast to the United Kingdom where, almost 100 days after Freedom Day, the government is facing mounting pressure from healthcare figures to make face masks mandatory and advise people to work from home .

Here, as infections in hospital accelerate at a rate of 2 to 3 per cent a day, and with an average of five coronavirus admissions to intensive care (ICU) daily, the pressure on a poorly equipped and under-resourced healthcare system may yet force the Government to change its response.

If the trends continue in this wrong direction, Nphet is forecasting a peak of 800 to 1,000 people in hospital and 150 to 200 in ICUs by late November. That is below the worst of the third wave in January when admissions peaked at 2,020 people in hospital and 221 in ICU, but it will still mean the HSE abandoning non-Covid services in winter, traditionally the busiest time for hospitals.

Maynooth University professor of immunology Paul Moynagh believes that, with so much of the population vaccinated, this moment is “probably as good as it is going to get” in terms of reopening but it comes with risks: managing the burden on the health system as we move from pandemic to endemic.

He sees mitigation measures in antigen testing, better indoor ventilation and booster jabs .

“It is trying to get that balance by recognising that you can’t keep closing down society to save the health system.”

Managing that balance and this fourth coronavirus wave as society reopens with the return of some of the riskiest indoor activities will make for another difficult winter.

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