Nphet letter to Donnelly warns of 3,000 Covid cases per day in September

Chief medical officer also warns that variant is less susceptible to vaccines

 Dr Tony Holohan, chief medical officer, Department of Health, said the situation in Ireland was one of “high incidence with an uncertain trajectory”. Photograph: Gareth Chaney/Collins

Dr Tony Holohan, chief medical officer, Department of Health, said the situation in Ireland was one of “high incidence with an uncertain trajectory”. Photograph: Gareth Chaney/Collins

 

The Delta variant poses a “substantial threat” to Ireland, as it is more transmissible and resistant to vaccines, the Government was warned as it prepared the final phase of reopening plans.

In a letter to Minister for Health Stephen Donnelly sent last week and published on Tuesday, chief medical officer (CMO) Dr Tony Holohan said Delta “is significantly more transmissible and less susceptible to vaccines than previous variants”.

Dr Holohan said there is uncertainty about the length of immunity, the long-term consequences of infection, and that Covid would be a global challenge for some time to come. From past experience, he wrote that he could not “fully rule out” the reintroduction of restrictions in the future.

“It is very likely that the Delta variant will continue to circulate extensively throughout the autumn and potentially later in the year, particularly among individuals that have not yet been vaccinated,” Dr Holohan wrote.

“This poses a very substantial threat, particularly to those who are not yet fully protected through vaccination.”

Modelling given to the Government suggests 2,500-3,000 cases per day next month, even in optimistic scenarios, and peaks of between 500-700 in hospital and 80-130 needing intensive care.

Central scenarios suggested 3,000-5,000 cases per day, 750-1,300 hospitalisations and 150-250 needing critical care.

The letter warned that the situation in Ireland was one of “high incidence with an uncertain trajectory”, and that while the disease may plateau in the coming weeks, the CMO said there were “at least transient” increases expected to arise from the reopening of schools and higher education.

The concern centred on additional mobility and social contact around schools and colleges rather than possible transmission in educational settings “where there are significant mitigations in place”.

The situation in hospitals is “challenging”, he wrote, with reduced capacity as a result of increasing Covid patients and associated infection control measures.

However, the overriding advice from Dr Holohan was that the vaccination programme would “facilitate a transition in our approach to dealing with the pandemic” over the medium term, building on progress made suppressing peaks of infection last winter.

Signalling a shift in pandemic policy, he wrote: “As we move forward, measures to combat the pandemic will increasingly be voluntary,” with individuals making “risk-based assessments for themselves”, with an emphasis on solidarity and collaboration across society, supported by the vaccine programme.

Transition

The Nphet advice was that in order to transition to a regime of personal responsibility, 90 per cent of the population aged over 16 should be vaccinated fully for two weeks.

The incidence, reproduction number, growth rate, impact and progression of infection to severe disease should “give confidence that we can suppress the infection sufficiently to minimise the harm of the disease”.

Furthermore hospitals and critical care occupancy should be reducing or at low levels, public health capacities such as testing and tracing should be robust and resourced, and there should be an absence of a variant of concern with increased potential transmissibility, virulence or vaccine escape.

A range of measures should be retained until next Spring, including wearing masks in healthcare settings, indoor retail and on public transport, while they should be encouraged based on individual risk assessment. Sector specific measures were advised for promoting self isolation, use of masks, distancing, ventilation and hygiene, while advice that non-essential international travel by the unvaccinated be continued.

Public health capacities needed to be resourced, while the health system should undergo “ongoing strengthening”, he continued.

The Nphet letter advises that many of the measures approved by the Government today should take place when these criteria have been met. It also states that only once the criteria are met, it would be appropriate that sectors commence the phased reintroduction of crowds at indoor cultural and sporting events.

The letter also flags a series of changes in the testing regime arguing that as the harm from infection declines, “the negative impacts of testing at the current scale are likely to become disproportionate to the benefits to human health”. There will be a review of the public health response, including testing, tracing and outbreak management, to be completed alongside the HSE’s winter plan.