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The new Covid measures may take weeks in some cases to make an impact

We must wonder why the rate at which cases translate into hospitalisations has hardly improved since vaccines were available

By now it plays out as theatre – the initial warnings, the appeal to personal responsibility, the grim predictions and, finally, the Taoiseach’s sombre address to the nation.

Other countries have had their own surges and crises in this pandemic – even now over a dozen European states have more Covid-19 patients in hospital than Ireland – but in few of them do events demand as much drama as in Ireland.

Almost two years on we still have the extended and complex decision-making process, the politicians’ fondness for the nearest microphone and the off-the-record briefings that all combine to delay action and dampen spirits.

Hospital Report

Total doses distributed to Ireland Total doses administered in Ireland
9,452,860 7,856,558

Public health officials and Ministers must be blue in the face having to repeat the basic public health messages; they certainly sound like a broken record for much of the population.


This, along with the Cassandra-like brandishing of “worst-case scenarios”, seems to be the only approach deemed capable of working.

We know how dangerous the Delta variant of Covid-19 is but worst-case scenarios are outliers that don’t generally come to pass. People inflect their behaviour according to the threat they perceive; instinctively most of us pull in our horns when external risks rise.

In future it might be simpler to stratify risk levels (based, for example, on case counts and/or numbers in hospital), link each level to specific actions and public health restrictions, and thereby spare the public all the hand-wringing and caterwauling these announcements provoke.


For now the Government is telling us that in this worst-case scenario up to 500 people could require admission to intensive care by next month. This clearly would be unsustainable* given we only have about 300 ICU beds. Even half this number would be unsustainable.

Once again the rate at which the situation is changing is dizzying. Once again the problem is magnified by the imminence of Christmas. Once again it isn’t clear which is the bigger problem: the number of extra infections and serious illnesses, or the fact the Irish health service just can’t cope.

We know too little about what is driving the current pressure on the health service. Things are clear enough in relation to unvaccinated people in hospital, but what about the vaccinated? Do they have underlying conditions? Which vaccine were they given? How long ago?

We can only wonder why the rate at which cases translate into hospitalisations has hardly improved since vaccines were made available. Last year there were 30-50 hospital admissions per 1,000 cases; this year the ratio currently stands at 35 admissions per 1,000 cases, according to the National Public Health Emergency Team (Nphet).

The case for extra resources for the health service is often made. Compared to other countries we lack critical care beds, as a recent OECD report showed. We don’t just need extra capacity to get us over this winter, but into the longer term too. Only this week another report showed that some children’s ICUs have been working at 114 per cent capacity.

But how is the health service managing the resources it has? Why, for instance, had University Hospital Limerick 95 patients waiting for admission on Tuesday while other similarly-sized hospitals had no patients on trolleys?

If parts of the society are to be closed down again we have to know the Government has done all it can to fund and reform the health service, and the health service has done all it can to ensure parts of the system are not misfiring.

Self-isolation rule

The measures announced on Tuesday will take time to have an effect – weeks and even months in some cases. Exemptions will be needed from the new five-day self-isolation rule for close contacts or else the health and education sectors will collapse.

In international terms there is nothing particularly remarkable about the decision to bring closing time for pubs and nightclubs back to midnight, but it is a new departure for Ireland. However implicitly, the Government seems to have recognised for the first time the link between alcohol and the creation of risky environments for virus transmission.

The extension of the booster campaign was inevitable but its impact will be limited so long as urgency is lacking. Two weeks after boosters were approved for 60-somethings there is little sign of vaccination restarting in this age group.

*This article was amended on November 17th, 2021

Paul Cullen

Paul Cullen

Paul Cullen is Health Editor of The Irish Times