Coronavirus in Ireland: What we know so far

Chief medical officer Dr Tony Holohan, his deputy   Dr Ronan Glynn (right) and chief clinical officer  Dr Colm Henry (second left) and Dr Cillian De Gascun (left) at a Covid-19 press conference at the Department of Health. Photograph: Colin Keegan, Collins Dublin

How is Ireland doing in the fight to slow the spread of Covid-19?

After more than two weeks of lockdown with wide ranging restrictions limiting commercial and social life, the battle rages on and there are no definitive signs that a peak has been reached. The country is at a “delicate and critical point” in its response to the coronavirus outbreak, according to Liz Canavan the assistant general secretary at the Department of the Taoiseach. Many people have fallen ill and too many have died and while there is some optimism that the Republic may not be hit as hard by Covid-19 as Italy, Spain and the UK, it is still too early to say what may happen in the weeks ahead.

What are the numbers?

On Tuesday, April 14th, 41 more people were reported to have died from coronavirus in the Republic taking the total number of fatalities to 406 while the number of known cases reached 11,479. Modelling data used by the National Public Health Emergency Team shows the daily growth rate has fallen from 33 per cent in the early stages of the outbreak to 9 per cent this week.

What is happening in Northern Ireland?

Ten more coronavirus-related deaths were announced in Northern Ireland on Tuesday, bringing the total number of fatalities to 134. On the same day a total of 1,967 cases had been identified in the North.

How is the Republic doing when it comes to testing?

Testing and contact tracing in real time – between 24 and 48 hours – is needed to fully contain the disease, experts have said. Minister for Health Simon Harris has said the mantra is to “test, test, test”. There have been widely reported shortages of testing kits and lab supplies and the waiting times for results, according to the Department of Health, was about seven to 10 days. But things have improved.

HSE chief executive Paul Reid said a backlog in testing had been reduced from a high point of about 35,000 people waiting for results to some 11,000. He told a briefing in Dublin on Tuesday that 25 laboratories were now being used to examine Covid-19 tests, including 20 in hospitals, the national lab in UCD, a Department of Agriculture facility and in Germany. Mr Reid said nearly 8,000 tests were completed on Saturday. “That backlog will continue to be reduced and will be reduced completely by the end of this week,” he said.

How does that compare with elsewhere in the world?

Mr Reid, has said that Ireland is a “top-tier” country although that claim has been disputed by some. Dr Sean L’Estrange, a social scientist in UCD, has conducted a comparative analysis of reported testing figures. “It is difficult to support the claim that Ireland’s testing practice for Covid-19 is in the top tier in the world,” he wrote this week. “Ireland is not doing badly and it is certainly not amongst the worst in the world by any stretch of the imagination. Yet compared with other similar-sized and resourced states in the European context, its performance is decidedly middling,” he wrote.

How important is the testing?

If you have symptoms, it may not matter all that much. If you become sick enough to be hospitalised, you will get a fast-track result but if not, you stay at home and self-isolate until the symptoms lift. The reason testing really matters is that it is a key part of relaxing restrictions. Building a system that can turn around results, and fast, is key, according to chief medical officer Dr Tony Holohan. “We need to have a contact-tracing capacity and testing capacity to give us real-time – in other words same-day or following-day – results,” he said.

Speaking of testing, will the Leaving and Junior Certificate exams go ahead?

Last week, Taoiseach Leo Varadkar said the State exams would go ahead “by hook or by crook” and so they will or at least one set will. It was confirmed on Friday that the Leaving Cert would take place in late July or August. The Junior Cert, meanwhile, is set to be replaced by school-based exams which will run early in the new school year.

The changes mean tens of thousands of students who are due to progress to third level and further education are likely to commence their courses much later than originally planned. Deadlines for students to complete practicals and project work in a number of subjects such as history, geography and home economics will also be extended until late July. Students had been given a deadline of May 15th to complete this work. While the move will bring much-needed clarity to students over contingency plans for the Leaving Cert, it is likely to be a major disappointment for many students who now face an extended summer preparing for the exams.

Movement is still seriously restricted, what powers do gardaí have to enforce this?

At the beginning of last week, Mr Harris signed regulations granting powers of enforcement to gardaí. The powers were passed by the Oireachtas in late March but became active only with the Minister’s signature. The regulations are based on the guidelines issued by the Government two weeks ago and anyone exercising more than 2km from their home or with people from outside their household will be in breach of the law. Anyone travelling beyond 2km for non-essential reasons will also be in breach. An offence will be committed only if a person refuses a direction from a garda to comply with the regulations. It is not the breaching of regulations that is illegal, but disobeying the garda’s instructions once caught.

Will there be many arrests?

Front-line gardaí have been instructed to use a four-step “graduated policing response” in the days ahead and should give members of the public “every opportunity” to comply with the regulations.

“Enforcement will be a last resort and only when all other avenues have been exhausted in most cases,” an internal Garda document says. Before resorting to arrest, gardaí must go through the four-step escalation process termed “Engage, Explain, Encourage, Enforce”. Engage involves asking people their name and address, reason for travel and if they are aware of the restrictions. Gardaí may arrest anyone who refuses to give their name and address. If required they then move on to the “explain” stage, which involves highlighting the risks of breaking the rules. They must then “encourage” those in breach to stay at home “to save lives”. The final step, “enforce”, involves using Garda powers to discourage further non-compliance. This should be done only when “necessary and proportionate”.

How was the bank holiday weekend?

There was a “very high level of compliance” with restrictions on non-essential travel over the bank holiday weekend, according to Ms Canavan. A major policing operation was put in place over the Easter bank holiday with checkpoints across the country to ensure people complied with public health guidelines, over fears people would travel to holiday homes due to the fine weather.

And were there many arrests?

Gardaí made seven arrests over the long weekend under the new legislation. An Garda Síochána said these arrests were made when people repeatedly refused to comply with directions to abide by the movement restrictions which prohibit unnecessary travel and exercise further than 2km from the home. In addition there were 144 incidents where gardaí enforcing the coronavirus restrictions instead made arrests under other, long-standing legislation. These incidents included arrests for public order breaches, assault, road traffic offences and drug offences. The arrests were made at house parties and street gatherings and where gardaí found people engaged in non-essential travel.

If I got Covid-19 can I get it again?

No one knows for certain what level of immunity those who have had and then recovered from the illness will have. “We simply don’t know yet what it takes to be effectively protected from this infection,” Dawn Bowdish, a professor of pathology and molecular medicine in Ontario told Scientific American this week.

What we do know is that immunity to other coronaviruses, including the common cold, can start declining within weeks of infection.

Within weeks? That doesn’t sound good?

No, but studies of Sars-CoV – the virus that causes Sars, which shares a lot of the same elements as Covid-19 – suggest that immunity peaks at around four months and offers protection for roughly two to three years. That would give time for a vaccine to be developed without those with the Covid-19 antibodies becoming reinfected.

Are more young people dying from the illness than expected?

The early narrative was that Covid-19 was an illness that largely spared young and healthy people but as it has spread across the world, it has shown itself to be more indiscriminate than many health experts initially thought. As it stands in Ireland more than 90 per cent of the victims have been over 65. While older people and those with pre-existing conditions are most at risk, it has occasionally hit young and apparently fit people including healthcare workers exposed to those with the virus. The youngest person to die so far was aged 30, the oldest was 105 years.

Why is that?

Sometimes previously undiagnosed conditions are later revealed and sometimes there are no such explanations.

What are the scientists saying?

There have been many theories circulating in medical and scientific circles. There is a school of thought which suggests that a huge dose may hit people much harder than smaller doses while another school of thought points to genetic susceptibility with some people more vulnerable to the virus than others, irrespective of their age. “It is very possible that some of us could have a particular genetic make-up that makes it more likely that we will respond badly to an infection with this coronavirus,” virologist Michael Skinner at Imperial College London told the Guardian newspaper this week.

“A person with a high viral load has more virus particles than one with a low load,” said virologist Alison Sinclair at Sussex university. “We do not yet know what impact viral load has on the symptoms of a person infected with Covid-19. Whether there is a link between a high viral load and worse outcomes is going to be important to find out.”

What has been happening in nursing homes in Ireland?

The number of coronavirus infection clusters in nursing homes around the country has reached 149, according to the latest detailed figures on coronavirus cases released by State officials. Nursing homes now account for one-third of the clusters of infection across the country. This is incredibly serious not only because of the vulnerability of those in such care settings. It has become clear that Covid-19 has virus loads which are three times what might be found with other respiratory viruses such as flu, including in older patients, who are more contagious than expected.

How significant is that?

It is very significant. “These are the highest viral loads for any virus I know,” Prof Marc Van Ranst at the Rega Institute for Medical Research in Leuven, Belgium, said this week. He said he was astonished at the number of the germs he saw from patient throat samples in his lab. Especially surprising, he said, was that elderly people harbour prodigious quantities of virus.

“Not many elderly [people] are going to transmit the influenza virus to someone else. They get infected, but are not infecting others,” said Prof Van Ranst – not so for Covid-19. “When I look at the viral loads that we find in elderly people, it is mind boggling,” he said. “That has been for me the big surprise with this virus.” This will influence how contagious elderly people can be and perhaps is reflected in the high number of Covid-19 clusters in nursing homes, he added.

What else have we learned in recent days?

The virus is also abundant in the throats of younger patients according to viral counts reported in the science journal Nature. Nine young to middle-aged office workers near Munich, Germany, who showed mild flu-like symptoms, had their nose and throat swabbed daily and spit samples collected for viral counts. “We detected Sars-CoV-2 in enormous amounts in the upper respiratory tract,” said Prof Clemens Wendtner, who led the research in Germany – 1,000 times more than for Sars. “This was shocking news.”

All nine patients showed a high rate of viral replication and shedding in their throat during their first week of infection. The virus does not need to travel to the lungs to replicate, and is abundant in the throat, making it easy to pass on. “It can be spread easily by sneezing or coughing,” said Prof Wendtner.

“The viral loads that people encounter when someone coughs in their general direction,” are so high, said Prof Van Ranst, that it makes transmission likely to happen. “Compared to other respiratory viruses, this is remarkable,” he added. It also meant it was easier for those with even mild symptoms to contaminate surfaces.

The Nature paper confirms that “for the milder form of the disease, it doesn’t go as far as the lungs, but stays in the throat”, said immunologist Prof Luke O’Neill of Trinity College Dublin. “It means it is very transmissible just by talking. You don’t need to cough,” he said. Also, people without symptoms, “are very infectious,” he added. “Sars never infected the throat. Went straight to the lungs. So that’s a big difference,” he explained.

Are men more likely to die than women?

The short answer is yes. With the worldwide death toll closing in on 130,000 it has become clear that men are much more likely to die from coronavirus than women. Charity Global Health 50/50, which campaigns for gender equality in health, has been tracking the breakdown internationally for deaths from the virus. In every country that publishes the data, significantly more men than women have died.

In Italy, which has the highest number of deaths from the disease, men account for 58 per cent of all hospitalised cases and 72 per cent of all deaths. In Spain, men account for 59 per cent of all hospital admissions, 72 per cent of intensive care unit admissions and 65 per cent of all deaths. In China, where the virus first started, 64 per cent of fatalities have been men.

In the Republic men account for less than half (45 per cent) of all confirmed cases, but 71 per cent of deaths.

Why is that?

Ireland’s deputy chief medical officer Dr Ronan Glynn said there were a number of hypotheses as to why this phenomenon was happening. “It is either biology or behaviour or a mixture of both,” he said. “In some countries significantly greater proportions of men smoke. The activity of smoking is often associated with touching your face.” Royal College of Surgeons in Ireland professor of medicine Sam McConkey believes the reasons may be more general.

“It’s just speculation, but I’m happy to speculate that men in general do not look after themselves,” he said. “We drink too much and we smoke too much and we do not go to the doctor. Women are much better at getting proper diagnosis and taking the proper tablets.”

How long will the restrictions be in place?

As it stands the restrictions on movement and social and commercial life in the country will remain in place until May 5th but even then we are only likely to see a partial lifting of the strict regime and that is contingent on the rate of infections continuing to fall.

What does “partial” mean?

Senior Government officials have begun to work on plans for a “phased” exit from the lockdown with the priorities expected to include the reopening of more retail businesses, construction and maybe schools – although that might only be for some classes and for a portion of the week only.

When the time comes for restrictions to be eased they will be lifted in “reverse order” with movement and retail looked at first.

Dr Cillian De Gascun, chairperson of the coronavirus expert advisory group, has warned against complacency about the dangers of Covid-19 because “given the opportunity this virus will run rampant” and he warned that “we are not going to return to a normal state of affairs” soon.

What else in being considered to bring the pandemic under control here?

Prof McConkey has said the Government was at a crossroads and was faced with two decisions on treating Covid-19. The first option would to continue efforts to flatten the curve over a period of six to nine months while the second choice is “more severe” and would see a “short, sharp response” to try to prevent the spread of the virus entirely in Ireland. This move would require a 32-county approach.

“It would be challenging. It would mean restricting travel and quarantining people coming into the country,” Prof McConkey said. “I feel it has to be a national decision, we would have to get Northern Ireland to go with us on this journey. It would have to be an all-island approach. It needs national discussion and involve all the parties in Northern Ireland.” This is the approach being adopted in countries such as South Korea and New Zealand.

Will the virus diminish as the summer approaches and temperatures climb?

That was a hope in the very early days of the crisis. While it is getting warmer, experts are no longer holding out much hope that better weather will kill off coronavirus. The flu virus goes into decline in warmer months, and is spread the same way as Covid-19, by way of small mucus droplets suspended in the air. When conditions are warmer, droplets are more likely to fall to the ground and not cause infection which is one reason flu is seasonal and dominant in winter. The other is because exposure to the cold during winter coincides with immune systems being stressed. “There is no indication that any of this applies to Covid-19,” Prof Kingston Mills from Trinity College told this publication’s Science Editor Kevin O’Sullivan. He said it may prove to be the case but caution had to be applied. He pointed out that Spain is “a damn sight warmer, and look at what it’s going through”.

Why are some people so infectious and what are superspreaders?

One of the questions scientists have been asking as the virus continues to spread is if some people are more infectious than others and the answer appears to be yes. There do seem to be superspreaders, a loosely defined term for people who infect a disproportionate number of others, whether as a consequence of genetics, social habits or simply being in the wrong place at the wrong time. There are also people who are infected but unlikely to spread the infection.

Two factors are at play, Martina Morris, emeritus professor of statistics and sociology at the University of Washington told the New York Times this week. “There has to be a link between people in order to transmit an infection,” she says. But, she adds, a link “is necessary but not sufficient”. The second factor is how infectious a person is. “We almost never have independent data on those two things.”

“If you are the first person in a crowded room to get infected, and if this is an easily spread disease, you will look like a superspreader,” she says. “Anyone in that room could have had the same impact. You were just the first in line.”

Dr Thomas Frieden, former director of the United States’ Centers for Disease Control and Prevention said superspreading events may involve people with symptoms that linger but who are not sick enough to stay at home. Or they could involve infected people who shed an unusual amount of virus.

People have been attacking 5G masts?

There was a suspected arson attack on two large telecommunications masts in Co Donegal over the bank holiday weekend. Conspiracy theorists have linked new 5G technology to the cause of the global pandemic. The Government here and governments across the EU have all stressed there is absolutely no link between 5G and Covid-19.

What is happening on the economic front?

The coronavirus pandemic has brought the global economy to its knees and is likely to result in the worst economic downturn since the Great Depression, the International Monetary Fund (IMF) has said. In its latest world economic outlook report, it said it expects the global economy to “contract sharply” by 3 per cent in 2020 with the euro zone, the epicentre of the pandemic for the past month, experiencing a much sharper 7.5 per cent contraction.

Its outlook for Ireland is slightly better though still grim. It expects the economy to contract by 6.8 per cent this year, less severe than the Central Bank projection for an 8 per cent contraction. The IMF expects the Irish economy to bounce back strongly next year, expanding by 6.3 per cent, against a euro-zone average of 4.7 per cent. However, unemployment could prove trickier to ease. The IMF says the jobless rate in Ireland will rise to an average of 12 per cent in 2020, up from a low of 4.8 per cent in February, and will stay elevated at almost 8 per cent in 2021.

What are the unemployment figures in Ireland?

There are 533,000 people registered for the €350 weekly Covid-19 unemployment benefit payment which was introduced in the wake of huge job losses. The take up of a temporary wage subsidy scheme for businesses was “continuing to grow,” and in total €199 million has been paid out under the scheme to date.

What is being done to aid European economies?

A €500 billion deal was reached between EU finance ministers last week. It has several elements. There is the employment guarantee scheme recently invented by the European Commission. If member states put up 25 per cent collateral, they can get a slice of loans raised by the commission on the market. This would be used to subsidise companies to keep employees on the books. The scheme would be worth a maximum of €100 billion.

There are also loans from the European Investment Bank to support companies: €25 billion of extra guarantees, so it can step up lending by €200 billion.

But the biggest chunk is from the EU’s bailout fund, the European Stability Mechanism, which was created to dig out states during the euro zone debt crisis. States can borrow up to 2 per cent of their GDP, with a total of €240 billion available. Usually, taking loans from the ESM comes with the requirement to balance the books – known as “reforms” by supporters, “austerity” by critics.

This time, borrowing will come without these strict conditions as long as the money is solely for responding to the pandemic and relates directly or indirectly to health spending.

What else is happening?

The European Commission says the new deal should be seen in the context of various other measures, particularly the decision by the European Central Bank to throw off prior restraints to print money, by buying government bonds to keep EU countries liquid. Finance ministers and the commission have also agreed to relax the usual budget rules to give states free rein to spend and support companies, and freed up existing unused funds from the EU budget to be used to respond to the crisis.

What is the Irish Government saying about the deal?

Minister for Finance Paschal Donohoe has said the Government may need limited access to the new European Union Covid-19 rescue package to help fund the wage subsidy scheme and support companies in difficulty.

Mr Donohoe has expressed confidence that the country “can create a new economy” and create new services to recover and move forward, but he cautioned, “we have a journey ahead of us”.

The new welfare supports will be monitored and may need to be strengthened to aid the recovery as at least 200,000 workers access the wage subsidy scheme. The Minister said it was possible that Ireland would need to access funds from the European Investment Bank to help fund companies and will consider whether to access the programme to help fund wage subsidy schemes. It is hoped that Ireland will not need to use the fund from the European Stability Mechanism, he added.

What are other people saying?

Alan Ahearne, the professor of economics at NUI Galway said the rescue package was a positive outcome, but warned that the figure needed was likely to increase. Prof Aherne said that as it stands Ireland will not need to borrow from the European Stability Mechanism’s new low-cost loan fund, as the European Central Bank keeps borrowing costs close to zero. He said he was “cautiously optimistic” the recovery would be “much, much quicker than a usual recession” given the welfare supports that have been put in place.

Is China over the crisis now?

No one thinks the crisis is over in any country in the world. However, the country where the first cases of the virus were recorded more than 100 days ago has made substantial progress in recent days. It reported zero new coronavirus deaths on one day last week for the first time since it started publishing daily figures in January. That is a milestone that offers grounds for some relief as the country works to stave off a second wave and struggles with ongoing outbreaks in Wuhan. The National Health Commission reported 32 new cases across China on Tuesday, all of them imported infections, bringing the number of cases involving overseas travellers to 983.

Are EU countries about to ease restrictions?

Some EU countries are easing some restrictions or at least they will in the days ahead. In Denmark, there is what has been described as a “cautious reopening”, starting with daycare and primary schools opening. The Danish prime minister Mette Frederiksen has described the process as “a bit like walking the tightrope”. In Austria, small shops, hardware and gardening stores have been allowed to reopen under certain conditions with all retailers likely to follow from May 1st. Spain and Italy have also started to partially lift restrictions.

The European Commission has urged all EU states to co-ordinate as they begin to ease lockdown measures, warning that failure to do so could result in new spikes of the epidemic.

In a set of recommendations to be adopted this week, the commission said: “It is time to develop a well co-ordinated EU exit strategy. The exit strategy should be co-ordinated between the member states, to avoid negative spillover effects.”

And when will it all end allowing normality to be restored?

No one can answer that question with any confidence but it is unlikely that all restrictions will be lifted for several months and the aftershocks, in terms of public health, economic life and social activities will be felt for a lot longer than that.

While Mr Harris has raised the prospect of easing some restrictions, he warned: “There isn’t going to be a magic point at the start of May where life as we knew it before the coronavirus can resume. I think, being truthful, social distancing is going to remain a very big part of life not just in Ireland but the world over until we get to a vaccine or effective treatment for the coronavirus.”

He said the key indicators to watch in the coming weeks would be the rate of growth of the virus, the average number of people in intensive care units and the reproductive rate of the virus, which measures how many people each infected person is likely to pass the virus on to.

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