On Thursday morning, as the laws underpinning nearly two years of sweeping coronavirus restrictions were about to fall by the wayside, there were nearly 1,600 patients in hospitals across the country with Covid-19.
About half of those patients were admitted because of coronavirus and the other half for other reasons.
There was one figure piquing the interest of Government Ministers: how many of the 800 people who went into hospital specifically because of Covid-19 have been fully vaccinated and boosted?
The answer was 370.
In intensive care units this figure was even smaller, with about 10-15 people being admitted because of Covid-19 while also being fully vaccinated, according to updates given to Ministers.
It reinforced a view in Government that for the vast majority of people who chose to get fully vaccinated, reopening was safe, was done at the right time and was still the right decision.
“If you are in hospital and you have chosen not to get vaccinated, obviously we are concerned for you and we are providing hospital services to you. But we are not going to make national policy based on people deciding not to get a vaccine,” one Cabinet source said.
In a week in which the Government has come under pressure to revisit restrictions, this was one of the unsaid reasons for not doing so.
Frontline healthcare workers and unions have asked Government to focus on the bigger picture, however.
President of the Irish Association for Emergency Medicine Fergal Hickey said the situation in Irish hospitals is "the worst that many of my colleagues and I have seen in our careers".
The Irish Nurses and Midwives Organisation (INMO) called for a return to mask mandates as well as measures around working from home. This came hot on the heels of a request from the Emergency Department Taskforce (co-chaired by the HSE) to the Minister for Health Stephen Donnelly to reconsider public health advice.
Two somewhat contradictory developments unfolded at about 3pm on Thursday.
Responding to the emergency taskforce's plea, the Minister's office emailed the group to say he was "acutely aware of the pressure which the current demand for Covid care is putting on the healthcare system, patients, and frontline staff working in incredibly challenging conditions in hospitals throughout the country". The email, seen by The Irish Times, said the views of the taskforce had been shared with the chief medical officer Dr Tony Holohan, leading some on the group to incorrectly believe action might follow.
Moments later a Cabinet sub-committee on health meeting was told, behind closed doors, that Dr Holohan did not believe there was any need for a change in advice on masks. The meeting was also told admissions to hospital as a result of Covid-19 were relatively low. The handful of Cabinet members present were also informed the country was probably in the peak of the latest wave and admissions should start to fall soon.
The message is clear that the Government is done with restrictions, at least at the current level of threat.
‘It is completely different’
Infectious disease consultant Prof Sam McConkey says the current wave “does not present anything like the same imminent threat and danger to life and limb and society as the previous five waves back last year and the year before. We are not in a situation where we are running out of oxygen, it is completely different to two years ago or one year ago”. He said he would recommend that people wear masks in crowded spaces but “speaking as a citizen, rather than as a health expert, I feel you really need a strong public justification to bring in anything as restrictive as forcing people to wear masks”.
Other related tensions surfaced this week, which have been privately expressed by sources in the HSE, public health and within Government, and these centre around the lack of clear messaging from the Department of Health and the Minister.
One public health source said the lack of clear communication around what the public should do, and what the Government was doing, was confounding, while some Ministers were surprised not to see an update brought to Cabinet on Covid-19.
Donnelly is understood to have been battling both bronchitis and the flu, and appeared to be still recovering this week while those around him say he took little to no time off despite his illness.
There is no modelling for the period ahead and it is understood public health officials do not feel there is a need for it
Looking ahead, there is a “cautious optimism” taking hold in Government that the worst of this wave has passed and that the drumbeat for enhanced public health measures may recede.
Public health officials have been parsing the numbers and they see a reduction in positivity rates in PCR and antigen tests. Again, the underlying rate of severe illness especially for those who are vaccinated is considered to be low. There is no modelling for the period ahead and it is understood public health officials do not feel there is a need for it.
One Minister said they are "eagerly awaiting" advice from the National Immunisation Advisory Committee, expected next week, about the next phase of the vaccination campaign. This will be the next big part of the puzzle and will determine a lot about how the country gets through the next phase of coronavirus, whatever it may bring.
That advice should tell us whether there will be a summer campaign of boosters or just a winter one.
“If you have to vaccinate over four million people, there is a significant amount of operational work required to do that,” a source said.
The HSE and Department of Health are also working on an emergency plan in case a new and more dangerous variant arrives and the population needs to be offered a vaccine very quickly. The price tag for all of this materialised this week and while the Government is keeping a tight lid on the exact figure, it is understood to be substantial.
This, of course, is coming on top of increased demands on the public purse amid the cost-of-living crisis and the response to the war in Ukraine.
With the National Public Health Emergency Team (Nphet) disbanded, a new group is being put together which will seek to have a greater gender balance than its predecessor and will have different kinds of expertise. It will be a different beast, or at least that is what the Government is hoping. Donnelly and Dr Holohan have had “one or two professional conversations” about who should be on it, said a source in the department who played down rumours of disagreements about its make-up.
The plan is to have a body that has less centralised power and is less about issuing letters with instructions on restrictions, and more about research and monitoring.
It will keep tabs on the international situation, examine advances in science and technology and seek out EU opportunities on how to work with other countries. There will also be a huge amount of planning on vaccination and testing and tracing.
Prof McConkey says he is “hopefully confident” that after two or three more weeks of high levels of community transmission there will be a dramatic drop over four to six weeks. He adds a cautionary note.
“There will be more waves. It is inconceivable there won’t be something in the future. I am hoping it will again be even milder but it could be a more severe wave. But of course, we don’t know. We have to deal with that when it comes.”