The figures tell their own story, and a remarkable one: 12 times as many Covid-19 cases on Thursday as during the peak of the first wave last April, with 50 per cent more patients in hospital, and rising.
After months of showing Northern Ireland up in a bad light, the Republic now has the higher level of virus transmission on the island. From being best in Europe, we are now worst in terms of growth in cases.
At the end of June 2020 we had three cases per 100,000 people; today the incidence stands near the 1,000 mark.
Hospital Report
No part of the country has remained untouched. In Belmullet, Co Mayo, one of the most remote districts in the country, one out of every 50 people have had Covid-19 over the past fortnight.
ICU admissions were still lower on Thursday than in the spring, but may not be for much longer. Given the lag time between cases and serious illness, the expectation is that more than 200 patients will need intensive care next week, higher than at any time in the pandemic.
We are still experiencing fewer deaths – 11 a day on average compared to 32 in the spring – but that could change if the health service becomes overloaded and nursing homes are not protected.
Why is this happening?
It is hard to argue with Tánaiste Leo Varadkar’s contention that “you don’t go from 400 cases a day and a 5 per cent positivity rate to 7,000 cases and a 25 per cent positivity rate because of one thing. It takes a lot of things.”
He put it down to five factors: the opening up of hospitality in December; household visits and family gatherings; intercounty travel; the new variant of the virus; and non-compliance at funerals and in shebeens.
Perfect storm
So, did we all party across county lines?
Contact tracers report large numbers of entire families testing positive. The anecdotal evidence suggests a perfect storm of pre-Christmas socialising by younger people, who then took their newly-acquired infections home over the holiday, where older family members contracted the virus in large enough numbers to fill the hospitals.
Add to this the hard-partying, post-funeral pubbing minority and you had the ingredients for another explosion in cases.
But even allowing for the time of year – spent indoors in close quarters with others – and the excess traditionally seen at Christmas, it is hard to explain what has happened in the past week without recourse to the new variant theory.
First identified in the UK only last month, the B.1.1.7 variant is said to be at least 40 per cent more transmissible than others (this is a relative risk, not an absolute one). It is now clear that this strain was present in Ireland at least as far back as November, and that it is rapidly becoming a dominant force – accounting for up to 25 per cent of all samples sequenced in the first week of January.
We still have a lot to learn about this variant but it does seem to be driving current trends. This may let the Government off the hook to an extent for not following public health advice before Christmas, but it poses all of us a new challenge.
The new variant may force a reset of current strategies. Level 5 restrictions may no longer be adequate to drive down case numbers, so additional measures could be needed. Things should become clearer during January.
There are at least signs that the current spike has reached its peak, and that the figures should soon start trending downwards. But how far down? Having failed to reach the target floor at the end of the last lockdown in November, what chance is there of doing so with the new, more transmissible virus in circulation?
It takes almost a week to walk off Everest; coming down off our current stratospheric heights will take even longer.
The distribution of vaccines will affect the calculus in a positive way. Every week 40,000 of the most vulnerable and exposed will be immunised this month and next. That should start translating into fewer hospitalisations and deaths, but if allowed the virus will continue to rip through the rest of the population with uneven results.
Uncertainty
There remains much uncertainty over the supply of vaccines. Health officials on Friday briefed journalists on progress, but during the course of the morning the situation changed several times. The EU doubled its order for the Pfizer-BioNTech vaccine. The European Medicines Agency brought forward its consideration of the Oxford/AstraZeneca vaccine, which is already administered in the UK, to the end of January. With its routine storage requirements, this vaccine is urgently needed as the centre-piece of a mass vaccination campaign.
At this stage it is hard to see the broad mass of the population being immunised before mid-year. This leaves the Government with some difficult choices from the end of the month.
We learned from the first surge that once closed services are hard to open again. Schools stayed open successfully and largely safely through the October peak despite the incidence among teenagers rising to about 200 cases per 100,000 people.
Schools remain controlled and safe environments for young people, as Dr Tony Holohan made clear again this week, though not immune to the dangers posed by high transmission levels in broader society.
In the first week of January the incidence among under-5s, 5-12 year-olds and 13-18 year-olds was 203, 226 and 488 respectively.
The number of school outbreaks, as opposed to cases among children picked up elsewhere, has remained small.
Absent further increases, this suggests a relatively small peak to come down off before children can return to class, though it may make more sense to open primary schools ahead of second-level ones.
