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Official Covid case numbers 'just the tip of the iceberg' as subvariants lead to summer surge

Last week there was a more than 50% jump in reported case numbers.

Experts have said the use of high-protection facemasks on public transport and in crowded spaces - both indoors and outdoors - would have an impact but a mandatory policy has been ruled out by government.
Experts have said the use of high-protection facemasks on public transport and in crowded spaces - both indoors and outdoors - would have an impact but a mandatory policy has been ruled out by government.
Image: Leah Farrell/RollingNews.ie

AS SUBVARIANTS OF the Omicron strain of Covid-19 cause a rise in official case numbers, experts have said the true picture may be significantly worse. 

According to the latest Health Protection Surveillance Centre (HSPC) report, the Omicron BA.4 and BA.5 subvariants are replacing the previously dominant BA.2 variant, which spread across Ireland in late 2021.

Between 12 and 18 June some 10,435 cases were reported, the HPSC said. This is an increase of 52.6% compared to  the previous week when there were 6,837 confirmed Covid-19 cases notified.

The positivity rate for Covid-19 tests has also risen compared to the previous week, with 29.6% of PCR tests returning positive compared to 24.5%.

There were also 13,059 positive antigen tests reported through the HSE’s antigen test portal, compared to 8,808 cases the previous week.

Speaking to The Journal, Dr Kim Roberts, virology lecturer at Trinity College Dublin, said this data, while it provides an indication of higher levels of transmission, is potentially missing a significant proportion of actual cases due to current PCR test eligibility.

“I think we do need to be aware that, because of the policy change around testing, we’re only being given a snapshot of the numbers, we’re not getting a full picture of how much transmission there is in the community,” she said.

“We have to err on the side of caution and realise that there is a lot of transmission taking place in the community, the official figures are just the tip of the iceberg and we have no idea how big that iceberg is.

“What that means is that we really don’t know how big a wave could be. Hopefully the impact on hospital cases will be reduced by the vaccine but in terms of disruption to work and education, that’s not clear.”

Currently PCR tests are only available to those who have symptoms and:

  • are age 55 or older and have not had a Covid-19 vaccine booster dose
  • have a high-risk medical condition
  • have a weak immune system (immunocompromised)
  • live in the same household as a person who has a weak immune system or provide support or care for them
  • are pregnant
  • are a healthcare worker

Those who have a positive antigen test and need a Covid-19 Recovery Cert can also book a PCR test. Antigen tests results can be registered with the HSE but this is a voluntary system.

Dr Roberts said the country is in a better position than it was last summer because a significant proportion of the population has had multiple doses of a vaccine. However she expressed concern that many people who are eligible for another booster jab have not taken it up.

“It is worth it, for those who are eligible, to get the booster as soon as possible because there is a lot of virus around,” she said.

Dr Roberts said it is more difficult now to make predictions about Covid trends as the level of data available is not the same as it was in earlier stages of the pandemic.

“We don’t know what’s driving this current potential next wave. What’s interesting is that the age group testing positive is 25-45 and that suggests transmission is happening in workplaces and possibly socialising,” she said.

We’re not seeing whether there’s been transmission in schools because of the testing criteria so when schools close we don’t know whether that will have an impact and slow transmission.

“It’s difficult to see, if it’s in workplaces and socialising, what’s needed to bring it down. We’re in a different phase of the pandemic now so there’s a change in what the HSE and government are wanting in terms of Covid transmission.”

Pressure on hospitals and primary care

Despite vaccination levels across the country, hospitals have been under pressure recently and some have been discouraging patients from attending their Emergency Departments where possible.

Over the last two weeks the number of people with Covid-19 in hospital has more than doubled. While as many as half of Covid patients in hospitals may not have been admitted due to their Covid symptoms, health officials have pointed out that the same infection prevention controls are required and this puts pressure on hospital resources. 

Yesterday there were 697 patients with Covid-19 in hospital – up from 360 just two weeks ago – and 21 of those were in intensive care units. 

In the community GPs have also felt the surge, Dr Denis McCauley, Chair of the Irish Medical Organisation’s GP Committee told The Journal.

“We are still deeply involved for two reasons; we’re seeing all the people with Covid and there is a certain level of immunisation we’re doing as well. We have interaction with the HSE on this weekly, in fact there was a meeting this morning,” he said.

What we have at the moment are subvariants that are very infections and more face-to-face contact between people as they getting back to living again. It’s a very transmissible virus, people are taking fewer precautions and previous infection doesn’t protect you.

He said anxiety about catching the virus has eased across all age groups and while this is understandable, it has contributed to a reluctance among older age groups to get another booster. 

Health officials have said that more than half of Covid patients in hospital have not received their booster and over a third never received a vaccine at all. 

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“If they get their vaccine between now and the end of July then it’ll be perfect timing to get a further protective vaccine with the flu vaccine in October and that is the most important one,” Dr McCauley said. 

He said aside from hospitalisations, GPs are still hearing from patients in the community who are “knocked flat” by the virus as well as those with long Covid symptoms for weeks after their initial infection. 

The reintroduction of a mandatory mask-wearing policy may not have much success, he said, as compliance would likely be an issue and the use of FFP2 masks would be required to make any significant difference.

“A recommendation would be better than something mandatory, but I don’t see that happening either at this moment,” he said.

Protection

Dr Roberts said even without enforced restrictions people can take steps to protect themselves including wearing masks – which is still official advice for public transport and in crowded spaces – ensuring indoor spaces are well ventilated or choosing to socialise outdoors and washing their hands.

“When it comes to wearing masks, it’s important people wear the best mask they can get a hold of,” she said.

“The surgical masks and simple cloth masks don’t really give much protection if you’re breathing in the virus so you’re looking for the FFP2 masks or N95 masks and they should be well fitted, snug to the face around your nose and mouth to give you the best protection.

“It’s worth remembering that the virus has evolved and changed over the last two and a half years. It is better at transmitting from person to person than it was at the start of the pandemic, that means it’s harder to reduce transmission and we have to work harder using as many different transmission-reducing strategies as possible.”

She said it is also important for people to tell those they have been in contact with if they have symptoms and test positive on an antigen test so that they know they were exposed.

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