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What does this week's Covid-19 data tell us about Ireland's third wave?

Despite a continued decline in incidence in recent weeks there are fears that decline has slowed.

Screenshot 2021-02-04 at 20.19.44 - Display 2 Source: Department of Health

THERE ARE CURRENTLY between 15,000 and 25,000 active Covid-19 infections across Ireland. 

Case figures reported each day offer an insight into our progress but Public Health officials remain focused on trends over multiple days and weeks. 

A total of 2,955 new cases were confirmed across Monday, Tuesday and Wednesday – compared to more than 3,635 new cases reported over the same period last week and 6,500 cases in the preceding week. 

NPHET confirmed a further 1,318 new cases last night.

Ireland’s national incidence rate is 397.1 cases per 100,000 of the population on a 14-day rolling average, according to data from the Health Protection Surveillance Centre – compared to 621.9 on this day last week and 1,140.7 the week previous.

The country reduced its 14-day average by more than 80% between 14 and 28 January. It has reduced by a further 40% since last week. 

Ireland’s reproductive number (Re) was estimated at between 0.4 and 0.7 last week having stood at between 0.5 and 0.8 the previous week. 

It has since risen again to between 0.5 and 0.8, according to chair of NPHET’s Irish Epidemiological Modelling Advisory Group Professor Philip Nolan.

There is the basic reproduction number (R0), which is the number of people who will be infected if no other factors are taken into account. Then there is the effective reproductive number (Re) - the number of people who will be infected if you take into account other factors, such as immunity through previous infection or vaccination or behaviour which has been altered by social distancing measures.

It is estimated that SARS-CoV-2 has an R0 of between 2 and 3.

To recap, NPHET’s modelling two weeks ago projected between 1,400 – 1,700 cases per day by 31 January if the R Number was maintained at between 0.5 and 0.8. 

Ireland trended slightly below that model at 1,300 cases per day – a positive outcome. 

In that case, why does it appear that cases have stalled or even increased?

Firstly, Public Health officials have noted a steep reduction in the number of people coming forward for testing at weekends compared to weekdays. This has a knock-on effect mid-week in case numbers as more people are tested on Mondays. 

Deputy Chief Medical Officer Dr Ronan Glynn also noted last night that people are waiting two or three days before coming forward for testing and encouraged anyone who is symptomatic to get tested immediately. 

Secondly, the HSE resumed testing of asymptomatic close contacts last Friday. Professor Nolan said this, too, will have an effect over the coming days on case numbers. 

Looking at 14-day incidence rates in individual counties, Monaghan has the highest incidence of Covid-19 in Ireland at 876.4 cases per 100,000 – a further 40% reduction since last week. 

Waterford is the second-highest county in Ireland with a 14-day incidence rate of 612.9. Louth is third-highest with a 14-day incidence rate of 609.9. 

Looking at Local Electoral Area data, Carrickmacross, Co Monaghan has the highest individual incidence of Covid-19 at 1096.2 cases per 100,000.

Enniscorthy in Co Wexford has the second-highest incidence of Covid-19 at 1,086.3 cases per 100,000. 

For a breakdown of Covid-19 incidence rates in LEAs around Ireland, see here

Counties with the current lowest incidence rates include Roscommon (167.3), Kerry (188.2) and Leitrim (190.4). 

‘Outbreaks’

Six weeks into Level 5 restrictions, Public Health officials and members of NPHET are confident that people are complying. 

It will be key to track over the coming weeks where Covid-19 cases arise. 

Outbreaks in nursing homes, healthcare settings and hospitals are difficult to contain and take longer to close down.

These infections will continue to contribute significantly to case numbers over the coming weeks considering the impact Ireland’s Third Wave has had in these settings. 

Chief Medical Officer Dr Tony Holohan said in a letter to Health Minister Stephen Donnelly last week that the number of healthcare-setting-acquired infections remains “very high”. 

Of most concern looking to late February and early March are levels of Community Transmission – where the source of infection is unknown – and outbreaks in non-healthcare settings.

Outbreak data from the Health Protection Surveillance Centre shows there were 29 new outbreaks linked to workplaces between 22 and 30 January with a total of 125 linked cases. 

There were 15 new outbreaks in childcare settings and 11 new outbreaks in food-processing facilities accounting for 110 cases. 

The total number of outbreaks since the start of the pandemic is 11,727. Of these, 6,678 remain “open” according to the HPSC’s recent data.

For an outbreak to be considered “closed”, there must be 28 days from the last case diagnosed or becoming symptomatic.

Screenshot 2021-02-04 at 15.48.57 - Display 2 (1) Source: HPSC

This week, the Department of Public Health Mid-West said it had identified “a growing number of social gatherings that have led to new infections and outbreaks in recent weeks” which included non-essential household visits and large social gatherings.

Dr Marie Casey, Specialist in Public Health Medicine, said colleagues are starting to see initial evidence of student clusters again, and urged all students to act responsibly and adhere to Public Health guidelines.

“We know that it is a very trying time for students with the current restrictions in place. We acknowledge the numerous sacrifices they have made over the past 11 months, and we understand the urge to visit friends and classmates in the current circumstances,” she said. 

“However – whether you are a student or not – household visits or gatherings should not be taking place at this time,” said Casey.

“I have seen on numerous occasions how an innocent social visit to a household has led to serious outbreaks, and with the current high levels of Community Transmission, this can happen again if we are not vigilant.”

Hospital & ICU

There have been 92 hospital admissions in the last 24 hours and 82 discharges. 

There are – as of this morning – 1,308 confirmed Covid-19 cases in hospital and 188 people in Intensive Care Units.

There were 1,620 confirmed Covid-19 cases in hospital and 216 people in Intensive Care Units last Friday. 

Screenshot 2021-02-04 at 15.50.51 - Display 2 Source: Department of Health

HSE CEO Paul Reid said today that current levels of Community Transmission continue to pose a “huge risk” to Ireland’s healthcare system. 

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HSE Chief Operations Officer Anne O’Connor said a reduction in hospitalised cases since last week does not mean patients have left hospital. 

It means they have been de-notified as Covid-19 cases but many still require hospital care once they are no longer Covid-positive, she said. 

Testing & Tracing 

Testing in January had been curtailed by demand. Close contacts of confirmed cases stopped being tested as the HSE prioritises people with symptoms.

However, the HSE confirmed that from last Friday, testing of asymptomatic close contacts had resumed. 

Testing had ramped up to almost 25,000 per day in early January. It slightly reduced to an average of 23,000 per day by 14 January and reduced further to an average of 22,000 tests per day between 14 and 28 January. 

On 7 January, approximately 174,000 tests had been carried out over the previous seven days. The positivity rate then was 22.7%. 

Approximately 167,000 tests were carried out between then and 14 January. The positivity rate reduced further to 17.9%.

On 21 January, approximately 154,000 tests had been carried out over the previous seven days. The positivity rate stood at 11.8%. 

Approximately 142,000 tests were carried out between then and last Thursday. The positivity rate had reduced further to 8.1%. 

Approximately 131,000 tests have been carried out in the past seven days as of Thursday. The positivity rate is currently 6.4%. 

Vaccinations 

Finally, 219,200 vaccinations have been administered in Ireland. That is a further 57,700 doses administered since last week

Of the 219,200 vaccines administered so far, 86,200 have been in long-term residential care settings – all of which have been first doses – with 133,000 administered to frontline healthcare workers. 

Of those, 78,000 have been given a first dose with 55,000 frontline healthcare workers now fully vaccinated. 

The HSE said yesterday that a further 29,000 vaccines will be administered in 78 long-term residential care settings, to frontline healthcare workers and to GPs next week. 

Healthcare workers with direct patient contact as well as residents at long-term residential care facilities over the age of 65 have been first to receive the vaccine. 

Both vaccines currently being used in the roll-out – the Pfizer vaccine and the Moderna vaccine – are mRNA vaccines that require a two-dose schedule.

HSE CEO Reid said today that the HSE has “always been clear that the Covid-19 vaccine rollout will have many twists and turns” in the first quarter of this year.

His remarks followed a recommendation by the National Immunisation Advisory Committee (NIAC) on Wednesday that people aged 70 and over should only receive mRNA vaccines – from Pfizer/BioNTech or Moderna – where possible.

“So far we’ve met all challenges in a safe, effective, secure and timely manner. Our plan is to meet the latest changing requirements in the same way. Bear with us for now,” Reid said. 

Reid said the HSE was now working through operational changes to re-adjust the country’s vaccine plan, and would present details on this to the government’s vaccine TaskForce shortly.

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