COVID-19 in Ireland

Well,

Here, this is what is actually going on in Ireland with COVID-19. This is the cliffnotes of what NPHET told the government about the situation of COVID in Ireland and what they should do. This is yours to read, understand or report for spam. Make of this as you will. [Source](https://www.gov.ie/en/collection/ba4aa0-letters-from-the-cmo-to-the-minister-for-health/).

Not fun facts: As per the CMO letter 2nd of December

* Case numbers have been pretty much in balance for community transmission with slight growth
* Highest cases are in 5-12. NPHET attributes this to adult carriers, community transmission and the fact that they are not vaccinated. 45 outbreaks in week 47.
* 7% of cases in over 65s.
* Boosters showing very positive protective effects on tranmission and severity in 70+.
* Ran 220k tests last week. The lads running them are exhausted and under pressure.
* From 31k antigen tests to close contacts, 21.5k were negative and 10k were positive. Of the 10k positive antigen tests, 56% were true positives.
* Hospital numbers are declining per case (Will continue with boosters).
* Sectors with highest 14 incidence: ‘Accommodation and Food Service Activities’, ‘Administrative and Support Service Activities’, ‘Construction’ and ‘Public Administration & Defence’.

Cases across all age groups appear to be stable or decreasing except for 5-11 year olds. 9-11 year olds particularly high. Roughly 10% of <12 yr olds tested every day followed by 35-44.

**ECDC (European Centre for Disease Control) – The big bitch in the sky**

*This was pre omicron*:ECDC stated that the burden of *delta* over December/January will be very high unless non-pharmaceutical interventions (NPIs) are applied + more vaccination.

Given the increase in inter-generational mixing and overall socializing, **the ECDC advises that NPIs should be implemented or reinforced now to reduce contacts and mixing during the festive season. It further states that the timely implementation of NPIs is critical for their success** and countries should anticipate that NPIs may need to be *retained for a prolonged period of time after the festive/holiday* period to effectively control virus circulation. (Bigger problem for less vaccinated countries).

On Omicron: The ECDC states that NPIs should continue to be implemented by countries based on an assessment of their epidemiological situation regarding the Delta variant and considering the uncertainty of the situation regarding the Omicron variant. Genomic surveillance, vaccinations, and boosters remain vitally important and enhanced contact tracing measures could help slow down the establishment of the variant. *Temporary travel-related measures should be carefully considered and should be regularly reviewed as new evidence emerges.*

**Health system preparedness**

About as you expect lads.

While there may be early signs that case numbers are beginning to plateau, they are doing so at a high level, which will lead to sustained pressure being seen across the health service. There are 141 vacant beds BUT they’re not evenly distributed. 16 sites have <5 available.

13 ICU beds available. None of which are in Dublin.

As of 1st December, 276 patients were receiving advanced respiratory support outside of critical care units, which places additional demands on staff on wards and also reduces the amount of staff available for redeployment to support critical care. Of these 276, 143 were COVID patients, with 133 non-COVID patients receiving care. The potential for the numbers of COVID patients requiring this level of care in a ward setting to increase and for the number of non-COVID patients to remain at a similar level for the foreseeable future is of deep concern.

While the SafetyNet arrangement with the private hospitals remains in place and is being used, the ongoing detrimental impact of the pandemic on the delivery of non-COVID care cannot be overstated.

*(yes this is the cliffnotes, the damn letter was 15 pages long!)*

**Summary of if we’re fucked or not**

Most indicators are going good but xmas means more than usual socializing. More socializing, more cases. Remember last year? The problem is this time we’re at an already high level of infection and hospital capacity to be going into this expected increase. Of note, the numbers in ICU are five times higher than at the end of November 2020. Also, Omicron maybe bad. Oh and the flu season hasn’t happened *yet*. That wouldn’t be ideal.

Each of these factors on their own provide a very real but as yet unquantifiable risk to our management of COVID-19 over the coming weeks. Taken together and set in the context of an already significant burden of disease and force of infection, they have the capacity to present serious challenges in the weeks ahead. Unfortunately, it is impossible to quantify the level of risk, either in terms of likelihood or scale of impact. This will only become known in time, when it may be too late to take mitigating measures.

**The NPHET Advice**

Since the next few weeks look dodge af: (Insert restrictions here, you have seen them, the government did all of them).

But “The NPHET advises that these measures should be implemented as soon as possible and should remain in place until **at least** the 9th January 2022.”

The NPHET believes that these are a targeted set of measures focused on those activities and settings that are likely to have the biggest impact over the coming weeks, while maintaining as much economic and societal activity as possible. In making these recommendations, the NPHET once again emphasises that our approach to the management of COVID-19 must continue to be underpinned by our core national priorities of protecting the most vulnerable to the severe impacts of COVID-19, minimising the burden on the healthcare system and continuing to keep schools and childcare facilities open.

**Models**

Assumptions:

“This includes the assumption, validated in prior model runs, that children under 12 years of age contribute less to overall transmission (50% less) of the virus than adults. The delta variant is assumed to have a transmission advantage of 1.97 over ancestral (wild-type) SARS-CoV-2, that is, delta is almost twice as transmissible.”

That vaccines work highly to prevent symptomatic infection but is reduced 37% by Delta. No change for severe outcomes. Peak immunity declines exponentially to 40-60% of peak effect with a half-time of 90 days; vaccine effectiveness against severe disease declines to 80-90% of peak with a similar time course. Booster vaccination rapidly restores effectiveness.

Expected further doses: The data on uptake of primary vaccination, and additional doses administered to date, are taken from the HSE CoVax system. It is assumed that booster vaccination of those aged 60 and older will be substantially complete by end-December 2021, those aged 50-59 years by 10 January 2022, with the remaining cohorts complete in February and March. The uptake of booster vaccination ranges from 50% in those aged 16 years to 90% in those aged over 85 years. Vaccination of children aged 5-11 years is assumed to effectively begin from 10 January 2022 with uptake of 60% achieved over three months.

Main model lines:

* effective social contact remains at the level estimated for the week ending 28 November 2021;
* effective social contact decreases by 10% from 29 November 2021 and is maintained at that low level;
* effective social contact increases by 10% in early December, and further increases, for late December and early January 2021, to the levels seen at Christmas 2020; and,
* effective social contact increases by 10% in early December, and further increases, for late December and early January 2021, to 20% above the levels seen at Christmas 2020

*effective social contact is an estimate not only of the level of close social contact, but also the risk of transmission associated with those contacts, including the non-pharmaceutical interventions (NPI) taken to reduce transmission, and the changing risk of social contact in the winter compared to the summer.*

Model when Delta is enemy #1 and Omicron is not a worry: https://imgur.com/a/aaVdXLr

Model when Omicron has 30% vaccine escape but it 5% more transmissible: https://imgur.com/a/femvL87

Model when Omicron has 30% vaccine escape but it 40% more transmissible: https://imgur.com/a/Anb2C30

Models of how this effects [general hospital care](https://imgur.com/a/JglXH4r) and [critical care](https://imgur.com/a/NMxh4Xa).

Editted for accuracy