Ireland and Covid-19: More than 1000 cases every day but normality looms

New modelling suggests New Zealand could still see a huge number of deaths from Covid-19, even if around 75 per cent of the population is fully vaccinated. But there’s another country, of a similar size, where that milestone is already within reach and control measures are largely gone. What’s happening there? Keith Lynch explains.

On September 21, Ireland recorded 1420 cases of Covid-19. Some 60 people were in ICU and another 270 in hospital. Yet next month, this particular country of 5 million will essentially do away with Covid-19 public health restrictions.

More than 70 per cent of the country’s population is fully vaccinated. Crucially, more than 90 per cent of people over 16 are fully vaccinated. The country is now vaccinating 12 to-15 year-olds.

The pandemic has not been easy for Ireland. There have been more than 370,000 cases and more than 5000 deaths. One of the scenarios outlined in modelling prepared for the government here, and published on Thursday, suggested New Zealand could see more than 1 million infected and 7000 deaths in a single year, even if 80 per cent of the population over five were vaccinated. We’ll get back to that.

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Early 2021 was particularly brutal for Ireland. On January 4, Bloomberg published a story titled ‘Why Ireland Has the World’s Worst Outbreak’. The first line asks: ‘Where did it all go wrong?’

At the start of the year, Ireland was seeing more than 6000 Covid cases daily. The fatalities were growing, dozens dying every day.

Weeks earlier, the government had decided to relax restrictions, allowing bars and restaurants to reopen. The Irish people were exhausted by ongoing restrictions and Christmas was coming. This did not end well, unfortunately coinciding with the arrival of the more infectious UK/Alpha variant.

As Covid cases began to rise, the country went into what it called Level 5 – a strict lockdown but not as tough as New Zealand’s Alert Level 4. It would last for months. In March, there were still hundreds of cases daily.

On July 1, the government announced a fourth wave was beginning. This one was down to the Delta variant. Around that time, about 54 per cent of the country had received one shot; 36 per cent was fully vaccinated.

Case numbers began to rise. But – and this may seem amazing to New Zealanders – on July 26, bars and restaurants opened again (only to people who were fully vaccinated or who had Covid-19 in the previous six months). There were 1200 cases that day. About 50 per cent of the population was fully vaccinated.

On August 12, The Financial Times ran a piece headlined: Ireland’s journey from pandemic hotspot to vaccine poster child.

Despite the arrival of Delta, Ireland has continued to ease public health restrictions to allow a return to relative normality. For example, on September 6, cinemas and theatres were allowed to increase their capacity to 60 per cent if all members of the audience were fully vaccinated or had recovered from the virus. The current restrictions are roughly comparable to Level 2.

But it’s worth keeping in mind that this is a phased approach and the Irish government has signalled things could yet change.

Masks will also remain a permanent fixture on, for example, public transport. People are expected to self-isolate if they are sick.

On September 13, Chief Clinical Officer Dr Colm Henry, of Ireland’s Health Service Executive (the public body that oversees health) told the national broadcaster, RTE: “What we are doing now is imagining what the transition from a pandemic stage to an endemic stage where this disease is no longer considered exceptional but part of a profile of other seasonal viruses.”

Another European nation, Denmark, is also pretty much fully open. About 75 per cent of its population is fully vaccinated. Covid-19 is no longer deemed “socially critical”.

Imagine Director-General of Health Dr Ashley Bloomfield telling New Zealanders at 1pm that Covid-19 will become background noise – just another disease people could come into contact with.

A look at the Irish numbers

To gauge where Ireland is at the moment, let’s look at three key reports from Ireland’s Health Protection Surveillance Centre, which publishes a plethora of data on the pandemic.

The first offers up a 14-day summary of Covid cases from September 3 to September 16. It showed:

  • There were 18,797 cases of Covid-19 detected. That’s almost 400 cases for every 100,000 people – this rate is falling.
  • 302 people were admitted to hospital (1.61 per cent) and 31 admitted to ICU (0.16 per cent).
  • The median age of the cases was 25.

You can see a breakdown of the ages of those cases below.

The profile of the cases is not surprising as the vaccine uptake is lower in the younger age groups and young people are typically more mobile.

Yet despite those case numbers, the majority of hospitalisations are in the older age groups, as you see below.

The second report looks at what happened between September 5 and September 11, what Irish authorities call Week 36.

Below, you can see the total number of cases for the entirety of the pandemic, versus the total number of cases in Week 36. (Week 10 is when it started).

One week is a small sample size, but it’s worth noting the huge drop off in percentage of people hospitalised.

Ireland had some 300 operational ICU beds (for adults), according to a report on September 22. About 270 were occupied (including 61 Covid patients). There’s also 31 ICU beds for children. On September 22, 26 were occupied (none with Covid-19 patients).

New Zealand’s ICU numbers are comparable.

This report also offers a summary of all deaths since the pandemic began in Ireland. It illustrates, as Prime Minister Jacinda Ardern has emphasised, the increased risk to older people.

New Zealand faces a slightly different dynamic as our Māori vaccination rates are relatively low. A number of studies have suggested somewhat younger Māori face a significant risk from Covid.

The other thing to note in the Irish data is underlying health conditions – 87 per cent of those who died suffered from one or more. Some try to minimise the risk of Covid-19 by suggesting it only affects those with underlying conditions. A 2020 Lancet report found 22 per cent of people around the world had at least one underlying condition that would increase their Covid-19 risk. That’s not an insignificant group of people. Māori and Pasifika people, for example, are more likely to have diabetes and asthma.

A couple walk their children along a normally bustling parade route in Dublin following the cancellation of the Saint Patrick’s Day parade and celebrations in March 2020.

The final report I’ve looked at is weekly deaths for the week from September 8 to September 14.

Over the course of that week, 11 people died. Their median age was 81. It’s worth keeping in mind here, despite the incredibly high vaccination rates in Ireland, no vaccine is perfect. Cases and deaths are inevitable. Ireland defines Covid-19 deaths as those in all possible, probable and confirmed Covid-19 cases, unless there is a clear alternative. Their approach is similar to the majority of European countries.

This particular report also offers more detail on the ages of all those who died in Ireland. You can see those numbers below. Now, it’s important to note that Covid isn’t just about death. The disease can severely impact people but not kill them, and its presence puts an extra load on the health system. Remember there are 60 Covid patients in Irish ICU beds now. The mortality rate, however, in those aged 85+ is staggering.

What about vaccinations?

In early September The Irish Times reported about half of all Covid-19 patients in hospitals and ICUs were fully vaccinated.

This may appear counterintuitive at first glance. Indeed, this type of stat is typically used to sow misinformation about the vaccines. Remember the day before that story was published, September 9, 71 per cent of the entire population had been vaccinated. This included nearly all older people. There are simply so many people vaccinated so there will, of course, be hospitalisations in that group.

It really is a numbers game. Think of it this way. If Ireland were to vaccinate 100 per cent of its population, every new case or every new death would be in vaccinated people.

They key thing, as The Irish Times said is that “in January up to 50 people ended up in hospital for every 1000 Covid-19 cases, now fewer than 20 hospitalisations occur for the same number of cases”.

Also, when you look at the Irish data from April 1 to September 11, it shows 251 people died of Covid-19.

Of those, 60 per cent were unvaccinated. About a quarter (61) had received two doses and are described by Irish health authorities as being “breakthrough infections”. The median age of these people was 82 years old. More than 70 per cent had an underlying medical condition.

But our models say different?

As you may have read, a number of models were released on Thursday outlining what could happen in New Zealand at different vaccination rates.

Michael Plank, a professor at the school of mathematics and statistics at the University of Canterbury, was one of the authors. He says the Irish situation is, very broadly, comparable to what we would expect to see in New Zealand.

Plank suggests extrapolating Ireland’s daily tally of 0.69 deaths per million people on September 21 to land on an overall death rate from Covid of about 3.45 each day. Multiply that by 365 and the number of deaths is sobering: 1250 in a year.

I asked Plank why then the modelling released on Thursday suggested 7000 people could die in New Zealand with a vaccination rate comparable to Ireland.

He said: “It could be that Ireland would see well over 1000 deaths if they opened up completely. And they may yet be forced to tighten restrictions over the winter months to prevent this happening. On the other hand, if control measures or vaccines are more effective than we assumed, things could look better than projected.”

He pointed out that in the scenario that outlined 7000 deaths in New Zealand, there’s an assumption around how the vaccine performs. If you tweak that model to assume the vaccine performs better, the number of deaths shifts to 1300.

The final point: Ireland’s vaccination rate is excellent, but there’s still room for improvement. Portugal, for example, has vaccinated 83 per cent of its entire population.