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To properly assess the current stage of the pandemic, it is more useful to start with the most serious outcome, death, than with the number of cases.
In mid-September an average of one person a day died with Covid-19; now that number is two a day.
While it would be better if no deaths were recorded, the figure hardly jumps off the page.
Mortality is much lower than in spring because those infected now are on average much younger. Earlier intervention and better treatment are also making a difference.
An important caveat: mortality rates tend to lag a few weeks behind other indicators, so these numbers will rise as an inevitable consequence of more hospitalizations. But given that the number of cases has risen since August, it is encouraging that the death graph remains low.
Two-thirds of the people who die with the virus are 80 or older, and 95 percent have underlying conditions, according to the Central Bureau of Statistics.
Covid-19 is a brutal disease for some, and the most severe cases can end up in intensive care. In mid-September there were nine cases in the ICU; today, that number is 25. With numbers so relatively small, it is difficult to make reliable predictions, but it is inevitable that the trend will be up for the next few weeks.
Here, then, is the first pinch point. On Thursday night, according to the HSE, 244 intensive care beds were occupied, 27 of them with Covid-19 patients and 34 were left free. It is not difficult to see this supply running out quickly based on current trends.
But the health service is used to dealing with surges in demand each winter during flu season, and each hospital has a plan to expand capacity when this happens. HSE estimates that it can scale up to 350 ICU beds to meet increased demand, or about 100 more than are currently occupied. When asked this week, officials declined to specify how many weeks of ICU supplies are in the system based on current trends.
Seventeen ICU patients were on ventilators Thursday. With over 1000 fans available, the supply here does not seem to be a problem.
Demand for beds
The second sticking point looming is the supply of hospital beds. The patient hospitalization rate in September was a third of last March. But according to Professor Philip Nolan, an official of the National Public Health Emergency Team, hospitalizations of patients with Covid-19 are growing exponentially and, in a month, we could have up to 450 in the hospital.
The demand for hospital beds always begins to increase at this time of year as respiratory discomfort spreads. As of Thursday there were 254 free beds in the hospital system, so obviously this is a problem if current trends continue. One of the challenges is that Covid-19 patients need to be treated for much longer than, say, flu patients: Nphet said this week that the average length of stay for a Covid-19 patient is 20 days in the hospital and 14 days in the ICU.
The health service is likely to react by canceling elective work to make way for an increase in patients with viruses, something it does every year during the flu season. And since you have a hard time coping with flu winters, the same is likely to happen in the coming weeks.
The last indicator to consider, and the least informative, is the number of new cases each day. This is actually a count of the number of positive PCR tests, a figure that includes false positives and people who are not infectious at the time of testing (although they may have been in the recent past and could become this way in the days when follow).
Case numbers are a useful indicator of the level of virus transmission. We must pay particular attention to the levels among the elderly, among health workers, and cases transmitted within health facilities, but the daily announcement of new cases does not deserve its status as a national obsession.
Unsuccessful fixation
It is true that the numbers are increasing exponentially, but focusing on this seems to get in the way of tackling problems that are almost as old as the pandemic: dealing with the border; enforce the rules we have agreed to; provide more ICU beds; speed up testing; expand contact tracing; and provide a framework for travel based on testing and quarantine options.
As this week progressed, the pressure to re-impose a lockdown has increased. Prolonged school closings after the middle of the term appear to be at stake, despite the lack of scientific evidence and the fact that this is not foreseen at any level of the Government’s framework plan. However, we have yet to see a proper cost-benefit analysis of the impact of the lockdown on a struggling economy and non-Covid health.
Officials also did not make clear what the strategy would be after a shutdown. Did we keep blocking for months, or would the restrictions be lifted, possibly causing another surge? Surely this would have to be answered before the country was closed again.
Some scientists say we should try to eliminate the virus, although it is difficult to see how this could be achieved in a country so dependent on trade and travel as Ireland.
Other scientists advocate protecting the vulnerable while opening up society. But given the lack of firm evidence of herd immunity and the large numbers in the vulnerable category, this is too great a risk for many to take.
It may be that “getting by,” perhaps with a little less melodrama than was seen this week, is still our best option. There is value in keeping schools and businesses open, and high morale, that is not reflected in the epidemiologist’s chart, while risks are managed within the levels of the Government’s framework plan.
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