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Mathematical experts tracing Covid-19 in Ireland are convinced that thousands of lives have been saved and an enormous number of illnesses prevented during the eight weeks of confinement.
But for many on May 18, when some of those restrictions are eased, it may not come fast enough. There are five tests to consider before the government proceeds to ease social restrictions next Monday.
The first concerns the Progress of the illness
Fortunately, all the signs are good, as you can clearly see from this graph that shows the number of new confirmed Covid-19 cases per day.
We reached a daily peak of 1,068 confirmed cases per day in mid-April. But on Wednesday of this week we dropped to 159 and that overall downward trend looks solid.
Confidence in this downward trend in new cases is based on progress in the so-called virus reproduction rate or R number. That is a measure of the average number of people that an infected person in Ireland will infect.
It fell from 3.7 in early March, to 1.6 in the middle of the month, and then again to 0.5 in late March. Most importantly, however, the breeding rate has remained stable at 0.5 in Ireland since then.
Effectively, this means that if ten people hired Covid-19 in Ireland today, they would infect only five more people among them. Those five newly infected people would infect only two and a half people, and so on.
If everything else were the same, the virus would be heading for extinction. Ireland’s Covid-19 breeding rate of 0.5 is lower than in any of our neighboring countries. In Northern Ireland, it is estimated at 0.8. In England it is just under 1.
The second test to satisfy is related to the capacity and resistance of our hospitals.
There is also good news on this front.
For one thing, the number of new patients admitted to the hospital with the virus was 100 people a day a month ago. Today admissions run at just 15 a day.
After that, the number of Covid-19 patients in general hospital beds has dropped from a peak of about 900 in mid-April to 449 yesterday. That is a 50% reduction in one month.
Additionally, we now have 1,202 empty beds in our hospitals.
The vanguard in terms of pressure on the capacity of our hospital is what is happening in the Intensive Care Units. The European Center for Disease Control noted that Ireland had the fewest intensive care beds per capita before the pandemic began.
We had only 5.6 critical care for every hundred thousand inhabitants. This compares with 8.2 in France, 11.7 in Italy and 19 in Germany, Italy 11.7 and 6.7 in the UK.
The low-level ICU bed was a major concern and added urgency to the need to impose the blockade before Covid-19 overwhelmed our hospital system. Since then, HSE has invested a large amount of money in expanding ICU capacity, which went from 225 beds before the pandemic to 418 beds with full staff today.
Even more important than that for decision makers this weekend is the trend in admissions to the UCI.
The latest figures show that the rate of new admissions to hospital critical care units has dropped from 14 per day a month ago to between 1 and 2 today. That has helped reduce the number of Covid-19 patients occupying ICU beds from a high of 160 last month to just 61 today, a 62% drop.
In fact, when all the non-coronavirus patients are added to the ICU, we still have 146 empty beds in the ICU. It is a sign of resistance within the hospital system that was not evident two months ago.
The third test to satisfy is related to virus testing for people and tracking contracts.
The HSE gave new details of its new system today.
By Monday, they said the total smear and lab capacity will be up to 15,000 tests per day.
However, they noted that the positivity rate in the Covid-19 tests has now dropped to just 3%. This means that they expect 97% of people to test negative for the virus.
Its new system, which will go into effect on May 18, will cause all those people to receive a text message immediately after the laboratory analysis to inform them of their negative results. This according to HSE will occur within two days of performing a swab test.
The remaining 3% of cases, that is, all those who are likely to be positive for the virus, fall into two categories when it comes to contact tracing.
About 90% of them will be straightforward with good details of close contacts. The HSE hopes to be able to complete contact tracing for all individuals the day after a SWAB tests positive. This task is made much easier by the fact that the average number of close contacts per case has fallen within the block. It has dropped from about 21 in early March to 2 or 3 close contacts today.
That allowed HSE to promise a three-day deadline for testing and contact tracing for the vast majority of people who tested positive for the virus.
The HSE described how the final 10% of people who test positive may be more difficult to locate by contact due to their circumstances. For example, they could be intensive care patients, very old people, or someone with language difficulties. They did not compromise on how long it could take to complete testing and contact tracing for such cases.
The fourth test before easing the restriction on Monday is the ability to protect and care for at-risk groups.
The recent Census of Nursing Home Mortality showed that deaths in long-term residential care settings during the four weeks ending April 19 doubled the number during the same period last year.
However, all 58,000 staff and nursing home residents have been screened for Covid-19 and the number of new cases is declining dramatically.
The last topic to consider before Monday is secondary morbidity risk due to Covid-19.
Because people had been reluctant to go to the hospital and also because certain hospital services were restricted due to the pandemic, the concern was that more people might die from non-coronavirus-related illnesses.
However, the latest HSE figures seem to indicate that the number of patients without coronavirus in general hospital beds has increased by 1,445 since mid-April. This is because the figures show that the number of patients in the hospital with confirmed suspicion of Covid-19 has decreased by 456, but the number of empty beds in the hospital has not increased.
In fact, the number of empty beds decreased by 989 during that period. The gap, which is 1,445 hospital beds, is supposed to be made up of new patients without coronaviruses who did not leave treatment last month, but are now on treatment.
This will undoubtedly alleviate some of the fear of secondary morbidity due to the pandemic.
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