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The pain inflicted on the country would be severe but brief, in our case four weeks. It would be sharp and intended to break the chain of Covid-19 transmission.
It is probably one of the few ways to sell the latest level 5 crackdown recommendation from the National Public Health Emergency Team (Nphet) to a nation asking, “Where is the evidence for such draconian measures?”
The Cabinet has rejected it for now and is opting for a Level 3 upgrade instead.
Nphet’s decision seems to be based on the current image, what is hidden behind the figures and, above all, the dire state in which the country could be with Covid-19 in just one month.
It relies heavily on the specter of the country hurtling toward higher infection rates, more illnesses, and more deaths as hospitals struggle to cope.
Only one direction
The trend in the spread of Covid-19 has been upward since the beginning of September.
There is no comfort in the daily numbers, although some counties have managed to slow down.
But the 14-day incidence in the most troubled counties shows that Donegal rose from 233.1 per 100,000 on Friday to 265.1 per 100,000 on Saturday. Monaghan’s rate rose from 172.7 per 100,000 to 177.6 per 100,000.
Dublin is showing a slight sign of stabilization: its rate fell from 168.2 per 100,000 to 162.6 per 100,000. But that was after two weeks of a Level 3 lockdown.
The graph goes up in most counties except Louth, Wicklow. Limerick, Laois, Waterford, Wexford, Mayo and Leitrim. There is strong local pressure to exempt several of these counties from a blanket lockdown.
Nationally, the 14-day incidence rate was 107.4 per 100,000 on Saturday, up from 100.9 per 100,000 on Friday.
Stop doing something
Forecast-based forecast looks bleak
Nphet suggests that a “do nothing approach” will lead to 1,600 to 2,300 new cases of the virus being diagnosed every day in just one month. Over the past week, the emergence of daily numbers over 300 or 400 has caused a chill.
The model would point to the country plunged into a crisis in early November, which would have a major impact on infections, deaths and hospitalizations.
How the virus spreads
One of the key areas for alarm is how the virus is spreading and the level of transmission in the community. More people contract the virus without knowing the source. This is fertile ground for a highly infectious “catch me if you can” virus like Covid-19, but it presents a nightmare for public health doctors trying to catch it in the absence of restrictions. By closing opportunities for people to meet and mingle, they have some chance of getting the upper hand.
Hospital wards and intensive care units
The figures for hospitalizations of Covid-19 patients and admission to intensive care units have been cited by opponents of the Level 5 lockdown who say they remain manageable. They mark the worst days in April when 900 patients with the virus were hospitalized.
But again, the trend is worrying. There are currently 150 Covid-19 patients in the hospital and 21 in intensive care. In mid-August there were only 14 patients hospitalized with the virus and eight in intensive care.
HSE’s winter plan promises 251 extra-acute hospital beds this year plus 232 in early 2021.
An additional 17 critical care beds will be added to the existing 282 intensive care unit beds.
Even if these materialize, and adequate staffing is ensured, it will not be able to keep up with demand. Non-Covid care will suffer again, and seriously ill patients will have operations canceled or cancer treatment delayed. Nphet predicts that in early November, 43 people a day will be admitted to hospital with Covid-19.
Deceased
Deaths are increasing again and there is a delay in mortality after an increase in cases. There has been a doubling of cases in those over 65 in recent weeks. Nursing homes are again at risk and have 31 outbreaks open. Seven of the outbreaks in nursing homes were detected in the last week.
Limp block
The recommendation to move 24 counties from Tier 2 to Tier 5 was likely due to poor performance of the Tier 3 closure in Dublin and Donegal so far.
Dublin is now on the last of its three-week Level 3 restrictions and despite the measures, only now shows a very modest drop in the number of cases. Donegal is still on the rise. The question is whether locks that are not hard enough have no teeth.
Public fatigue
This is at the heart of many of the places we find ourselves in today. It must be recognized that the virus is still highly infectious. In addition, the opening of schools, although it is not the scene of transmission, is causing an increase in the movement of people in cities and towns.
The reality is that too many people are ignoring anti-Covid self-discipline. They may be doing their part by wearing a mask at the store, but then they run into a group of neighbors outside and don’t physically distance themselves. These actions are adding up.
But even with a difficult confinement, can people be strict with themselves again? And when it’s over, is it just a matter of time before the punishment starts again?
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