Widespread confusion and some consternation sums up the public response to the latest inflections in Government policy as the Covid-19 pandemic continues.
The changes, driven by surging numbers of Omicron variant cases, risk muddying the clear public health messaging needed but were forced on the Government by the staggering growth in infections.
New rules on testing and periods of self-isolation are complex, vary across different cohorts and appear to have been drawn up in haste. In particular, the requirement for people with a positive antigen test to confirm this with a further PCR test has puzzled many and looks set to be reviewed quickly.
Hospital Report
We are, as chief medical officer Dr Tony Holohan pointed out on Friday, in the paradoxical situation where people are at a relatively low risk on a individual basis, yet at a bigger risk across the population. This is because even a small fraction of a very big number – the infections caused by Omicron – can still be a big number.
About one in 50 people has tested positive for the virus in the past 10 days and, because the testing system is overloaded, the true proportion is probably closer to one in 25.
Thankfully, the vast majority of these infections result in only mild illnesses, even fewer than in earlier stages of the pandemic when other variants were dominant and fewer people had immunity due to vaccination or previous infection.
Dr Holohan said the rate at which cases turn serious is low relative to earlier phases, with a hospitalisation rate of 10 per 1,000 cases. Equally, though, the number of Covid-19 patients in hospital has risen six days in a row and will on New Year’s Day reach a level not seen since last February.
Testing capacity
The 682 Covid-19 patients in hospital on Friday is less than one-third of the peak reached last January, but back then most other activity had ceased. It is in no one’s interest – but especially that of patients – that these levels are scaled again.
Not all of these patients have Covid-19 as their primary diagnosis, but that doesn’t mean all these infections are incidental and it doesn’t change the need for them to be treated. Because of the lack of testing capacity, it may be that many patients with Covid-19 are only being diagnosed when they get to hospital.
Hospitals fill up every winter with people suffering from respiratory viruses. But as Dr Holohan has said, the present increase is not sustainable, so what matters is when the peak comes.
Patient numbers in ICU have so far remained stable, though a higher-than-average number appear to be very sick and need mechanical ventilation.
Encouraging signs
The pressure on hospitals will ease some time after case numbers drop, but it is going to be difficult to gauge the peak of this wave. First, many cases are going untested. Second, others are being determined by self-administered rapid tests that are less sensitive than PCR tests.
In the US, the Food and Drug Administration has warned at-home antigen tests, though they remain an important tool, may be less sensitive to picking up the Omicron variant.
At least the signs from other countries are encouraging. Denmark’s cases are growing more slowly. One Danish study attributes the rapid spread of Omicron to its ability to evade immunity rather than an inherent increase in transmissibility, so our high vaccination rates should help.
In South Africa the government has relaxed restrictions. Scientists say its peak has passed with no major spike in deaths or hospitalisations. "It was a flash flood more than a wave," one official has been quoted as saying.