Reasons for optimism despite high coronavirus incidence rate

Throughout this pandemic, the focus on daily counts of Covid-19 cases has been excessively narrow, even blinkered. These days, it is simply misleading.

Ireland on Friday went to the top of the European pile for Covid-19 incidence, according to the latest data from the European Centre for Disease Control, but yet the situation here is more positive than it has been for some time.

One reason Ireland has high Covid-19 case numbers is because we test for the disease more than other countries. But even allowing for the undoubtedly high incidence at present, there is reason for optimism in the near future.

First, case numbers have stabilised in recent weeks and are starting to fall. This effect is more pronounced when the figures are arranged by date of infection rather than date of reporting, because of the time lag in notifying some older cases.

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The Health Protection Surveillance Centre has only just restarted reporting infections by epidemiological date, following the cyberattack on the HSE in May.

Its latest report shows the five-day incidence of cases slipping below 1,000 cases a day, having been close to 2,000 in mid-August. Test positivity is also falling.

Even allowing for inconsistencies in daily reporting, the 14-day incidence has been in slow decline for two weeks now. The disease rate is falling in all but nine of the 26 counties. The trend seems to be cleaving to the more optimistic of the projections made by the National Public Health Emergency Team in the summer.

High vaccination rates provide a second reason for optimism. Only Malta has more people immunised than Ireland within the EU.

For all the coverage of breakthrough infections and waning immunity, the greater truth is that vaccination continues to protect against serious illness.

You may contract Covid-19 despite being fully immunised, but your experience of the disease is likely to be much milder than if you were not. And you are probably less likely to transmit the disease onwards.

Covid-19 will continue to be a tricky and often tiresome challenge, and as infectious diseases consultant Paddy Mallon has pointed out, everyone is likely to be exposed to it as society opens up. Caution is still advised, but this does not preclude a return to a more normal existence.

Inevitably, the return to school will lead to more cases; these surges have proved transient during previous re-openings. At second level, many students will be vaccinated, thereby reducing their risk of infection and of being forced to miss class as a contact of a confirmed case.

Uncertainties

There are still uncertainties. The Delta variant is more transmissible and, according to a report last week in The Lancet, it doubles the risk of hospitalisation. Its impact on schools as they re-open could be significant, particularly if large number of pupils are forced to stay at home.

Few of these children will suffer serious illness from the virus and, unlike in previous waves, most will be returning to homes where adults are fully vaccinated so they are less likely to cause further illness in the household.

The search by some for “scariants” continues. One new variant, C.1.2, which originated in South Africa, was wrongly reported last week as mutating “two times faster” than other strains.

Another, B.1.621 or Mu, was added to the World Health Organisation’s watchlist. Yet neither strain appears to be able to outspread the Delta variant.

Even if cases continue to decline, the number of Covid-19 patients in hospital and intensive care will stay high due to the time lag between infection and serious illness.

Hospitals will remain under pressure, but nowhere near to the extent they were at the start of the year.

One of the main challenges will be to sift through the different symptoms of presenting patients, so that differential diagnoses can be made of Covid, flu or other respiratory ailments common in the winter.

Now that vaccination has cut Covid down to size, we no longer need to focus health provision so relentlessly on one single threat, when there are so many other diseases and life-events that can affect our wellbeing.