Why are deaths and hospitalisations from Covid-19 falling so dramatically?

The recent rise in the number of coronavirus cases in Ireland has alarmed a public weary after almost six months of restrictions. But there has also been a welcome fall-off in the numbers of people dying and being hospitalised due to the disease.

In the period from August 1st to August 26th, there were 2,300 confirmed cases of the disease in the State, but just 13 deaths*. At the height of the pandemic in April, 38 people a day were dying on average, many of them nursing home residents.

Across Europe, despite cases steadily creeping up in recent weeks, death rates are also markedly lower than they were earlier this year.

In Italy, where up to 900 people were dying a day in spring, more than 1,000 cases were confirmed last Saturday, but just three deaths were reported. France recorded almost 5,000 new cases on Sunday, the highest daily total since May, but only one death. In the UK, where deaths surpassed 1,000 a day during the worst of the pandemic, less than six people are now dying on average daily.

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David Higgins, a data analyst with Carraighill Research, says the falling mortality rate is directly related to a decline in the number of over-65s contracting the virus.

Some 93 per cent of the State’s total deaths from the virus have been in this age group, with four in five among people over 75 and 44 per cent among those 85 and older.

Deaths

About 90 per cent of all cases among the over-65s were nursing home residents. Between March and the end of June, almost 6,000 cases were confirmed in nursing homes, resulting in 968 deaths. These facilities account for 56 per cent of all Irish deaths from the virus, one of the highest rates in the world.

Since the end of June, the numbers over 65 getting the virus have fallen both in absolute terms and as a percentage of the population getting the disease.

In the month up until August 24th, the latest date for which figures are available, there were 119 cases among the over-65s. The numbers are growing, though, as there were just 50 cases in the over-65s in July. Yet there were 427 cases among the same age category on April 22nd alone.

Minister for Health Stephen Donnelly warned on Wednesday that Ireland may have to go into lockdown again if the upward trend continues.

However, Higgins says the statistics suggest that measures to keep the elderly safe, including cocooning, are working . “Even if that is going to continue into the winter with a couple of hundred cases a day, you should still have a smaller share of over-65s getting it because they are protecting themselves.”

For a lesson in how complacency around coronavirus can have terrible consequences, one needs to look no further than Florida. The state reopened from lockdown in early June, when it was experiencing 2,000 cases a day but few deaths, as the disease was mostly confined to the young. Within a month, it was experiencing 15,000 cases and more than 250 deaths a day. It became an epicentre of the pandemic in the United States.

Dr Emma Hodcroft, a molecular epidemiologist at the University of Basel in Switzerland, says data for that period in Florida showed the virus steadily creeping through the generations.

While noting Europe is not in the same space as Florida during July because mask wearing and social distancing are much more prevalent here, Hodcroft still sounds a note of concern.

“I do think it’s wishful thinking to believe it will only stay in younger age groups. We do not live in bubbles, and the more cases there are, the more opportunity to spill over into other age groups,” she says.

“Many studies have shown we are not anywhere near herd immunity in most places in Europe, so there’s no reason to believe our older age groups are somehow protected from being infected – except through our actions as a society.”

Hodcroft sees the current spike across Europe as an “alarm bell” while deaths and hospitalisations continue to be low.

Control transmission

“My hope is that we can take smaller actions now to get cases under control. It is usually easier to control transmission while cases are low and test-and-trace is most effective.”

Dr Clíona Ní Cheallaigh, an infectious diseases specialist at St James’s Hospital, believes the key to ensuring deaths do not rise again is to keep the virus out of nursing homes and other congregated settings where vulnerable people live. This will also lead to lower hospitalisations and admissions to intensive care units.

“It’s all about who it is infecting. We had very few homeless cases because there was really good work done to stop the spread to them,” she says. “At the moment the group Covid-19 is spreading into is relatively okay, but we do see some young deaths and other people get really sick with it. It’s not necessarily a minor illness in younger people.”

One theory around the reduction in deaths is that the virus itself is weakening. Paul Tambyah, a senior infectious diseases consultant at the National University of Singapore, has suggested the particular strain which is currently circulating in Europe and in Asia is more infectious but less deadly than previous ones.

However, Kingston Mills, professor of experimental immunology at Trinity College Dublin, fundamentally disagrees. If the virus had weakened, rates of hospitalisation would fall, but they have not done so, he argues. "There is no question that the virus has changed, but for people to think that it is less virulent than it was three or four months ago would be completely against all scientific principles as to how the viruses mutate."

Ruairí Brugha, professor of epidemiology and public health medicine at the Royal College of Surgeons in Ireland, believes a key factor in lower death rates is that doctors are now much better at treating the disease than previously.

“I was in touch with the head of a major teaching hospital and the mortality in its intensive care unit is 10 per cent lower than in other countries. We have to give credit to clinician management,” he says, while cautioning that deaths will start to rise again if young people act irresponsibly.

“The fact that young people are infected means they are not taking good preventative measures themselves. They risk spreading the infection to the older people or their families that they come in contact with. There are real risks to older people down the road.”

*This article was amended on August 28th, 2020.