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Professor Philip Nolan Profile picture
@PhilipNolan_SFI
Sep 20, 2020 • 8 tweets • 3 min read • Read on X
We must protect the vulnerable in our communities from SARS-CoV-2. It is our responsibility more than theirs, because the primary means to protect them is for the rest of us to suppress transmission of the virus and keep circulating virus at very low levels. 1/8
If we look back to March through to June, the number of cases in any given county in people aged 65 and older correlates with the number of sporadic cases in the community. High levels of virus in the community increase the risk for older and other vulnerable people. 2/8
This is a lethal virus, and mortality rises quickly with age. The case-fatality rate for those cases reported March to June was 0.2% in those aged 20-39, but 33% in those 85 and above. 3/8
We know from our SCOPI sero-prevalence study that back then we were detecting one in three cases, and our testing was biased to those with severe disease, so now we would expect hospitalization and fatality rates to be less than one-third of what we saw in March and April. 4/8
Our best estimate of infection-fatality ratio at present is that it ranges from around 0.1% in those aged 20-30 to 7-8% in those aged 85 and older. If we fail to protect the elderly, we may expect 4-6% mortality in those cases aged 65 years and older through the winter. 5/8
The recent rise in cases in Ireland started in younger age groups with very mild disease, but now we are seeing rising cases in older people, hospitalisations and deaths. We had 4 deaths with COVID-19 in all of August, and 18 so far in September. 6/8
There are those who are saying we are not seeing hospitalisations or deaths in this phase of the pandemic. We are, sadly. They are delayed, and now occurring at the rates that we would have expected. They will rise further if we don’t act now. 7/8
This is why I limit my social contacts, avoid congregation and crowded spaces, wash my hands, keep my distance, wear a face covering. If I don’t, I constrain and risk the lives of valuable, valued, but vulnerable members of our society. 8/8

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More from @PhilipNolan_SFI

Professor Philip Nolan Profile picture
Dec 18, 2021
Omicron will be a very significant challenge, but we are acting early, quickly and comprehensively. If we take a booster vaccine when offered, significantly limit contacts, mitigate risk, self-isolate if symptomatic and restrict movements if a contact, we can get through it. 1/22
The purpose of the formal restrictions is to significantly reduce risky social contact, the opportunity for the virus to transmit; they are to reinforce a call to all of us to prioritise our socializing over the coming weeks to a small group of people who matter most to us. 2/22
We already have, by reducing our contacts and adherence to basic public health measures, begun to bring infections and hospitalisations down after a significant surge of the delta variant in early November. This was difficult, but we did it together. 3/22
Read 22 tweets
Professor Philip Nolan Profile picture
Nov 21, 2021
Let’s think and act positively. We can, with collective action, control transmission of SARS-CoV-2 again, and relieve the pressure of COVID-19 on our healthcare system. The effective reproduction number is currently estimated at around 1.2 1/12
If we can reduce our close social contacts by 30%, and/or mitigate the risks of those social contacts by 30%, we will have done enough to see the level of infection, case numbers and ultimately hospitalisations decline. 2/12
The more we prioritize and limit our social contacts, and mitigate those risks, the faster things will improve. The rising numbers of people in hospital and ICU are an urgent call to action. 3/12
Read 12 tweets
Professor Philip Nolan Profile picture
Nov 17, 2021
The latest modelling of SARS-CoV-2 infection in Ireland shows that we urgently need to reduce transmission if we are to avoid further dangerous increases in cases and hospitalisations. Stay home with symptoms, limit contacts, use basic mitigations. 1/20
The current surge in disease began soon after the relaxation of measures on 20 Sept 2021, and accelerated from 22 Oct 2021 through the mid-term break. The increase in effective social contact is the primary driver, along with waning vaccine immunity. 2/20
Vaccines are very effective, but over time the immune defence against simple infection wanes. Fortunately, protection from severe disease is well maintained. The waning immunity means that increasing social contact causes a large and increasing force of infection. 3/20
Read 20 tweets
Professor Philip Nolan Profile picture
Oct 16, 2021
Why are SARS-Cov-2 infections increasing in Ireland? It’s complex, but most likely a mix of increased mobility and social contact since late September, slippage on transmission prevention measures, and more social mixing indoors. 1/16
We had high but stable levels of infection through September 2021, but this was created by a very dynamic and delicate balance between increasing vaccine protection suppressing the virus, and increasing social contact creating opportunities for the virus to spread. 2/16
We started at a disadvantage compared to most of Western Europe. We were hit by a very large wave of delta infections in July, with most of the population under 50 not yet vaccinated, driving daily cases from 300 to 1800 per day between June and August. 3/16
Read 16 tweets
Professor Philip Nolan Profile picture
Sep 22, 2021
There is no evidence that the reopening of schools has led to an increase in transmission or levels of infection amongst school-going children or more widely across the population. 1/14
The level of infection in children and adolescents had increased in the course of the summer as the delta variant increased the rate of transmission. 2/14
This had stabilized at a high level in children aged 12 and under, and decreased markedly in 13-18 year olds, as vaccination reduced incidence in adults and adolescents, and began to reduce the probability of children becoming infected. 3/14
Read 14 tweets
Professor Philip Nolan Profile picture
Sep 12, 2021
A lot of commentary saying that most or all schoolchildren will be infected with SARS-CoV-2 in the coming months, based on an uncritical reading of this modelling study. It is highly unlikely that the scenario modelled will happen in the real world. 1/12

medrxiv.org/content/10.110…
First, it’s not plausible. In the 12 weeks after primary schools reopened in March 2021 we detected 5,279 cases in children aged 5-12 years, or just under 1% of the population. The vast majority of these infections were transmitted in the community, not in school. 2/12
Even if delta is 50% more transmissible than alpha, it’s a long way from 1% of the population to 50-75% of the population becoming infected in 12 weeks; note also that most transmission was in the community, and the majority of the community is now vaccinated. 3/12
Read 12 tweets

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