Thread by @andrewflood

8 days since my last #Covid19Ireland update & I'm going to flag a number of metrics making me nervous. First off over the last 5 days a very large swab backlog appears to have accumulated so in terms of cases we are probably seeing an increase rather than a decrease /1

With actually notified cases we appear to still be under reduced transmission curve, add in those 900 and we wouldn't. Without those the 7903 cases this week are 86% previous, with more like 98% so not seeing expected decline /2

Covid hospital cases have been slowly increasing for several days now when they were expected to decline
354 Hospital is 119% last Thursday
285 New Hospital Cases this week is 115%
NHC are 3.1% of cases 6 days back /3

A pattern continuing into ICU occupancy, also rising and would rise a lot more were it not for deaths
69 ICU is 117% last Thursday
38 ICU admissions is 123% previous week
ICU admissions are 14% of NHC
Reduced ICU capacity is what would lead to reintroduction of measures /4

The vaccination program has slowed a lot, in the week to yesterday only as many people got a 1st dose as were infected (both around 8k) - the problem is there are enough unvaccinated over 12s & adults to generate 12k hospitalisations. How fast they are infected is key /5

Where are these cases coming from? It's not the schools, school cases in all ages have fallen faster than end of CC testing would explain. The age groups rising are all adults of working age - suggesting its the return to offices & activity around that like public transport /6

As of Monday this was the percent of each age cohort fully vaccinated by Oct 4th & in table how many hospitalisations may come from each. 40-49 understand their risk least here
10-19* 52.1%
20-29 82.4%
30-39 83.6%
40-49 88.1%
50-59 95.2%
60-69 96.5%
70-79 101%
80+ 102%
/7

The number of deaths has increased substantially in recent weeks. By month of death
June 18
July 20
August 71
September 117
October 16
Allowing for late reporting October will probably exceed September - indeed it may be that 120+ a month is what endemic Covid looks like /8

With little additional vaccination expected the question with winter coming & nightclubs opening is whether enough vaccination has happened to prevent rapid exponential growth that would overwhelm ICU- we already seem to be seeing an unsustainable rate, will it halt? /9

Without additional vaccination we are relying to the epidemic being slowed enough that additional immunity comes through remaining population being slowing infected & mostly surviving. If thats too fast we lose other healthcare & there are many excess deaths as a consequence /10

I'm nervous because its not clear to me thats now what is starting to happen. But also because I think few people realise that the cost of endemic Covid may be similar to the mortality of the last two years - that will be the price of ending most measures /11

But as part of that a substantial extra load on a healthcare system that could hardly cope pre-pandemic. If we are looking at 1000s of extra hospitalisations a year additional resources are badly needed, in particular to protect vulnerable patients from infection /12

To be clear - vaccination means things can't go explosively off the rails in the way they did last December - but we can and may see a slow build up to an unsustainable level. Additional vaccination is the only sustainable major route to reducing that risk but how to convince?

In the week to yesterday NI/RoI
Deaths 17+31=48
Cases 7918+7967=15,885
New hospital cases 176+267=443
Vaccine
1st dose 5,091,968 (+620) 74.2%
Added this week +11,424 (+0.2% pop)
Full 4,911,565 (+2,248) 71.6%
Added this week +30,020 (+0.6% pop)

https://twitter.com/auto_plot/status/1446176572734586883?s=20

I forgot to mention it explicitly but the other stat I don't like is that the percent of cases hospitalised 6 days later has been rising the last week (now around 3%) and the percent of those hospital cases in ICU 3 days later is still around 12%.

That outcomes for unvaccinated table upthread had an error in the ICU column as I'd used the lower mortality percentage for 40+ Correcting that makes clearer the urgency of getting a greater proportion 40-50 yr olds vaccinated to reduce possibility of restrictions being needed

I've spun off a sub thread here thats more speculative on future risks based on my understanding of what various experts I pay attention to have said about the virus & vaccine effectiveness and how I think that translates to the context of Ireland

https://twitter.com/andrewflood/status/1446406858944700448?s=20

Hmm and the outlook got a little bit worse - hopefully this positive swab spike is driven by a single large outbreak (college/meat plant?) & not the leading edge of a trend across multiple locations

https://twitter.com/andrewflood/status/1446473678070374404?s=20