Thread by @andrewflood

A general comment - high levels of vaccination has allowed the risk of moving on from significant restrictions with 1/4 of the population unvaccinated (2/3 not eligible to be). In the Irish HCare context the main role 18 months of NPIs had was buying time for vaccinations /1

https://twitter.com/andrewflood/status/1446192480425234435

Our health system was too under resourced for 'flatten the curve' to have been sustainable as a route to population immunity. With too few ICUs that would have taken 5 years of switching between some opening & lockdown to avoid high excess deaths when ICUs ran out. /2

It would also have involved in the region of 40k deaths over those years - thats the IFR for a population with our age structure and where hospital oxygen does not run out. If the curve is not flattened it probable doubles or worse. But we mostly stalled Covid till vaccination/3

Unvaccinated but eligible 400k may generate as many as 12k hospitalisations & 1100 ICU admissions. Vaccines are thought to be 80-95% protective against hospitalisations & ICU need. 5-20% is still a very large health demand if we see exponential growth /3

On top of that we have an enormous backlog of people needing treatment for other reasons. A waiting list 700-900k long. And the risk of a bad flu season. A fresh Covid wave could see a lot of excess deaths from health care being blocked & delayed /4

A further complication is significant evidence that vaccines wane in effectiveness at stopping infection over about 6 months. Even if this doesn't impact severe outcome protection it would mean a large significant wave of infection creating the healthcare overload situation /5

Probably the single most effective guard against the future need for restrictions to halt such overload is a higher level of completion of vaccination for 40-49 age which cuts potential unvaccinated hospital demand by 1/3. 180k vaccine doses achieve that /6

Otherwise we are probably heading into a 'flatten the curve' 2.0 as we wait for 1 million infections with 12k hospitalisations & 100s of direct deaths to give enough immunity to reduce the risk to survivors from subsequent infection. /7

That is there is a personal cost to some of the unvaccinated to getting immunity the hard way through infection but there is also a collective cost to society in terms of breakthrough infections, blocking of other healthcare & subsequent reintroduction of restrictions /8

The hard core anti-vaxx crowd are unreachable however a lot of the under 50s who are not vaccinated may simply see this as a personal decision about risk to their health. And not the wider implications of that 1 person like them in 30 who ends in hospital for a few days /9

A positive HSE campaign taking the positive angle of getting vaccinated to help ensure others have access to healthcare may help. But I suspect so too would people with influence spontaneously explaining why they got vaccinated in those terms. Too much focus on those who haven't

Interesting statistic via Paul Reid that 67% of those in ICU now are unvaccinated (and 3% dose 1 only). Given only 10% of adults are unvaccinated thats a real testament to the level of protection vaccines are giving /🧵

https://twitter.com/paulreiddublin/status/1446398969685368855?s=20

Useful thread and unusually the replies add to it on Mumbai possibly reaching a level of immunity that means Covid is becoming endemic. 4-5 deaths a day, 500 occupied ICUs in a 13 million population, however its a much younger on average one than Ireland

https://twitter.com/muradbanaji/status/1445778377621716997?s=20