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
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 /🧵
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

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More from @andrewflood

7 Oct
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
Read 18 tweets
7 Oct
With #SaveTheCobblestone trending a video of Finbar Furey spontaneously borrowing a guitar to perform Paddy Dear at A Celebration of Traveller Music #5 there is 2016. The Cobblestone was the only one of 15 venues willing to host the CTMs apparently /1
The Cobblestone is one of those bars I like but find too popular, its always crowded with an eclectic mixture of locals, musicians, lefties & tourists who've managed to find a genuine piece of Irish music culture a short walk from the Disney land versions of Temple Bar /2
The @CobblestoneDub back room was the venue for most of the Stoneybatter & Smithfield History project events including this talk by Fergus Whelan on Oliver Bond and the king-killers of Pill Lane. The dissenters of Church Street in 1798 from 2014 /3
Read 11 tweets
29 Aug
While I’m hopeful that our high & rising vaccination levels will prove enough over the next month to see cases fall from peak this threads a good data based counter view that so far the evidence is not that strong for this hope.
🤞🏻or🙏🏻 time depending on your preference
The challenge now is that only short term data gives us a clue as in the last 2 weeks alone the remaining unvaccinated adult population has been cut by 1/3. But short term data bounces around with good days & bad days - right now they are good
And we are putting an enormous additional load on in terms of mass sports events, schools reopening, universities soon & probably a whole lot of additional relaxations rolling though September. But the unvaccinated should also be cut by at least another 1/3 in that timeframe
Read 4 tweets
28 Aug
Calling my final tracker NPHETs Exit becomes 'official' with this morning's announcement - todays 1997 cases are 94% last Sat & we have slightly negative growth for the week as the 12,640 cases this week are 99.7% previous - hopefully this better than expected track holds /1
Hospitalisation is still showing a working week on week increase but on the plot its not a problem so far as so far its better than the best NPHET scenario
324 hospital is 125% last Sat
337 new hospital cases this week is 139% last week
337 NHC is 2.7% of cases to Aug 22
/2
The initial tight grouping of curves makes ICU more ambiguous but it also appears to be following the least worst 'Reduced Transmission' path
61 ICU is 113% last Sat
37 ICU admissions this week is 116% previous
37 ICU admissions this week is 12% of NHC to Aug 25th
/3
Read 5 tweets
27 Aug
Todays 1875 cases are 89% of last Friday & on the NPHET's Exit plot are almost on Reduced Transmission curve which is well interesting. There are 12,768 cases this week which is 101% last week - a growth rate close to 0 despite the level of 'return to normal' /1
The hospital plot is also optimistic so far, below the RT curve but the rate of increase from last week is less reassuring if it continues into next week
326 hospital is 130% last Friday
344 new hospital cases this week is 154% last week
344 NHC is 2.7% of cases to Aug 21 /2
Not enough time has passed to separate out the least worst ICU curves but if case growth stays near zero then the ICU growth should be slow
59 ICU is 113% last Friday
36 ICU admissions this week is 116% last week
36 ICU admissions is 12.5% of NHC Aug24 /3
Read 9 tweets
27 Aug
NISRA total of Covid19 deaths in the north rises to 3140 - thats the figure to 20th August its likely the real total is last least 3181 and more likely 3197. April excess deaths peak across pandemic has also been exceeded which confirms error of opening too much too early /1 ImageImageImage
I messed up with my thread linking last week with the result that there are two weeks of my daily stats updates at the linked thread from two weeks back but will continue todays & the rest of next week below this one /2
Continuing pattern of a larger proportion of cases in the north occurring in over 60s but at least last weeks rapid rises in cases & severe outcomes has settled down. Now at 1690 deaths per millions, 165% the rate per million in the south /3 ImageImageImageImage
Read 4 tweets

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