Thread by @andrewflood

My hmmm I fear this might be the 5th wave of last week has solidified strongly in last days with todays 2,066 cases being 210% of last Weds & the 11,423 cases this week 143% of previous week. On the cases plot we are visibly rising fast & non longer on Reduced Transmission /1

Post vaccination if it was just cases my concern would be qualified but its clearer from hospital situation - this lags cases so next week will be worse
408 hospital cases is 118% last Weds
341 new hospital cases in week 128% previous
NHC are 4.3% of cases in week to Oct6 /2

ICU is more complex, in part because of 6 deaths in the last 3 days leading to a dip. It lags but there might be a glimmer of hope in terms of post-vaxx severity
69 ICU is 98.6% last Weds
32 ICU admissions this week is 89% previous
ICU admissions are 10% NHCs /3

We are seeing a more modest case increase in the north where hospital admissions are still falling, over 45% of cases there are in under 20s which is the probable reason for that, more to follow /4

https://twitter.com/andrewflood/status/1448284546798129158?s=20

We hit 90.6% of over 12s dose 1 vaccinated today so its entirely understandable a lot of people are wondering how the hell is it possible for cases to rise. Unfortunately that's Delta & vaccines that are very good but not a 100% barrier /5

https://twitter.com/andrewflood/status/1447586120296972292?s=20

The worst of all the stats above is one you may not have noticed - that 'new hospital cases' has risen to 4.3% of cases the previous week. This is because the age of cases is older on average as more people in their 50, 60s, 70s & 80s get infected /6

https://twitter.com/andrewflood/status/1447906691895504897?s=20

The increase in cases is happening (almost) everywhere, only 5 counties are doing better this week (in blue) than they did the previous week. /7

Returning to the NPHETs exit plot lets note that we were expected to do far far worse. We managed to stay below Reduced Transmission for over 5 weeks as everyone over 12 who wanted to got vaccinated. An important collective achievement but tragically it turns out not enough/8

Tonights NPHET press release focused on the need to get more of the remaining 300k adults vaccinated. And that would make a huge difference in terms of whats to come and whether or not we NEED to reintroduce measures to protect healthcare /9

I say NEED above as at a certain point there isn't a choice. At the current rate of case rise we are facing months when almost no medical care that isn't an emergency procedure will be possible as Covid & flu swamp the hospitals. Thats unacceptable so has to be avoided /10

So we face 3 choices
1. A lot more of those 300k get vaccinated to protect the healthcare system from the fact 12,000 of them are wrong in their Covid won't hurt me gamble
2. Measures come back to reduce transmission
3. We accept a lot of people being denied life saving care /11

There isn't a 'make the virus monster go away so we can get back to normal' option in there, even if we throw a prolonged tantrum at the unfairness of these choices. We only have some combination of those 3 choices, all of which are bad /12

In March 2020 there might have been a 4th choice, organise globally to make Covid19 go away through elimination. But once the EU & US choose a 'learn to live with it' path that is no longer an option, instead we are locked into a long life disrupting attempt to minimise harm/13

And here's the thing. Living with Covid is going to be very unpleasant & will continue to be for a number of years. In mortality alone I expect 1500+ deaths per year as we wait for a combination of survival immunity, booster shots & better treatments to reduce that /14

But while grim thats not the real problem. We don't have a well resourced health system & Covid has demoralised HCWs causing some to quit. Yet realistically there will be 20k+ Covid hospital cases in year 1 of 'living with' at current vaccination levels (we have 11k beds)/15

The much bigger problem is currently over 10% of those hospital cases go into ICU. If 2/3 of ICU are unvaccinated now then that might fall to 4% once everyone is vaccinated or post infection. But 1400 ICU in Yr 1 of living with, we have 300 ICU units /16

We could argue about my assumptions above which would make things somewhat better or worse. But thats a distraction from two tasks
A. In the coming days choosing as a society the balance between the 3 trade offs above we can live with
B. Really resourcing healthcare /17

The 'global north' has been protected from these considerations for the decades after TB & Polio were controlled. But malaria & AIDS have ravaged the global south, exacting a constant & considerable toll. In this pandemic the protection of vaccine patients is costing us /18

Previous global pandemics have led to profound transformations of the societies that came through them - I feel the math above calls out for a transformation of this one - a move away from hyper individualised neo liberalism & towards collective solidarity /19

Similar ross border rise suggests weather has a role
NI/RoI
Deaths week 22+26=48
Cases week 8969+11423=20,392
ICU now 33+69=102
New Hospital cases in week 163+341=504
1st dose week +9,081
Fully vaccinated +24,985

https://twitter.com/auto_plot/status/1448342690513526785?s=20

/20