Thread by @andrewflood

NPHET recommending lifting of most restrictions is onbasis of overall strategy & our recent experience of Omicron post booster where hospitalisation rates are low & stays short. 892 hospital cases is 87% last Friday as we continue to descend from a peak in lower range of fears/1

It's always tempting to want for data 1st & I have concerns around age incidence but with 819 new hospital cases this week at 82% previous we are also seeing a consistent post peak decline in numbers being sent to hospital /2

When we last had 'its almost all over' messaging in late September the case hospitalisation rate was about 4 times the current rate & it then peaked at about 8 times the current rate. Today New hospital cases in week are 0.58% cases in week to 6 days earlier /3

As we have discussed several times on Plague Tapes the cost of existing with Covid will be substantial as demonstrated by the 1000 deaths from the start of August. But that is current strategy & probably at this point the only realistic one, particularly with Omicron /4

But my concern with current messaging is that as with late September it may be misread as things now being 'safe' on an individual level rather than as being a level of hospitalisations that the health system can sort of cope with. IMHO that's what caused that mid October spike/5

For most of the population the individual risk is now very low, for part of the population recently boosted its currently very low but that may change in weeks or months as antibodies contract. And for some, the immunocomprised the risk remains very significant so cases matter/6

Up to mid November I was doing a crude calculation each week of the potential ICU demand from the unvaccinated population who had not yet been infected (the presumption being infection gives some significant protection if you survive the 1st time without to much damage) /7

Post Omicron that is probably unneeded as the 'not vaccinated but also not having survived infected' population must now be tiny. Vaccination would still add significant protection at the individual level but a wave sending so many to ICU as to overwhelm is now less likely/8

Which presumably is where the recommendation to drop vaccine certs is coming from - the implementation was very weak in any cases - I was only every properly checked including proof of ID once, & that in the first week. Mostly it was a glance at my phone, if that /9

I'd like to see additional measures that would do permanent good, in particularly around ventilation requirements & guaranteed sick pay and employment protection. It was pretty daft that we accepted being infected at work because people could not stay home without pay loss/10

But other than that given everyone over 4 who wants to be vaccinated has now had the opportunity & at least with current variants healthcare can cope as badly as a normal year (something else to be fixed permanently) the NPHET advice makes a nervous sense to me /11

Existing with Covid will I suspect turn out to be often miserable. Even post vaccination a significant number may be left with Long Covid, an individual, social and economic cost. Life expectancy will fall (it already has). Vulnerable people will have fewer opportunities/12

We may well see the need for some reintroduction of restrictions in winter & when new variants arise. We got lucky with Omicron as it was less frequently severe, Alpha & Delta where more frequently severe. Vaccination will help but regular boosters may be needed for many /13

The long term lesson is the need for a global pandemic response that is not driven by neoliberal everyone for themselves capitalism. It may well have been that containment & elimination were possible but in Europe & the US the decision from the start was not to try /14

It was only when hospital systems started to collapse under the numbers of sick that it was realised it was politically unacceptable to allow 1-2% of the population die so we saw a crude Plan B of lockdowns to buy time. With repeated premature attempts to return to normal /15

In that context Ireland's lower pandemic mortality was in part thanks to decades of under investment in healthcare. Like most of Europe we used ICU capacity as the limit and ours was so small it meant lockdowns had to happen sooner than say Belgium with 6 times the capacity /16

Our housing crisis leading to high levels of overcrowded intergenerational housing made the mostly failed experiments elsewhere of 'isolating the vulnerable' impossible from the start. Another lesson there that is unlikely to be learned by those in power

https://twitter.com/andrewflood/status/1450759660500365312?s=20

I've seen some 'should have opened in the summer like the UK' chatter. In that context its worth comparing here with the north to early Nov
Deaths in north per million from June 20th to Nov 1941-1581=387
Deaths in south per million from June 20th to Nov 1098-1014=84 /🧵

Whereas once many measures aligned after that date the difference was considerably less & slower notifications in south will be part of difference
Deaths in north per million from Nov 5th to Weds 2179-1941=238
Deaths in south per million from Nov 5th to Weds 1227-1098=129 /🧵

Important additional point on the 'exit' - too much policy is based on average impact and if we know one thing about Covid we know averages are almost meaningless when it comes to each individual /🧵

https://twitter.com/Theresa_OKeefe/status/1484494249697677314?s=20

I anticipated the NPHET recommendations back on our January 10th Plague Tapes 'Back to the end of the Pandemic as we have known it' but we've been having variations of the conversation in this thread back to last June./21

On a personal level once I got through xmas & its high risk intergenerational mixing I stopped trying to dodge Covid in a major way & have instead started to antigen test every 2-3 days to hopefully know when to isolate but tests should be subsidised /22

I would remain happy to dodge Omicron just as I really prefer not to get the flu each year. For an immunity top up I'd much prefer an additional vaccination although I'd like to see everyone get the chance globally first. I'm planning international travel /23

But while I am glad I can think like that I'm concerned for those around me who can't, some of whom remain extremely vulnerable. I'd like to see better consideration of how they can be best protected in being able to live there lives rather than seen as acceptable casualties/24

Back to todays data - that's a pretty clear peak in ICU admissions in the 1st graph even if occupancy is still on that long plateau
88 ICU is 106% last Friday
49 new ICU this week is 84% previous
New ICU this week is 0.03% cases, 5.34% new hospital cases
/25

Curious jump in swab positivity today - I wonder if this is because the hospital labs are a smaller proportion of total on Fridays as routine admissions tend to happen early in the week /26

Worth keeping an eye on the north where data publication is faster as excess deaths have returned in the week 7-14th & cases are now increasing again driven by school age cases being 43% of total cases /27

https://twitter.com/andrewflood/status/1484531911498285062?s=20

Looks like the government are going for the open everything at once approach so that will certainly mean a case increase with their bet being that healthcare will be able to handle it due to lower hospitalisation rates. Medical workers deserve every cent of that 1000 euro /28

This thread ended up as more opinion than data but to log the not terribly accurate yet case data
11,338 cases is 66% last Friday
91,791 cases this week is 62% previous