Holohan: Current tests will miss 40% of Covid cases coming into country

"It is anticipated that a total of at least 500-1,000 deaths may occur in the month of January," Dr Tony Holohan wrote in his latest letter to the Government.
Holohan: Current tests will miss 40% of Covid cases coming into country

Dr Tony Holohan said the country is seeing rapidly increasing incidence of coronavirus in long-term care settings and vulnerable groups. Photo: Colin Keegan,

Up to 40% of Covid cases among people travelling into the country “will be missed” under current Government guidelines, while up to 1,000 people may die of Covid-19 this month alone, Dr Tony Holohan has warned.

In his latest letter to the Government, the chief medical officer says that if passengers are only required to take a PCR test then two out of every five cases of Covid-19 will not be detected.

The letter dated January 14, seen by the Irish Examiner, says the National Public Health Emergency Team (Nphet) continues to advise against all non-essential international travel.

While noting and welcoming the requirement now being provided for in law whereby arriving passengers from all countries will be required to present evidence of a negative/not-detected RT-PCR test result, taken 72 hours prior to arrival to Ireland, Nphet considered that further measures should be adopted.

“A pre-travel test alone is not a sufficiently robust system for the prevention of disease importation and modelling shows that even the best-performing tests will miss up to 40% of cases,” Dr Holohan warned.

In response to the emergence of variant strains, many EU countries have adopted more stringent travel policies to meet these new risks. These include combinations of pre-departure testing, quarantine requirements on arrival and post-arrival testing rules, he said.

Dr Holohan, in his letter to Health Minister Stephen Donnelly, said Ireland continues to experience an epidemiological situation of “profound concern”.

He said predictions suggest that deaths will reach a peak of at least 25-30 deaths per day this month and that these levels will persist at least for the rest of January.

"Given the large number of recently notified outbreaks in long term residential care facilities and hospitals, we can, unfortunately, expect to see, in addition, a large scale of mortality in these settings. It is therefore anticipated that a total of at least 500-1,000 deaths may occur in the month of January," he wrote.

He said Nphet’s scenario models also suggest that peak demand for hospital care will occur in the coming days with 2,000-2,400 people in hospital, including 250-300 people in ICU.

Furthermore, an optimistic scenario suggests that there may be as few as 650-800 people in hospital including as few as 110-120 people in ICU at the end of January 2021, he said.

Disease incidence remains exceptionally high but has begun to fall, with the 5-day case average per day at 4,956 and 14-day incidence at 1,449 per 100,000, Nphet said.

The numbers of individuals with Covid-19 in hospital and intensive care units remain at very high levels and continue to increase, impacting very substantially on the delivery of non-Covid health and social care.

“Incidence remains very high across all age groups, especially in young adults. Incidence in those aged 65 years and older continues to increase and represents a particular cause for concern given the severe effects of the disease in these age groups. Incidence in those aged 18 and younger remains at, or below, the population average,” he said.

Dr Holohan said the country is seeing rapidly increasing incidence in long-term care settings and vulnerable groups.

The marked impact of widespread transmission is being observed in both the number and scale of new outbreaks occurring in health and social care settings, including in acute hospitals and long-term residential care facilities, Nphet warned.

Given the high attack rates in congregated settings once infection enters, it is likely that a number of these settings will now experience a high number of deaths. In addition to deaths associated with nursing homes and hospital outbreaks, mortality in the community is also increasing, and it can be anticipated that there will be a large number of deaths in the coming weeks, Dr Holohan said.

Growth rate, having peaked at almost 18% per day over the 14-day period up to January 10, is now starting to decrease. The average number of adult close contacts of confirmed cases peaked at 4.7 on December 28 and is now falling rapidly (2.3 on January 12). 

The test positivity rate and the number of positive tests per day is decreasing. Average daily case counts have peaked at 6,500 per day and it is hoped that this number will continue to fall.

Nphet has warned there were 17 new clusters notified in acute hospitals in week 1 of 2021. There are currently 101 open clusters associated with 42 acute hospitals; there have been 91 linked deaths and 1,153 linked cases to these outbreaks.

Nphet said there were 58 new clusters notified in nursing homes/community hospitals in week 1 and 13 new outbreaks in nursing homes in the following week.

There are 132 open clusters associated with nursing homes; there have been 91 linked deaths and 1,690 linked cases to these outbreaks.

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