What advice did Nphet give Government about July's reopening?

Taoiseach Micheál Martin at Government Buildings announcing a delay in reopening. Picture: Julien Behal Photography/PA Wire

The most optimistic projection of Covid case numbers in the wake of the Delta variant will lead to 165 deaths by the end of September, Nphet has warned the Government.

The latest letter from Chief Medical Officer Dr Tony Holohan to Health Minister Stephen Donnelly was published as Taoiseach Micheál Martin confirmed the Government will follow Nphet's advice not to press ahead with the reopening of indoor hospitality.

The letter accepts Nphet's modelling is "uncertain", saying this is due to questions over how much more transmissible the Delta variant is. 

The latest letter from Chief Medical Officer Dr Tony Holohan to Health Minister Stephen Donnelly lays out four scenarios to the end of September for the spread of the Delta variant. File picture: Colin Keegan, Collins Dublin

It says this is based on new suggestions from Europe that the Delta variant and the Alpha variant, which is the current dominant strain in Ireland, are not as transmissible as thought.

"When the Alpha variant became dominant in the UK and subsequently in Ireland, its transmission advantage was estimated as between 40% and 90%. 

"Subsequently, as the Delta variant emerged, Public Health England estimated it as having a further transmission advantage of 50%-60% over Alpha. 

However, more recently, the ECDC has used more conservative estimates of the transmissibility of Delta, suggesting that Delta is 55% more transmissible than Alpha, but that Alpha is only 25%-30% more transmissible than preceding variants."

The letter goes on to lay out four scenarios to the end of September for the spread of the Delta variant – optimistic, central 1, central 2 and pessimistic.

• In the first scenario, 81,000 cases would be seen, with 1,530 hospitalisations, 195 ICU admissions and 165 deaths. 
• In the central 1 scenario, there would be 187,000 cases, 3,490 hospitalisations, 450 ICU admissions and 545 deaths
• Central 2 would see 408,000 cases, 7,690 hospitalisations, 985 patients in ICU and 1,230 deaths.
• Pessimistic would see 681,900 cases, 12,985 hospitalisations, 1,685 ICU admissions and 2,170 deaths.

In its presentation to the Government, Nphet said the middle-case scenarios are the most likely to be seen. 

Fourth wave

However, the letter says the variant is likely to cause a fourth wave of infection. It says a return to schools in September causes additional uncertainty around modelling as infection then will be "sustained by infection in children and adolescents, who are not currently eligible for vaccination".

The profile of SARS-CoV-2 infection, of severe Covid-19 disease requiring hospital or critical care, and resultant mortality over the coming weeks is very uncertain. 

"What is clear is that the Delta variant, with it is clear transmission advantage over the Alpha variant, is rapidly becoming the dominant strain, and in our partially-vaccinated population, the increased risk of onward transmission associated with this variant makes a significant fourth wave of infection likely. What is uncertain is the magnitude of this fourth wave, and its severity in terms of hospitalisation, mortality, and long-term sequelae.

The rate at which a fourth wave might develop, and its scale, depend on this transmission advantage, and model scenarios vary widely depending on assumptions about transmission."

It has been confirmed today there has been no independent overview of the Nphet modelling, but Mr Martin said he does not envisage that happening. He said there was "a plethora of outside voices who will question policies, decisions and modelling".

Indoor activities too risky

The letter goes on to say that numbers at outdoor events should increase, but warns it is too risky to do this for indoor activities. It says  the Government should consider pausing any further reopening unless a system to determine who is and isn't vaccinated can be put in place.

"The other measures which were due to be eased on July 5 which, by their nature are high-risk activities which will involve significant levels of social mixing in indoor environments, should only be permitted for those who have been fully protected by vaccination or who have had Covid-19 infection in the previous nine months. 

"The planned easing of these measures should only proceed once a robust, non-reproducible and enforceable system of verification of vaccination or immunity status can be put in place to support this. If this is not deemed feasible, the Government should consider pausing further easing of these measures until such a system can be instituted."