Poor contact tracing capacity and travel behind 500-plus per day Covid cases

Virus case numbers have remained stubbornly higher than Nphet's modelling predicted. Niamh Griffin reports

File Photo: NPHET indicated at Friday's briefing that the plateauing of Covid-19 infection numbers was being caused by increased social mobility and mixing. Picture: Eamonn Farrell / RollingNews.ie

It feels as if Ireland has been in Level 5 since time began, but somehow daily case numbers have rarely dropped below 500 this month. Why is this?

There are a number of pressure points, from the virus itself and also from pre-existing problems in the health system.

Starting with the numbers: on February 11 Nphet sent modelling for March to the health minister.

Deputy chief medical officer Dr Ronan Glynn wrote: “If we can maintain a reproduction number between 0.5 and 0.9 for the coming weeks, we remain on track to have 200-400 cases per day by March 2021, and 100-300 cases per day by 15th March 2021” The R-number instead has risen and is now estimated at between 0.8 - 1.1. And so far 311 is the lowest daily case count in March with most days running over 500.

In the same letter, Nphet reported 250-400 people in hospital and an additional 40-60 people in critical care in mid­ March.

This week ICU numbers remain higher than even the worst prediction, with 82 people in ICU today. General hospital numbers were closer to Nphet's modelling at 360.

But this is still more than the 298 Covid-patients in hospital on  October 19 when Level 5 was announced.

The number of deaths counterintuitively shows a glimmer of hope. This weekend the John Hopkins Covid-19 portal shows a 7-day average of eight deaths for Ireland, down from 26 at the start of March.

The first conundrum is why deaths and hospitalisations are dropping but case numbers are still high.

Three-quarters of those who died so far in the pandemic were over-75 according to the Health Protection Surveillance Centre. They are, to some extent, vaccinated now and protected.

And treatment is improving, so people with less severe symptoms can be supported at home instead of in hospital. One programme using pulse oximeters has allowed GPs and hospitals to monitor over 2,000 Covid-19 patients at home.

But why are case numbers still so high?

A key issue is how hampered public health departments are in tracking the virus. Ireland has 60 public health specialists compared to Scotland’s 180.

So when people ask how come we don’t have retrospective contact tracing, that is why. And if we do not know exactly where the virus is spreading from, it is hard to stop.

It is hard to recruit for these roles, because the conditions compare badly to other countries; only the health minister can fix this.

More pressure comes from the B.117 UK variant. This swept through Ireland after over 50,000 people travelled here for Christmas with lax guidance in place for quarantine.

This variant is up to 70% more transmissible. Doctors report treating whole families together, compared to last year when some people in a household would be ill and others not.

The median age for last week’s cases ranged from 21 to 52 years old which includes people of working age. Mobility data shows as many people going into work now as before Christmas, meaning some people who could work from home are not, for whatever reason.

The lack of statutory sick pay has been reported as contributing to a higher case-load in sectors where work-from-home is impossible.

Serial testing is being done in nursing homes and meat-plants which helps to track outbreaks. But unions would like much more support and more use of antigen tests in other sectors.

All of this is reflected in the latest Covid-19 GP Community Tracker report which shows the decrease in cases that started in January has stalled.