9 months of Covid in Ireland 🇮🇪 — What do the Data tell us about the Virus?
All opinions or views expressed are my own, and do not represent the opinions of any entity with which I have been, am now, or will be affiliated. Relevant sources and citations have been hyperlinked where possible.
All of the data and graphs included are accessible at lockdown.donal.me
The defining characteristic of the beginning of a new decade, an unprecedented, highly contagious global pandemic. Aggressively dominating the media, livelihoods, personal liberties, public purses, the psyche and economics of a nation.
Prelude — The Calm before the Storm
Long ago back in January and February, reports first started to roll in from Wuhan and more worryingly fellow European States about the spread of a novel infectious disease. Those of younger generations may have somewhat recalled previous viral outbreaks such as Ebola, Avian Flu and perhaps even the original SARS, however these thankfully had little to no impact on the day-to-day of the Irish population, responsible for relatively few deaths on a global scale.
SARS-CoV-2 on the other hand seemed a meaner successor, infectious with a batty vengeance. Shocking images from its Asian epicentre made their way into international media telling of deaths untold, a growing inability to care for the number of patients who were contracting the disease, lockdown, and general pandemonium. Given the global world we live in today, or lived in prior to the onset of the disease at least, the preponderance of international travel meant that the disease, contagious as it was, not to mention a sneaky 5-day incubation period, was always likely to make its way outside of Asia, and that it did. In fact, there is a likelihood it had been circulating elsewhere since towards the end of 2019.
Many countries began to report their first recorded case towards the end of February, Ireland was no different. A quote from Dr Tony Holohan (Ireland’s Chief Medical Officer) at the time does not seem to have aged well:
The health service is well used to managing infectious diseases and has robust response measures in place.
On March 11th, Ireland’s first reported Covid death occurred in Naas General Hospital. The following day, Taoiseach Leo Varadkar announced the closure of schools. 3 days later, pubs and restaurants were ordered to close. On March 18th, NPHET — a crack response team of Irish Civil Servants within the Health Sector — issued their first statistics on what they knew about the Virus in Ireland at that point. Interestingly, even at this early stage, indications were that the % of cases who required Intensive Care, and the Case Fatality Rate were rather low.
Cue April and May, by far the worst months in terms of Death count for the virus in Ireland. And the peak of the so-called First Wave. However, it is prudent to note that the majority of these deaths occurred in Nursing Homes. And that the entire country was under Stay-at-Home orders while these deaths occurred. Most of them occurring well after 14 days from its introduction (lest a lagging incubation period from pre-Lockdown contraction be claimed as the cause).
Positive Rates & Case Fatality Rates
It is pertinent to note the Positive Rate and Case Fatality Rate in the above graph. Positive Rate refers to the proportion of Test Results in a given day that return positive. A small amount of these are expected to be False Positives, however thankfully, the general False Positive Rate (FPR) of the PCR swab tests used to identify Covid is very low. That said, the combination of moving away from testing only symptomatic cases to Test & Trace, a higher volume of tests resulting in more technical errors, and a lower prevalence of the virus among the general population, have likely only served to increase the FPR in recent months. Not to mention the largest issue of them all regarding testing, which is the unscientifically high amount of amplification cycles (40–45) used by the HSE in their testing. Here’s an explainer and defense from NPHET’s own Cillian De Gascun on the matter. But a takeaway is, you can test positive even if you aren’t symptomatic, contagious or at risk.
We see the Positive Rate was high from April through the beginning of June, assumedly due to the vast majority of tests being carried out on already symptomatic patients, or posthumously attributing the virus to those who had died. It flatlined thereafter however, staying below 0.5% for much of June and July. This is below the potential FPR range of 1–3% given by Cillian De Gascun himself. So what’s going on here? It would appear that we effectively eradicated the virus given some of the already low Positives from this period must be False Positives. It has since heightened once more but not to the lofty peaks of April and May.
Looking then to the Case Fatality Rate (CFR), we observe it peaked from May through the beginning of August. Once more we ask ourselves what was the cause? We know the CFR of the disease over time to have been 2.62%, why was it so elevated during this period? A few thoughts on why this may have been the case: recording deaths as posthumous Covid cases, an older age profile of cases (whom we know to be at more risk), or, the most pressing explanation, dying with Covid as opposed to dying from Covid. 93% of recorded deaths have featured underlying clinical conditions. In the absence of a high number of (asymptomatic) cases to bring down the CFR, it is possible it was allowed to reach new heights.
A final note on CFR, given the restrictions on testing back in April and May to only those who were showing definite symptoms of the virus, the true number of cases at the time is likely vastly under-reported. Fears of a Second Wave surpassing the First in terms of case count are widely unfounded for this reason. The original peak to which we are comparing is only a fraction of what it would be had we been testing in the same manner and to the degree which we now are.
An Agedemic
In line with previous points, the age profile of cases has changed drastically over time. Initially the highest amount of cases were recorded among the most elderly population, again no wonder, as a lot of these were Nursing Home-related. The Second Wave however sees the virus more prevalent in almost all other age brackets, particularly those aged 15 to 24. This group accounts for almost a quarter of cases since mid-September, significantly more than any other age group. What are the differences between the first and second Lockdown? Schools remained opened during the second, with plenty of asymptomatic Testing and Tracing.
ICU Beds not Required
Thankfully, we know that the disease is far less impactful to younger people. Only 0.06% of cases in 15–24 year-olds require ICU, which is to say if 10,000 cases were recorded among them, we would only expect 6 to end up in ICU. This is the lowest ICU rate of any age bracket. In fact, the highest ICU rate of any age group is still only 4.37%, and this is among 65–74 year-olds. Though the CFR is higher in 75 year-old+ cohorts, less of these deaths required ICU care given many of them were posthumously labelled a death with Covid. All this results in the median age of death from the virus in Ireland being 83. This is slightly above the general life expectancy of the country. It is not the age-indiscriminate killer we all feared at its onset, it targets older vulnerable populations who have underlying conditions, and even at that, it is not fatal for most of them.
Due to the above ICU rates, the country’s ICU beds have thankfully not been inundated, not even close since April, as has always been NPHET’s dismal R-modelled fears, and a continuous rationale for Lockdown measures.
It must be said however, that surviving Covid is not without consequence in some cases. Though there are limited data on the exact prevalence at present, the virus can cause elevated risk of thrombosis. It seems to be related to the severity of the virus in most cases. Which is to say that these unfortunate life-long ill heath effects, while devastating, would seem to occur in a significant minority of cases, and are certainly less prevalent and immediately fatal than cancers, which are undergoing seriously delayed diagnoses at the moment due to the response to the virus.
Conclusion
While we knew little about this novel disease at first, and were rightly cautious due to how contagious it was and the number of initial deaths it was causing (in elderly populations), after 9 months, the data are now in. It is not risky to most, especially the comfortable majority of case numbers reported who are younger than 55 years-old. Less than 1% of cases require ICU attention, 93% of deaths include an underlying condition, and the median age of death is higher than the general life expectancy at 83.
While we do not wish for any member of our society to meet an untimely death, the median age of death vs life expectancy point would seem to somewhat dismiss this at face value. But more importantly, there has been a huge devastating effect of the measures instigated in an attempt to respond to the virus on all aspects of life for the entire population, including but not limited to: mass unemployment, poorer physical wellbeing & mental health, delayed cancer diagnoses, increased suicides & domestic abuse, poorer educational outcomes, billions in national debt accrued which will need to be repaid, the exacerbation of poverty and inequality, and much much more. NPHET are considering none of these effects with their unrealistically negative ‘modelling’, pessimistic and unidimensional view of a much further-reaching macro situation.
The government are not being sufficiently questioned by mainstream media with regards to a quantitative cost-benefit analysis of their ongoing response to the situation. It would appear the politicians have simply generously opened up the nation’s chequebook for all (at the expense of future taxpayers, predominantly young people who are disproportionately impacted by the brunt of the measures despite being at little to no risk from the virus themselves) — with the notable exception of student healthcare workers of course in a beautiful irony. They are merely kicking the can down the road until we have a vaccine and all will be magically cured with regards to Covid. However the economy and future prospects of young people in particular will likely be in tatters at that point.
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