Covid-19: Is there a fourth wave coming? One day’s figures do not tell us much

Amid warnings of a fourth wave of Covid-19, there now is a mixture of fear and resignation in Government: fear about the sudden rise in cases, and resignation that things will get worse before they get better.

The Coalition now faces excruciatingly difficult – and high stakes – choices about reopening the social and economic life of the country, against a background of forces pushing in opposite directions: the worry about a fourth wave of the virus and the widespread sense that the public is reaching the limits of its forbearance and co-operation with current restrictions.

Warnings of a fourth wave of coronavirus infections were thick in the spring air, after the highest daily figures in almost a month were reported on Sunday.

With average daily cases stalled for weeks now, the National Public Health Emergency Team (Nphet) had been sounding the alarm already last week, warning Ireland could be "in trouble" if things worsened even only slightly

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Decisions will be made by politicians and public health officials over the next week or 10 days in advance of the April 5th deadline. But Taoiseach Micheál Martin’s interview with RTÉ at lunchtime on Monday gave a good indication of the direction in which the Government’s thinking is edging. He spoke about the need to avoid any indoor congregation but signalled that a relaxation of outdoor restrictions may be possible. This could mean a return for children’s sport, socialising in small groups outside and, sources say, a phased return for construction outdoors. The Taoiseach indicated that he expected the final phase of reopening the schools, for the remainder of secondary school students, to go ahead as planned on April 12th.

All very well, say the pessimists in Government, but what if cases take off again in the coming days? Sources briefed on the subject in Government indicate that a rise over the coming days, after social events on Mothers’ Day and St Patrick’s Day last week, could push cases up by hundreds a day. “Could you really reopen the schools if there were a thousand cases a day?” asks one official.

Easter holidays

The pessimists also wonder about the effects of the Easter holidays. “There’s a considerable degree of non-compliance at the moment,” shrugs one source. “And there’s going to be more over Easter.”

But there are other voices too, though, urging both a focus on the medium term (with an eye on the expected rise in vaccinations next month) and the factors which are keeping the numbers high.

There is a widespread view that the coming weeks will be extremely difficult, but that things will improve quickly once the vaccine programme speeds up in April and May.

And just as one swallow does not make a summer, so one day’s figures do not tell us all that much; we should know that by now. There are numerous potential causes for daily variations in the figures. The more important trend is that numbers won’t come down despite the current lockdown, so something is going to have to change.

The severity of the pandemic is best measured not by the daily numbers but by counting the death toll, the number of patients hospitalised and those admitted to intensive care units.

For three of the past 10 days, no deaths were recorded. The highest number of daily deaths was 18. This compares to a peak of about 100 deaths on the worst day of the third wave in mid-February.

The early vaccination of vulnerable groups has clearly helped to cut the death toll from Covid-19. While still deadly, we are unlikely to see the kind of mortality we witnessed twice in this pandemic again.

ICU numbers are falling slowly, while the number of patients with Covid-19 in hospital is stable or static.

We're not there yet, thanks to the slow rollout of vaccines in the EU, but we can see from other countries how things might get better. In Israel, where 60 per cent of the population has had at least one dose of vaccine, infections are subsiding despite the reopening of society.

Rather than fixating on daily case numbers, we need to home in on the reasons they continue to occur after a three-month lockdown.

Some counties are doing really well, while others are blackspots, but we are largely in the dark as to why. Why, for example, has Offaly 10 times the number of cases as Leitrim or Kilkenny over the past fortnight?

For the most part, we’re not retrospectively tracing cases, because there are too many of them. Yet there are too many of them because we are not doing retrospective tracing. These problems are not insurmountable with proper resourcing of public health, better co-ordination and better use of IT.

As the Government considers the easing of restrictions, it needs to consider all the indicators and not just case numbers. It also needs to look at the parts of our pandemic response that are not working as they should, and take steps to improve them.