Holohan sets out ominous picture for January in letter to Government

It is hard to see how public health officials will not seek a third lockdown in January given their extremely gloomy forecasts of recent days.

Chief medical officer Dr Tony Holohan, both in his letter to Government last week and his comments at the National Public Health Emergency Team (Nphet) briefing on Monday, clearly foresees daily case numbers after Christmas reaching the kind of level that twice previously triggered recommendations for swingeing restrictions.

The euphoria surrounding the rollout of a Covid-19 vaccine in Northern Ireland and the rest of the UK is understandable. But for now, and many months to come, restrictions are the only way Government knows to rein in surging case numbers, when other public health measures have failed.

In his letter Dr Holohan set out an ominous picture; case numbers did not fall far enough after the last lockdown, they are already rising again, and Christmas is approaching with all the potentially risky socialising that entails.

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As a result Nphet is already revising its modelling forecast upwards. Previously it had forecast up to 1,200 cases a day by mid-January; now Dr Holohan is predicting this will be a reality by the second week of the month.

That might not seem like a big difference but it is when you are dealing with exponential growth, as seems likely next month.

That our figures have already “bottomed out”, as the chief medical officer said, is evident in the divergent trends over 14 days and seven days.

Ireland has the lowest 14-day incidence of the virus in Europe, and this rate has dropped 25 per cent over the previous 14 days.

In contrast, the measure of trends over the past seven days is up 11 per cent compared to the previous seven days, and Ireland suddenly has the fifth fastest rising seven-day incidence in the EU.

The heavy messaging of public health officials against socialising over the coming weeks may dampen festivities somewhat and curb the spread of the virus, but only to a limited extent given the high starting point after Level 5 restrictions.

High figures

Our big problem is an amalgam of smaller problems which are not difficult to discern.

First, the Border; the incidence of the virus in Donegal is 2.5 times the rest of the country, and is rising again more quickly than elsewhere. Louth also has high figures.

This is hardly surprising given that Northern Ireland has four times the number of cases as the Republic. The virus continues to spill over from the North, seriously damaging the Republic's chance of reining it in.

We also have a hospital problem. The two counties with the highest incidence at present are Donegal and Kilkenny, where large outbreaks in local hospitals are filling wards and causing deaths.

Across the country hospital outbreaks accounted for 46 deaths out of the 140 that occurred last month, more even than the 41 recorded in nursing homes.

According to Dr Holohan’s letter, there were 60 hospital clusters last month in 24 locations, involving 1,000 cases.

This is why serial testing of healthcare workers is being introduced in January, making Ireland the first country in the world to undertake such a measure. Though why wait until January?

The high incidence of cases among over-65s is also a problem, though continuing outbreaks in nursing homes may largely account for this.

Both the hospital and nursing home outbreaks are being brought under control, and another positive sign is the continuing low number of cases in schools (a trends seen in the UK and other countries).

Even so, as Dr Holohan says, a surge in January is now “more likely than not”.