With test positivity rates of up to 50 per cent, Covid-19 infections have again climbed to unthinkable levels thanks to the Omicron variant.
It is easy to be distracted by the jaw-dropping case numbers recorded over the holiday period, but the more important trends relate to hospitalisations and intensive care admissions.
The number of coronavirus patients in hospital continued to fall in the run-up to Christmas even as infections were rising, because of the time lag involved. But there were 60 new admissions on Tuesday, the highest daily figure since last February.
It is too early to say whether this is the start of a trend or simply a blip caused perhaps by reporting over the holiday period. Hospital numbers will rise, inevitably, but at least the early data from other countries further along the Omicron curve is encouraging.
High mortality ‘history’
In England for example, the number of Covid-19 patients in hospitals is up 27 per cent in a week, but still stands at only one-quarter of the levels reached last January. Doctors are reporting more cases of "incidental Covid" among patients admitted for something else but then diagnosed with the virus. One government adviser even claimed on Monday that high death rates from the virus were "history".
Denmark, given its size and high vaccination rates, is perhaps the best comparator for the Republic. Cases there, having surged to record-breaking levels, have stabilised, while hospitalisations have so far come in at the low end of projections.
Positive tests have a wider influence beyond the health system. Regardless of severity, people have to self-isolate for 10 days while their close contacts have to restrict their movement for five or 10 days, depending on whether they have been boosted.
This knocks thousands of workers out of circulation and leads to disruption of essential services and normal commerce – witness the mass cancellation of flights over the holiday period.
In the US, the Centers for Disease Control has cut the period of self-isolation for cases with no symptoms from 10 days to five, arguing that the virus is most infectious for the two or three days after symptoms start.
Something similar is likely to be at least considered here.
The Health Service Executive has struggled valiantly to increase testing capacity in response to massive need, from 150,000 PCR tests a week to 250,000 at present and shortly to 300,000.
However, the utility of PCR tests costing up to €200 a pop increasingly has to be questioned, when demand so clearly outstrips the resources available.
The HSE can tell us it takes 1.4 days from referral to result for a test but it can have little idea how long people have been trying to get on the portal to book an appointment. For weeks now, slots have been as rare as hens’ teeth in most of the country, for most of each day.
Long waits mean longer spells in isolation for those who test positive. Inevitably, some people will fail to self-isolate as required while enduring the wait for a test, with the result that virus transmission persists.
Other patients
The huge demand for testing is causing strain in other ways. One Dublin GP said she fielded 41 calls in four hours for test referrals from people unable to book an appointment online, thereby affecting provision of care for other patients.
We could suspend PCR testing for a period, and just tell people with symptoms to self-isolate. Or we could, as some doctors have suggested, make greater use of antigen testing to triage those with symptoms and identify the most infectious.
With the hyper-transmissible Omicron variant now completely dominant, the point of widespread contact tracing is also moot. If most cases are being missed, or diagnosed after a delay, what is the point of chasing the contacts of the minority that have been identified?
As the Australia-based Irish public health doctor Niall Conroy has observed: "It's useful to fairly regularly think about the restrictions that we apply and re-evaluate them continuously in terms of their utility, the evidence base and the best use of resources."