When will we know if the latest Covid surge has us in trouble?

For a second year Ireland and the world are trying to navigate Christmas with Covid. What do we know about where we are now, where we are going, and what the powers that be will do if it all goes off the rails?

The first, most obvious and most important thing is that the Omicron variant has arrived in time to make a meaningful difference at Christmas. We will almost certainly see record highs of infection in the coming days. There are a lot of people infected with Covid, and they, in turn, are likely to infect a lot more people over Christmas.

“It’s going to rip through the community,” a senior source said on Thursday. “It’s ripping through now”.

The unknown is how many will get seriously ill. There is some suggestion Omicron may be naturally less severe, and that existing vaccine protection and boosters will protect against serious disease. So, the link between case numbers and hospitalisations may weaken further.

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This is welcome: however, there is also a level of infection at which it doesn’t really matter. Even if the number of people being hospitalised for every thousand infections drops further, if many thousands are being infected every day the threat remains the same.

Therefore it seems there is a level at which further public health interventions would be advised to protect hospitals. This is desperately difficult but Covid is relentless: it has always been the case that people mixing spreads the virus, and past a certain threshold that presents a systemic threat.

Vaccines,behaviours and mitigations have shifted the contours of this equation, but it still works in roughly the same way. That is the pitiless nature of this virus.

Optimism

How likely is that threshold to be breached?

Senior public health sources say there are grounds for optimism: there is nothing currently in the data that would prompt advice for additional measures, sources said (although the implicit caveat is clear). Restrictions were introduced early in Ireland, and the population is well versed in how they work. Vaccine penetration is high and the booster programme is performing well. So disaster is not a foregone conclusion: we could still yet “surf” this wave, one senior source said.

The next question is when will we know if we are in trouble.

This is tricky. There is likely to be a significant delayed presentation as people endure symptoms over Christmas. It will be several days before concrete signals emerge. There are many moving parts, and many of them new: the variant, vaccines, boosters and decreasing severe outcomes all impact on the metrics that tell us things might be going seriously wrong.

The key factors being monitored will be the size of the wave, the degree to which it hits people aged 40 and above, and how this translates into hospitalisations.

The rate of change will also be key. Next week if people are trying to figure out whether things are going wrong while muddling over the data that’s likely a good sign, one source said. If they’re really going wrong it will be obvious.

And at that stage experience tells us that the virus will move fast, as will the response, and the options may narrow to the grim reality of harsher restrictions.

Contingency plans

In the meantime the Government has detailed civil servants to develop contingency plans for operating in the teeth of an unprecedented wave: one aspect is likely derogations from isolation rules for certain key workers who are tagged as close contacts.

What triggers a response, how the risk of transmission could be mitigated if close contact rules change, and planning for significant events across different sectors are also under examination as the Coalition narrows its focus on keeping public services running.

A fraught, challenging Christmas period seems unavoidable. A disastrous one would cause untold political and social damage.