Covid infections surge across Ireland as Omicron takes hold
10 January 2022
People wear protective face masks while out Christmas shopping in Dublin.
Over the course of December and early January Ireland has seen a surge in Covid infections. As the highly mutated and highly transmissible Omicron variant has become dominant the figure for infections has reached a level that dwarfs those seen in early periods of the pandemic. The record number for daily cases is set and then soon surpassed while the peak of this wave still to be reached. Yet in the face of this surge both the Irish government and the Stormont Executive limit themselves to the most minimal interventions.
In recent weeks the south has seen surging infections associated with the increasing dominance of the Omicron variant. This comes in the wake of an extended period when infections were already rising albeit at a more gradual rate. Indeed, cases were already on the rise in early September when the Irish government announced its timetable for the lifting of nearly all Covid restrictions. From then the number infections, and also hospitalisations, continued to not only rise but do so at a faster pace. On September 1st there were 1796 daily cases; 360 Covid patients in hospital; with 56 in ICU. By October 22 - the day on which the last remaining restrictions were lifted - the corresponding figures were 2474 cases; and 457 patients; with 90 in ICU. This continued through the unexpected late autumn wave until early December. On December 5th, 5,156 new cases of Covid-19 were reported by the Department of Health while the number of hospital patients stood at over 500, of whom 110 were in intensive care. All this was before the Omicron variant had a presence in Ireland.
It was in this context - of rising Delta related infections - that the Irish government reinstated a number of restrictions. On the evening of Friday December 3rd Taoiseach Micheál Martin announced a range of measures that would come into effect the following Tuesday and be in place until January 9th. These measures were relatively limited. They included the closure of nightclubs; the reduction of attendances at indoor events; limits on mixing between households: and hospitality venues only being allowed to operate on a table service basis. A number of financial supports were also reintroduced. Despite the limited scope of such measures the Irish government viewed their reinstatement as a major blow to its plan to wind down its pandemic response. As in earlier periods of the pandemic - when public health advice came into conflict with the government’s priorities - officials were blamed. There were numerous off the record briefings on how ministers felt they were forced to change course by reports and correspondence being made public. It was reported that a Cabinet subcommittee on Covid, attended by senior officials from the National Public Health Emergency Team (Nphet) to discuss its advice, was “very tense” with several Ministers expressing frustrations. Tánaiste Leo Varadkar was said to have been “very critical” of the public health team, saying he felt their media appearances were making it difficult to communicate about the pandemic. In response to these reports the Taoiseach denied that public health officials had been “gagged”. Micheal Martin said that the Government would continue to follow advice from Nphet but that ultimately ministers would decide. He added that the Government would “need to hold our nerve”. The ominous import of this was that the introduction of further public health interventions would be resisted even in the face of a deteriorating situation.
This stance came to the fore as the Omicron variant established itself and became dominant. As December progressed the level of infections grew rapidly and by the middle of the month daily cases were averaging around 5000. The number of hospital patients had risen to over 400, with more than 100 of these in ICU. In a letter to the Government, chief medical officer Dr Tony Holohan warned that at a peak of infections, between 2 per cent and 5 per cent of the population could be infected with Covid-19 at any one time, and between 6 per cent and 25 per cent could be a close contact of an infected person. He stated that consequences of this for essential services and the wider economy were “significant” and that the risk of excess demand for healthcare was “very high”. Under the most optimistic scenario modelled by Nphet - at the peak of infections there would be between 8,000 and 10,000 cases per day, 500-750 people would need general hospital care for Covid-19, and 150-250 people would need critical care, or some 650-1,000 people in total in hospital. The pessimistic scenario projected in excess of 20,000 cases per day, over 1,500 people requiring general hospital care, and in excess of 400 people requiring critical care, or more than 2,000 people in total in hospital. Dr Holohan also warned that any surge of the disease would be “amplified by increased effective social contact over the Christmas period”.
What is notable is that this stark warning over the likely progress of Omicron - and advice regarding the holiday period - was largely ignored. While some further restrictions were announced on December 18, they amounted to no more than minor adjustments (such as earlier closing times for pubs and restaurants) to what had been announced earlier in the month. There were no changes to the number allowed for household visits or to domestic travel for the Christmas period. It was also stated that there were no plans for further Covid-19 restrictions before the end of year. What was announced in advance was that schools - despite their role as a driver of infections - would return as planned in January. In the earlier period of the pandemic the Irish government had gone along with advice from health officials - even if this was often partial and half hearted. The unambiguous rejection of advice this time marked a decisive shift by the Irish ruling class - in common with those in many other countries - away from public health interventions, leaving little beyond vaccination as protection for the population.
However, even with a high level of vaccination, infections have continued to rise dramatically. From averaging around 5000 daily cases in mid-December by December 24th that daily number had risen to over eleven thousand. We have also seen the lagging indicator of hospitalisations begin to rise dramatically. On December 24th the number of Covid patients was reported as 393, but by January 1st this had risen to 656 and on January 10th it had passed the 1000 mark (for the first time since last February). Over the last week the figure for daily cases has been regularly surpassing 20,000 (with a record 26,122 cases being confirmed on January 8th). These numbers for infections and for illness requiring hospital admission are not far off those in the worst-case scenario projected by Nphet. Given that we are not yet at the peak of the Omicron wave it is possible that these could be exceeded. The number that has remained steady is for those patients that require intensive care. It has been around the 90 mark for an extended period despite rising cases. This is well below the worst-case scenario projection of 400 and also the actual figure of 200 during the height of the pandemic in January 2021. The number of deaths is also low. This suggests that vaccination is continuing to hold the line against the most serious form of the illness and that Omicron itself may be less severe than previous variants. However, the sheer volume of cases, combined with its disruptive impact (close to 15,000 staff are absent due to the virus), are exerting huge pressure on health services.
Northern Ireland has also seen rising Covid infections related to the increasing dominance of the Omicron variant. As with the south this trend has been accelerating over the course of December and took a jump upwards in the final week of that month. Almost 23,000 people in Northern Ireland tested positive for Covid-19 over the Christmas period. According to figures released by the Department of Health (on 29th Dec) 22,972 new cases of the virus - or approximately 4,500 cases per day - were confirmed during the five-day period between from midnight on December 23rd to midnight on December 28th. This number for new positive cases represented a significant increase from the previous daily case record of just under 3,300 cases per day, which was reported as recently as Christmas Eve. The 3,000 positive daily cases mark was exceeded for the first time on December 22nd. The growth of infections continued to accelerate rapidly as December drew to a close. On December 31st, just nine days on from that 3,000 daily cases mark being hit, the Department of Health reported another record high of 7,215 new cases. The extent of the spread of the virus is even more stark when we consider that for the first half of December the number for daily cases was averaging around 1,500.
One of the consequences of rising infections has been an increase in hospital patients. Given the period between infection and the development of serious illness this was not immediately apparent, but two weeks on from Omicron establishing itself as the dominant strain, these numbers are once again on the rise. This reverses a trend, which since mid-November, had seen the number of Covid patients in hospital fall from the 400-500 range (which it had been in since mid-August) to below 300 by mid-December. While this still represented about 8% of the hospital population it was a significant decrease. The fall in hospitalisations aligned closely with the roll out of the north’s booster problem from early October onwards. However, as mentioned above, the figures for hospitalisation are now rising. On Christmas Eve (24th) there were 256 people with Covid-19 in hospitals; on Wednesday (29th) that had risen to 277 patients; and on Friday 31st December the figure was 314. In relation to hospitals there were rises in all categories over the final week of December with admissions at 186 (up from 145 the previous week) and ICU beds occupied by Covid patients standing at 34 (up from 32 the previous day). There are now just seven (out of a total of 96) ICU beds available. Almost every hospital in Northern Ireland is operating beyond capacity. Overall, the capacity of the healthcare system is at 105%. The number of Covid related deaths is also on the rise with 18 reported in the last week of December (up from 13 the previous week).
These figures show how precarious the situation is in the north particularly in relation to pressures on the health care system. While we have seen regular reports of new record high infection figures there have been warnings from health officials that the peak of the Omicron wave will not be seen until the second week of January. The full impact of that, in terms of illness, will hit towards the end of the month and into early February. Given the already weakened state of the health service - both as result of years of cuts and the already accumulated impact of Covid - any increased pressure risks pushing the system towards collapse. The disruptive element of the pandemic to the normal operation of the health service has had - and will continue to have - a hugely negative impact on a wide range of people who suffer both from Covid and non-Covid conditions.
This accumulated impacts of Covid have been particularly severe in the north as it has really had no respite from the pandemic over the last year. While the current upsurge is following a similar trajectory to the south - unlike the south - it is not surging from a relatively low point but from a prolonged period when infections and hospitalisations have been at a high level. Case numbers were on the rise from July. They dipped a bit, but stayed high, between mid-September and late October. Those numbers continued to rise steadily until the dramatic Omicron upsurge of mid-December. During that pre-Omicron period (from the beginning of August to mid-December) there were very few days when the number of daily cases was below 1000. On most days it is well over this mark. Between August and mid-November, the number of Covid patients in hospital was in the 400-500 range. At times Northern Ireland was recording some of the worst infection and death rates in the developed world.
The poor record of the north on Covid is largely down to the abysmal leadership coming from Stormont. Over the past two years we have had political leaders ignore the public health regulations they had enacted; MLAs claiming financial supports they weren’t entitled to; a minister blaming one section of the population for the spread on the virus; MPs and MLAs ridiculing and mocking public health officials; and one-party using a cross community device to veto proposed public health measures. While the DUP have been responsible for most of this - aligning itself with the most right-wing elements of British Conservatism that rail against even the most minimal restrictions - all the other parties have accommodated their anti-scientific bigotry. In the politics of the north, keeping the Stormont institutions intact - no matter the level of incompetence or corruption - has taken priority over public health.
So, the familiar pattern - of denial followed by belated half measures - has repeated itself once again in Stormont’s response to the latest surge. In early December when infections were rising - and the emergence of the Omicron variant was being viewed with increasing concern - the Executive took the decision to do nothing, merely restating the existing guidance. Deputy First Minister Michelle O'Neill said there are no plans to increase the level of Covid-19 restrictions before Christmas Day and that existing restrictions were "sufficient". The Executive continued to do nothing despite being presented with a paper from health officials in mid-December which warned that there could be 11,000 Omicron variant cases each day in Northern Ireland in a worst-case scenario by the end of the month. The paper also stated that action would be needed for a "reasonable chance" of keeping hospital inpatient numbers below 1,000. First Minister Paul Givan said "more clarity" was needed on the issues before the Executive could act. It wasn’t until December 22nd (the same day that daily infections passed the 3,000 mark) that the Executive announced further public health measures. In the event what was announced was quite minimal - consisting of the reintroduction of some restrictions in hospitality venues and the restatement of guidance around household mixing and the wearing of face masks. Given the deteriorating situation at the time - and the projections of what was to come - these measures (to be put in place between December 26th and January 13th) appeared completely underpowered. They certainly did not match up to the warning from Michelle O'Neill a few days earlier that Omicron would hit the north "like a ton of bricks". The Executive met again on December 27th - when they must have been aware of the dramatic rise in infections over the Christmas period - but once again decided to do nothing. In the first nine days of 2022 Northern Ireland’s Department of Health reported 58,000 cases of Covid19, an average of 6,400 a day, and more than the entire first six months of 2021. On Jan 7th it was reported that there had been 241 hospital admissions in the past week (up from 233 the previous week; that there were currently 402 inpatients (up from 398 seven days ago); and that there were 31 Covid ICU beds occupied. Over this week a further 20 Covid deaths were reported, bringing the total number of deaths to over 3,000. The Executive met again on January 6th and once again decided to do nothing.
Both the Irish government and the Stormont Executive are following what can be described as a “wait and see” approach to the Omicron surge - holding off the introduction of stronger public health measures in the hope that the current extremely high level of infections will not translate into large numbers of people requiring hospital treatment in the coming weeks. The underlying assumption is that the booster programme (on top of an already high level of vaccination) will continue to hold the line against serious illness and death. There is also the expectation - encouraged by the experience of other countries that have gone through the Omicron surge - that this variant will prove to be less severe than those that preceded it. In all this - as it has been throughout the pandemic - the primary metric in these calculations is the capacity of health services to cope under increased pressure. The measurement for success that has been set - of keeping hospitalisations below the peak of January 2021 - illustrates this very clearly. The task is limited to riding out the immediate storm of the latest wave and then managing Covid as it moves towards an endemic state. This new status quo is often summed in the phrase “learning to live with the virus”. Anything more ambitious than this - such as elimination - is dismissed as unrealistic or too costly.
Given the low bar Stormont and Dublin have set themselves, their measurement of “success” may be achieved. The continued resilience to illness conferred by vaccination and the probability that the Omicron variant is less severe than Delta would point towards that. However, there are other trends that point towards a more negative outcome. While vaccines are still effective, they are not as effective as before - they have a reduced efficacy against the Omicron variant. This may be marginal but even a small decrease can translate into many more people becoming ill. Moreover, while there may be a smaller percentage of those with Covid suffering serious illness, this could well be offset by the greatly increased transmissibility of Omicron and the impact of a much higher number of people being infected within a shorter time frame.
The experience of this pandemic - as with all communicable diseases - is that prevalence rather than severity - is the key factor. Covid 19 (in the form of the Omicron variant) has never been more prevalent than it is today. While the current wave may be shorter in duration than those that went before. And while illness may be less severe on an individual level - its disruptive impact on a societal level could be much greater. This disruption and its consequences will be seen most immediately in health services. Already in a poor state - and having suffered the accumulated impact of the pandemic for almost two years - they will be under pressure like never before.
The Irish government and the Stormont Executive are repeating the same mistakes they made during the peak of the pandemic in early 2021 when delays in introducing public health measures resulted in avoidable illness and death. They counter this charge with the claim that the achievement of high levels of vaccination now makes such measures unnecessary. Behind this is the unstated assumption that infections no longer matter. Yet the emergence of the Omicron variant shows this to be false. The positive impact of vaccination is always at risk of being undone if the virus is allowed to spread through large population pools where it will have the opportunity to mutate and evolve. A highly vaccinated population within national borders is not a guarantee of protection. What is also being left out of this equation is the impact - on both individuals and society - of Long Covid - the persistence of symptoms after initial infection. For many people Covid 19 will not be a passing illness - whether that be mild or severe - but one that also causes chronic conditions.
The alternative to the “learning to live with the virus” approach - which is really just a repackaging of the “herd immunity” proposition from the earlier period of the pandemic - is a strategy for the suppression and eventual elimination of Covid 19. Most immediately this requires the application of effective public health measures in order to reduce infections and break community transmission. The objective should be to get to a state where the virus is suppressed and remains suppressed. To be sustained over a longer period this will require the creation of an effective monitoring, testing and tracking regime under which outbreaks can be quickly detected and contained. Another critical element of such a strategy is that it is international. The experience of the pandemic shows that national responses, or nationalistic responses, do not work. This has been exposed by the limitations of a vaccination programme which has barely advanced in many developing countries. Such inequities - the results of the hoarding of vaccines by Europe and North America, and the protection of vaccine patents (restricting their production) - have undermined the global fight against the pandemic.
It is claimed that a suppression strategy is impossible to pursue. However, this ignores both historical evidence and contemporary experience. In the recent past it was possible to suppress a number of communicable diseases (measles, mumps, & rubella) and completely eliminate others (smallpox and polio). There are countries and the regions in the world today where governments have adopted - or even partly adopted - a suppression strategy against Covid 19. In Asia - China, South Korea, Taiwan and Singapore - are exemplars of this. In the Pacific region there is New Zealand. These states succeed in suppressing the virus - even before mass vaccination - and have continued to keep it under control. As a result, rates of illness and death have been much lower than in countries where the virus has been allowed to spread. The critical point to be made about this is that there is nothing new or innovative about this approach or the methods employed. Health authorities in these countries are merely following the long-established playbook for tackling communicable diseases. That this hasn’t been done in the most mature capitalist societies of the world demonstrates the degree to which the collective capacities of these states and their political leaderships have decayed.
The same is true for Ireland. Despite the self-congratulation the authorities have not handled the pandemic well. Ireland - both north and south - has done well with vaccination but in terms of infection and death rates it is comparable to - and sometimes worse than - other countries in Europe. One of the most glaring failures has been the lack of coordination between Belfast and Dublin and absence of common public health measures and regulations across the island. The weaknesses of a national approach have been mentioned above but in Ireland we haven't even reached that level.
At this stage of the pandemic the approach of Irish authorities is much the same as the Boris Johnson government in the UK. They share the same assumptions about how pandemic will develop and how states should respond. These are that the current Omicron variant is mild; the virus is entering an endemic state; and that the current wave and what follows can be managed through the most minimal public health interventions. However, all of these are doubtful, and there is evidence - particularly in relation to the increasing pressures faced by health services - that this high-risk approach has already backfired.
The main reason Ireland has failed on the pandemic is that its flawed strategies have largely gone unchallenged. There hasn't been any opposition from the trade union movement - either over workplace safety or the health of workers more generally. Trade unions have endorsed the government’s position. Wherever resistance has arisen - such as among teachers over the full return of schools - they have worked to impose government directives on their members. In the face of the latest surge of infections the demand from ICTU is for the reconvening of the Covid-19 stakeholders’ forum to discuss proposals to relax rules around isolation. There’s no suggestion that anything more should be done to improve the safety of workplaces. What’s on the agenda is another reckless move which will increase the risk to the health of workers. The only concern of ICTU is that the illusion of trade union influence is maintained by including them on a committee. It is also notable that the trade unions - despite their claims to be organised on an all-Ireland basis - have avoided any calls from an all-Ireland strategy. Even in the midst of the greatest public health crisis in 100 years the priorities of partition and social partnership continue to prevail.
A working-class programme for the pandemic would base itself on the strategy of suppression and elimination. It is the only sure way of removing this threat to the lives and livelihoods of workers. Such a strategy has a sound foundation in medical science and practice. In Ireland, at this point in the pandemic, there should be a demand for the immediate introduction of public health measures that will reduce the current high levels of infection. These should include working from home; remote learning; and restrictions on indoor gatherings. The confirmation that Covid is an airborne disease requires mitigations such as the improvement of ventilation and air filtration in schools and workplaces as well as the supply of high-quality masks need to be given greater prominence. Testing must also be expanded with the provision of LFT/antigen test kits to homes and workplaces. All of this should be underpinned by financial support for workers who have to isolate or who are in sectors of the economy that have been adversely affected. Beyond this latest surge there will be a need to create an effective monitoring, testing and tracking regime under which outbreaks can be quickly detected and contained. This will have to be done on an all-Ireland basis and also in coordination with other countries. For this strategy to be effective it will have to be advanced at both a national and international level.
While there is a cost attached to such a strategy it is becoming increasingly clear that it is not one the ruling class in Ireland is willing to pay. They want a return to some form of capitalist normality even if that means allowing Covid to remain at a level where it continues to spread within the community. The fight for health is at its heart a class struggle. Moreover, it is also a political struggle that will come up against the twin pillars of capitalist rule in Ireland - partition and social partnership. Any groups of workers who resist the consequences of “living to live with the virus” - will immediately find themselves in conflict with the existing leadership of the labour movement. This battle - to achieve independence for working class organisations - has to be won if any struggles - around the pandemic or anything else - are to advance.