A Glass Half Full
A Status Report on Ireland in the Time of COVID-19
Updated: 7/4/2020
Iam a glass-half full kind of person (I think) and I have been anxiously looking for any hint that things might be going in the right direction when it coems to how Ireland is dealing with COVID-19. Each evening, I have eagerly awaited the latest ‘numbers’ so that I can do the quick calculation about daily increases to get a sense of whether things are trending downwards, as they need to be.
To be honest it’s been a bit frustrating. I dont want to get summary data on the news. I want a detailed daily data feed that I can analyse using code. But trying to get a feed of Irish data on COVID-19 has been impossible. To their credit the Health Protection Surveillance Centre provides great dashboard with some of the high-level data and the government also releases more detailed daily analysis reports (as PDFs) containing exactly the type of in-depth analysis that I am looking for — cases, deaths, hospitalisations and ICU beds etc. — but its all locked away in PDFs rather that some raw data format that can be manipulated in code. Sigh. So, as of this evening I have started to manually collect and transcribe the data from these PDFs, so that I can begin some analyses, at least until a more accessible data-feed becomes available.
For the benefit of those who might be reading this from outside the emerald isle, in Ireland we are now in a fairly strict lock-down, and increasing levels of restriction have been in place since March 13th, when school and colleges closed and people were encouraged to work from home. At the time of writing, all non-essential workers have been instructed to work from home and there are a variety of limitations on our movements. Suffice it to say that life feels severely curtailed, and as a result people are anxious to see some evidence that the restrictions, which started two weeks ago, are helping to stem the flow of infections.
On the face of it there are signs that things are heading in the right direction. For example, the graph below shows how the rate of increase of confirmed cases has been exhibiting a downward trend. Ten days ago the total number of cases was increasing by 25–35%, but this had fallen to less than 15% at the time of writing.
So is this reason to be hopeful? Yes and no. Yes, because the rate of increase is falling. No, because there is still a lot of uncertainty around testing due changing testing criteria and long post-test delays before results are known (up to 10 days). It is at least possible that the declines above might be an artefact our testing programme; if we are testing fewer people or the wrong people then the number of new cases may fall.
Okay, so does that mean we have to wait until testing improves before we can tell if our social distancing measures are working? Perhaps not. One the great things about the government’s daily analysis reports is that they provide data on hospitalisations and the number of ICU beds currently occupied by COVID-19 patients. It is reasonable to suppose that such factors provide a more accurate estimate of the current state of play of COVID-19 in Ireland. Sure, it is possible that there are unknown cases who are sick enough to require hospital care but who are not currently in hospitals — and perhaps have not even been tested — but it is likely that they are much fewer in number that the large number of mild, unknown cases that are currently missing from the total case count.
The question then becomes whether we see a similar drop in the daily rate of increase in the number of hospitalisations. As is evident from the graph below, we do see such a drop. In mid-March the hospitalisation count was growing at a rate of about 25–30% per day but this has been falling and the trend-line at the time of writing indicates a daily increase closer to 10%. A cautionary caveat is that the number of data points is still small and there is a lot of uncertainty around the trend, but if the increase in hospitalisations continues to fall then we can become more confident that our social distancing measures are helping. This is a big deal.
The recent narrative has shifted somewhat, from how many cases there are to how many ICU beds will be needed, and this is certainly a major worry for the Irish healthcare system. When we look at the rate of growth of patients that need ICU beds, since mid-March, we see a similar downward trend. Once again there is still a lot of uncertainty — there are some very large (70%) and some more modest (<10%) daily increases — but the trend suggests that the pressure for additional ICU beds is moderating from about 40% extra beds required per day to about 5% extra beds required per day.
We absolutely cannot become complacent because even a small increase in the growth rate of ICU beds could quickly overload the system.
To conclude, I think that the current measures are working. It doesn’t mean we are out of the woods yet, but there are reasons to be hopeful. The daily increase in cases is slowing, and while this could be an artefact of testing, the similar trend for hospitalisations and ICU beds should not be as impacted by testing. If we had not acted over the past few weeks, then Ireland would look very different today. No doubt the number of cases, hospitalisations and ICU loads would have increased to unthinkable levels, swamping the entire healthcare system, and bringing the country to its knees. This did not happen, but the danger is far from over. We must draw strength and resolve from our progress to date to stay home and starve the virus. It’s a simple calculus: if we limit contact to within our households and remain disciplined about virus hygiene (hand washing, disinfecting surfaces, etc.), then there will be few ways for the virus to spread.
