On Friday, the Government announced an 8pm curfew for pubs, restaurants and other indoor settings to reduce social mixing in order to suppress the fast-spreading Omicron variant.
Other countries have gone further. The Netherlands has closed all but essential shops until January 14th and radically reduced household mixing in a nationwide lockdown designed to quell a fifth Covid-19 wave. Here, the declaration on Sunday that the variant is now dominant raises the spectre of more severe restrictions given how Omicron cases double in just a matter of days.
While Omicron is spreading two to four times faster than the Delta variant, it is not clear whether it will lead to similar or more severe disease, or what effect the State’s widespread vaccination programme will have on preventing people from getting seriously ill.
Even if a small percentage of a larger number of infected people become severely ill, that will result in large numbers of severely ill people requiring hospital or critical care.
National Public Health Emergency Team (Nphet) modelling indicates there will be 8,000-10,000 new cases a day if social contacts fall by 10 per cent under the most optimistic assumptions for Omicron but the numbers could exceed 20,000 a day under a pessimistic outlook.
Hospitalisations during this coming wave could range from 500-750 to more than 2,000 from the best- to worst-case range, with between 150 and 250 people requiring critical care under the optimistic scenario, putting an already over-burdened healthcare system under severe strain.
‘Stricter’ measures
These figures raise questions about whether the Government went far enough with the restrictions or whether more severe action will be required to flatten the Omicron curve.
The views of medical, science and public health experts vary.
Ruairí Brugha, emeritus professor of public health at RCSI University of Medicine, believes “stricter ‘lockdown’ measures” such as pub and restaurant closures will be required before the end of this week and may need to last four to eight weeks to control a high volume of cases.
He expects “a lot of shutdown of public sector events” starting this week before being reviewed in January. He foresees Omicron cases spreading “like a fire, just sweeping through”.
“I don’t think we are quite prepared for it. I don’t think imposed measures at this point will have a huge effect,” he said.
He expects the vast majority of new Covid-19 cases – 90 to 95 per cent – to be mild and “managed within people’s homes” but this will still make for a “surreal” Christmas.
"There will be a requirement for people to take control more seriously. The good thing in Ireland is that the population has been ahead of the politicians," he said.
Dr Ray Walley, a Dublin-based GP and associate professor of general practice at UCD, thinks that the restrictions are "appropriate" and much will depend on the basic health measures people take.
Fast decisions
“We are coming to a period at Christmas whereby it will be really in our own hands what we do and how much we mix. There is a natural break for some period over Christmas. I hope that will work to our benefit,” he said.
Still, he feel the Government will need “to move very quickly” if tougher action is required to protect the health system and to reduce the likelihood of healthcare workers becoming sick.
“It needs the support of politicians to make decisions quickly because whatever decision is made now it takes 10 days to see the results,” he said.
Intensive care consultant Dr Catherine Motherway expressed concern that even if one person in every 1,000 out of 9,000 new daily cases required critical care, it would be "too much" for a system still treating 100 Covid-19 patients in ICUs – a third of its capacity – from the Delta wave.
The head of University Hospital Limerick’s intensive care unit hopes that the public understands just how infectious this new variant is and that people take their own precautions, “meeting in smaller groups and safely”, without the need for more severe restrictions.
“After almost two years of living with this, we shouldn’t need to be locked down to know what to do. We should know what to do,” she said.
“If we cannot control it by this particular set of restrictions, I would hope our politicians will make hard and unpopular decisions if they have to.”
Dr Anne Moore, a vaccine specialist at UCC's school of biochemistry, said the Government had to plan for Omicron cases translating into hospitalisations at the same rate as the Delta variant.
Surge of cases
If that scenario materialised, then the country would be “in a very bad place again”, she said.
“The Government is damned if they do and damned if they don’t to try to mitigate that, if it does happen,” she said.
Restrictions and going into a lockdown are “all about preventing” a surge of cases into hospital.
“We still have not done anything about that. We don’t have a solution to that,” she said, adding that the Government needed to be “incredibly cautious”.
“Nobody wants the dark, dismal days of last Christmas where everybody was locked down. Christmas is the end of the week. We do need to see some progress and we are not,” she said.
Prof Anthony Staines, head of health systems at Dublin City University, said the high case numbers and arrival of Omicron had left the country in "an emergency-brake situation."
“We should be saying to everyone: stay home, don’t go out, don’t go shopping, don’t visit anyone else. If you are going to visit anyone, do antigen tests before you go,” he said.
Prof Staines, a member of the Independent Scientific Advocacy Group said that an eight-week lockdown – similar to the lockdown of last winter – could bring cases down. The group has in the past called for pre-emptive, short and hard lockdowns as a last-ditch effort to eliminate the virus when case numbers reach high levels. *
“You are trying to stop the hospitals being flooded. What’s driving decisions in the Netherlands, which has a much stronger hospital system, is they are afraid their hospitals will get flooded. Our hospitals are full right now,” he said.
“I don’t see how we can avoid hospitals being flooded without some restrictions on movement. I really hate the thought of that but I think that is a reality.”
* This article was amended on December 20th, 2021.
