NPHET LAID OUT stark scenarios to the Health Minister about the impact on the reproductive number if hospitality was reopened and household visits were allowed.
In a private letter to Stephen Donnelly, the Health Minister, about the most recent meeting of NPHET, it said that:
“We remain especially vulnerable to a rise in reproduction number given the ongoing high case numbers per day and the high likelihood of significantly increased socialisation given the time of year.”
The current best estimate of the R number is 0.7 and 1.0, it said.
It said that international evidence which suggests that the closure of hospitality might reduce R by between 0.1 and 0.2 accords with NPHET’s national data, and the prevention of mixing between households “might have an equivalent effect on R”.
NPHET also said if restrictions are eased now, from a higher baseline force of infection, a third wave of disease “will ensue more quickly and with greater mortality than the second”.
It warned that “the disease trajectory could once again turn quite quickly” in Ireland.
Hospitality and social mixing
When it comes to hospitality, it said that the risks associated with these settings remain too high at current infection levels, and that hospitality settings and gatherings in places like bars and restaurants have been associated with super-spreading events.
Because of this, it recommended that hospitality remain closed, except for take-away and delivery, over the eight-week period. But if some element of hospitality is retained, it was of the view that the easing of measures regarding to household mixing as it set out in its letter could not also take place.
NPHET said that its advice to government is that “we do not have the flexibility to enable resumption of hospitality in restaurants and bars if we are to enable an easing of the current prohibition on mixing between households while protecting the core objectives of protecting public health and those who are most vulnerable, and the ongoing provision of essential health and social care, education and child care services”.
Using modelling, NPHET predicted that even in a very controlled scenario where R is held at 1.2 from 1-21 December, and returned to that level from 7 January 2021, “modelling suggests that the level of disease in January 2021 will present a real and substantial threat to the ongoing protection of public health and of the most vulnerable”.
But according to its modelling, if R is maintained below 1.2, case numbers remain low.
However, if R is 1.4 or greater, NPHET said we would exceed 400 cases per day in January 2021.
“If we start with higher case numbers in early December, this threshold will be breached sooner,” it said.
“Ireland is in a very precarious position where we are vulnerable to a sudden sharp increase in incidence.”
It said that while “significant progress has been made” in reducing the incidence of the disease, the five-day case average remains at a high level of approximately 300 cases with a reproduction number “which is likely to increase above 1 in the weeks following easing of measures”.
It said Ireland followed a similar disease trajectory to many other European countries during the summer, following the response to wave one. But after the introduction of level 5 measures, the country diverged from European neighbours in terms of disease trajectory.
It said that since then, we have seen a substantial reduction in disease incidence “commensurate with a stabilisation or reduction in terms of hospitalisations, critical care admissions and deaths”.
It is reasonable to conclude, said NPHET, “that Ireland averted substantial disease transmission and its associated morbidity, mortality and pressure on healthcare capacity and delivery”.
But it said that “we remain especially vulnerable to a rise in reproduction number given the ongoing high case numbers per day and the high likelihood of significantly increased socialisation given the time of year”.
NPHET said that “in simple terms many people may not follow public health advice to limit social activity” this Christmas.
A rise in disease incidence is likely to be compounded by significant inter-generational mixing in the Christmas period, it added.
NPHET said it will continue to monitor closely the effects of the move to level 3 in the coming weeks.
When asked about the above at a press conference following his address this evening, the Taoiseach said:
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“NPHET were clear you couldn’t do both in terms of the hospitality and the household restrictions.”
He said that the government has decided to maintain having no visitors until 18 December, which is more conservative than NPHET suggested.
“There are risks attached to this,” he said, adding that’s why he said in his earlier address that ”all of our behaviour is key here”. The Taoiseach also noted that a CSO survey said that there was a high level of low overall life satisfaction as far back as last April in Ireland.
He said that there are balances and calls the government has to make, given the impact on people’s wellbeing.
“I think we’re going to keep an eye on this obviously and will be working with NPHET and others to make sure this is under constant review,” said Martin.
He added: “The challenge is to get through Christmas. We want this to be sustainable.”
Things will be reviewed again on 6 January, and the government is “learning all of the time” in relation to this, said Martin.