As the Taoiseach assured the nation in his State address on Friday that the end of the pandemic was “within grasp”, 38 of its victims fought for breath in hospital intensive care units around the country.
hese are now mostly people in their 30s, 40s and 50s, unvaccinated, some with no underlying health issues and some will have small children.
It used to be the case that most of those in ICUs were older people because the risk of getting severely ill from Covid-19 increases with age. The number of people critically ill in ICUs has fallen dramatically from the 221 peak in the third wave. But so has the age profile, as the virus works its way through the unvaccinated.
According to Colman O’Loughlin, the president of the Intensive Care Society of Ireland, one of the most extraordinary impacts of the Covid-19 vaccination programme has been how young patients have supplanted older patients in ICU, albeit in much fewer numbers.
“We are seeing young people in their 30s and 40s coming into ICU,” he said.
Some have been in ICU for two to three months. “It is worth noting that several of these patients are in their 30s and 40s. These are patients who would have been incredibly unwell, patients who came very close to passing away but who managed to keep going,” said Dr O’Loughlin, who is an intensive care consultant at the Mater hospital in Dublin. Four of the six critically ill Covid patients currently in his care are under 50.
More recent hospitals admissions are those who were too young to be eligible for the vaccine and unlucky enough to become critically ill.
“It is not the case that if you are young and fit and healthy that you are completely immune to this,” he said. “Of the people in their 30s, 40s and 50s that we see at the moment, some of them have no risk factors,” he said. “They are not smokers, not obese or diabetic and are not on treatment for heart disease. They are incredibly unlucky.”
Youth alone does not ensure survival. “The bigger hospitals can all speak to young people who, if it wasn’t for Covid-19, would be alive today. Thankfully it is rare but it does happen,” he said.
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Many who survive suffer lasting after-effects. “We have a celebration for patients when they leave ICU. For them, they have travelled only a quarter of the journey and there is a lot further to go,” he said.
“It is a disease that hasn’t gone away. Thankfully the rates have gone down because the highest risk groups have been vaccinated. But it is not the case that we are in the clear. For sure, it’s not,” he said.
No one wants put wants to put a dampener on the eagerly anticipated, much longed-for return of lost freedoms. But people on the frontline of health care who have battled through three waves of Covid-19 say the path back to normality is fraught with risks.
The good news is that more than 1.5 million people have received one shot of the vaccine and around 560,000 are fully vaccinated. Deaths have been “virtually eliminated” from nursing homes and, according to recent HSE figures, eight people have died of Covid-19 in 12 days.
But the daily confirmed cases are stuck around the 400 mark. Tánaiste Leo Varadkar warned his party colleagues last week that 2.5 million people remain to be vaccinated and a “fourth wave” of the pandemic is possible. The surging B.1.617.2 or so-called Indian variant that now accounts for more than half of all cases in the UK, has started its ascent in Ireland. The number of detected cases rose from 72 reported last Friday week to 128 on Monday.
Aside from the 2.5 million unvaccinated people, tens of thousands are awaiting their second shot of AstraZeneca — currently administered at 12- week intervals — and are just 33pc protected against the variant. Many of those are in their 50s and 60s and vulnerable to serious illness. Even two shots of AstraZeneca give just 60pc protection against the new strain.
Irish scientists who are part of the Zero Covid-19 group have warned that the variant is “spreading like wildfire” across the UK.
“We’ve little chance of keeping it under control if it gets established here, and it will if we open up as a fast as we are now planning to do,” tweeted Professor Anthony Staines on Friday.
Meanwhile Limerick is an example of how the path back to normality can veer dangerously off-course. Public health doctors reported a surge of 272 new cases in eight days, blamed not on wild student parties, but on people of all ages meeting mostly in private homes.
According to Dr Ina Kelly, chair of the Irish Medical Organisation and a public health consultant, the risks of lockdown are close to outweighing the risks of reopening.
“We [public health consultants] are cautious because our role is to protect the physical health of people. But it is also to protect their mental and social health, so we have to be pragmatic as well,” she said. “The benefits of the restrictions will continue. The risks are becoming much more significant from an economic perspective and a mental health perspective.”
Public health doctors expect a fourth wave “of some sort” but with reduced mortality and sickness. “The biggest risk to us now are new variants of the virus, especially variants that we are too unprotected against. Our biggest protection against that is the mandatory quarantine system.”
The balance has shifted. Younger people awaiting vaccination have replaced older people as the cohort now most at risk of Covid-19. The numbers who will get severely ill from it are statistically tiny but immeasurably significant for those unlucky few.
Contrary to public perception, young people are largely cautious, according to Professor Pete Lunn of the ESRI's behavioural research unit. Data shows an increase in people moving about, he said, but it is amongst older vaccinated people.
“The impression we get from the data is that there are a lot of people waiting to get vaccinated before changing their behaviour.”
“There is no doubt that fewer people in their 30s and 40s will require hospitalisation,” said Colman O’Loughlin. “But the fact is that some will. That is the catch. Some will. It is tragic because it is the age group that will have young families as well. And that is really tough.
"Nobody out there knows who those people are. It could be anyone in that age group who could get sick if they are not vaccinated.”
While Dr O’Loughlin believes society must start functioning again, the message for continued vigilance cannot be overstated.
“Many people out there under the age of 50 are still exposed to this virus,” he said. "People should be aware of that. People need to take precautions for a bit longer, until we get past this.”