Nursing home patients lose big in the All-Ireland Coronavirus Championship

Covid-19 galway

I was watching the Queen’s speech to her royal and loyal subjects the other night. I couldn’t help but marvel at all of the things that she has lived through, stretching back to World War Two.

While Boris Johnson was getting carted off to St Thomas’s hospital in London, stricken down by the dastardly coronavirus, there she was addressing the nation. Calming 60 million of them and reminding them that this too shall pass. She outlined the attitude and characteristics that would help guide them through these choppy waters. I was delighted that a little humour was high on her list. So with that in mind let us proceed.

There is an often used legal strategy, one you’ve probably seen in whatever Netflix legal drama your overdosing on in quarantine. It usually involves, in one of it’s episode’s, a theme around the big guy vs little guy. The little guy usually has right on his side but is scant of resources. The big guy usually has wrong on his side but has seemingly unlimited resources. And so the dance begins.

In these scenarios, the little guy will usually look for exculpatory information from the big guy to assist him/her in his cause. The big guy will either attempt to hide the information or even worse, provide the information but ensure it is buried in a limitless amount of other information. On the latter strategy, the idea is to exhaust the little guy’s resources.

I am reminded of this, in a weird way, when digging through COVID-19 data from Ireland and around the world. Today, I’m going to look at some of the winners and losers of the COVID-19 outbreak in Ireland. Well mainly the losers, to be honest, but the purpose isn’t primarily to criticize. Rather to highlight that we can do better in the weeks ahead.

For the purpose of this exercise I am using data from the Health Surveillance Protection Centre. All graphs and information in this piece is from that source. Specifically their series of data reports entitled ” Epidemiology of COVID-19 in Ireland “

For the nerdy amongst you can find the full series of reports here

I suppose I should start by offering my own opinion and see if I can back this opinion up with the available data. You can decide for yourself then if there is something in what I am saying. And if there isn’t, hopefully, you’ll be inspired to do a little digging yourself. The more people asking questions the better as far as I’m concerned.

The overwhelming losers in COVID-19 Ireland have been nursing home residents and health care workers.

The first point to note is that there is no shortage of data on either of the above sectors of our society. The only criticism I would have is that some of it is a little opaque. Each day a mass of data is generated around the number of new coronavirus cases and the number of new deaths. Here in Ireland and around the world. For most people this is quite enough information to digest on a daily basis.

However to make headway in trying to forecast trends or indeed understand what has happened in Ireland during the past month (March/April 2020), this unfortunately is not enough. There is a mountain of underlying data beneath each day’s headline grabbing case numbers and it is necessary to dig through this daily too to try and paint a picture of what is actually going on. If you have the time and most of us don’t. Like the little guy most of us don’t have the resources even when we have the inclination.

The weather has taken a little turn towards the summer in the last few days, in the old world that would bring to my mind thoughts of the May-time and the dawning of the GAA championship season. As a Galway-man speculation on the trending fortunes of Galway and rivals Mayo is never far away. To entertain myself, if not the Queen, I thought I would highlight the fortunes of these two specific counties in the coronavirus championship that has usurped this year’s race for the All-Ireland championship. And in the process make a broader point – Hopefully.

The first positive in doing this, is that analysis of the cornavirus championship has an obvious advantage over that of a football championship. We are indeed able to level the playing field to a degree. Rather than focus on numbers of cases in each county with all the inbuilt bias that implies depending on populations, we will instead focus on the number of cases per head of population and in this particular scenario the number of cases per 100,000 people in each county. So each county starts the championship on an equal footing in terms of numbers.

Now, when you represent this graphically, as the HSPC has done below, we can see exactly the effect the coronavirus has had on each county and there are some surprises. I am using two different points in time, less than a week apart, to see how each county performed in this particular round of the championship.

The first game between Galway and Mayo was played on April 2nd or thereabouts and it was indeed a tight affair. Rather than describe it, let me allow the HSPC, to graphically represent it instead.

The first thing you’ll notice is that the two teams were very evenly matched at this point. Mayo slightly ahead of Galway with 48.7 infections per 100,000 people as opposed to Galway’s 40.7.

Importantly both were performing very well and defending tigerishly against the devil that is COVID-19, and almost 4 times better than the epicenter in Dublin. population density doesn’t have the same advantages in this particular set of Hunger Games. With Dublin reporting an infection rate of 167 cases per 100,000 people.

However over the course of almost a week the fortunes of one county deteriorated rapidly and took a nose-dive. And that county was Mayo. Within 6 – 7 days Mayo had suddenly double the number of infections that Galway did on a per head of population basis.

This is one reason why careful analysis can be useful. On the bare bones of actual number of cases Galway still as of today (April 10th 4 pm) have a few more gross number of cases than Mayo but when you look at it properly below, you can see that Mayo have an infection rate of 99.6 per head of population to Galway’s 51.9.

The Question is WHY has this changed so dramatically over the course of a few of days?

Has Mayo’s Sam Maguire jinx followed them into the coronavirus world you may wonder. I think not. There is a more prosaic reason and in my opinion the answer lies in observing the data related to nursing homes and other residential care type facilities. Let me attempt to prove that point here now.

On April 2nd there were a total of 12 cluster outbreaks in the West of Ireland that were associated with nursing homes, hospitals and what I would broadly categorize as other long term residential facilities. And again I’ll allow my glamorous virtual assistant Marty Morrissey show you a diagram below to analyse.

Now by April 6th 2020 this field of play had changed and the picture had altered somewhat dramatically. The West of Ireland were now reporting cluster outbreaks in 22 locations. The biggest jump was in the number of nursing homes reporting cluster outbreaks.

In 4 days it went from 4 to 13. An increase of 9 nursing homes in 4 days. Now I am not saying all of these outbreaks happened in Mayo but what I am saying is that Mayo is the only county in the West that has seen it’s infection rate double in the same period of time. Roscommon had a large increase too but they were operating off a very low number of cases to begin with. And similiar their football team the Rossie’s can make a few footballers go a long way.

I would find it difficult to believe that Mayo’s sudden doubling could happen on just an individual case by case basis. It is possible but I would venture unlikely.

Coronavirus cases Galway and the west

I must point out that the word cluster can be a misleading in the current coronavirus conflict. The HSE define a cluster as anything more than two people in the same location. It would be interesting to get the actual numbers of people infected in residential care facilities in each county as opposed to the more opaque cluster groups that they give us by region. The below diagram suggests that the total number for ALL cluster groups is 1288 as of April 8th 2020. I suspect that might not be the full story.

We have not received detailed information about how the HSE responds to outbreaks in nursing home and residential care facilities. I would have thought that when one person whether it be a health worker or a resident is infected that the whole institution would be immediately prioritized for testing, lockdown and protection. That in essence there would be emergency response units deployed to lock it down.

It is in these scenarios that reporting numbers can get lost – if the cluster patients and staff associated with the infected person are not tested in a speedy fashion. We have seen that France again today are reporting more residential care deaths that were not previously reported. This is fine as long as we have a mechanism to add them later.

The question is do we in Ireland?

These two groups are the most at risk categories of people and bizarrely they’re also the most vulnerable to spreading the disease rapidly. And I fear that is exactly what has happened in the first few weeks of the outbreak in Ireland. The numbers and data are too overwhelming to ignore.

26% of all people infected are Health Workers.

206 out of 299 of the cluster outbreaks have been in a nursing home, hospital, residential care facility or long stay unit. Overall I think Ireland have done a pretty good job on social distancing and our actions have probably prevented our deaths from being in the 10’s of thousands.

But no-one will convince me that we have done a 10/10 job protecting the vulnerable. We certainly have not. Equally no one will convince me that we have done a good job protecting Health workers.

At the end of the day the numbers don’t lie.

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