Irish Student Nurses a bright light in the gloomy COVID-19 statistics.

The number of coronavirus deaths suddenly jumped by 10 people yesterday bringing Ireland’s overall total to 19. May they all rest in peace.

If yesterday marks anything, it marks the end of the beginning. For people out there growing increasingly anxious, I would point out that it is a trend consistent with other countries and that this sudden increase in death toll isn’t particularly a definite signifier of Ireland’s unpreparedness. Let me try and explain why this happened.

Ireland recorded it’s first death on or around March 11th. So we are roughly two weeks into the pandemic proper. Now one of the features of COVID-19 is that severely affected patients require ICU care but most particularly assisted breathing via a ventilator. Nothing new there then for most of you.

What you might not know is how long on average people require ventilator assistance that contract coronavirus. I am going to use the state of New York to help me explain.

New York is rapidly becoming the most tested and transparent place on earth with regard to their testing and sharing of their statistics. The Governor Andrew Cuomo is also doing an excellent job of communicating what the state is doing and how the state is using their data to plan for the days and weeks ahead.

As of today (March 26th) New York has performed testing on just over 122,000 people in the state of New York. Daily testing has ramped up to over 18,000 COVID-19 tests per day using a mixture of state and private labs. Currently New York has 37,000 positive cases. I reference all this data because the state has built up a critical mass of information that is larger than almost every other country in the world bar 2 or 3.

What New York has extrapolated from it’s data is that patients with severe cases of coronavirus may require 20-30 days of ventilator assistance. By way of contrast – in normal peacetime conditions – patients presenting for all other types of illness that require ICU and ventilator assistance generally only require a ventilator for 3-5 days. This is why there is such an increasing panic around the world about ventilators.

It is the length of time that people require respiratory assistance that is wreaking havoc on the health systems across the globe. In essence, what the above data reveals is that in a normal hospital environment, over a 20 day period, 4-5 people would be able to use the same piece of a equipment. In the current scenario that number is 1.

Now let’s return to Ireland and have a think about things in the above light. Today’s figures revealed much the same number of new cases as any other day this week but crucially we also have our first wave of ICU patients passing 14+ days in care and most probably on a ventilator.

The recovery rates for people after this time are low. Obviously a lot of families are facing some hard choices in the coming days. The statistics from New York reveal they are prepared to allow 20+ days for a patient to recover but sadly not everyone makes it that far. I have little doubt that the Irish Health care system will give every patient every opportunity to recover. But we have moved into a stage where most ICU beds will have plenty of patients that have been 14+ days on ventilators and unfortunately the prognosis for a lot of them will not be good. The numbers will be consistently a little higher as result.

In the face of this sudden spike in the number of coronavirus victims today I wanted to point to a couple of rays of sunshine breaking through the darkening clouds. It’s not all doom and gloom.

The first is the outstanding work student nurses and the supporting HSE functions are doing on contact tracing. Finally the government have seen the light and agreed to pay them. The work they are doing on tracing is vital to the country and amongst other things gives us visibility on whether measures we are implementing are successful. In simple terms, this work helps remove the support network around each instance of the virus. The virus doesn’t spread itself it requires people close to it to do the spreading.

I spoke to a source yesterday regarding the Irish contact tracing program and they revealed a very encouraging statistic. Two weeks ago when the first cases of coronavirus were popping up across the nation the average number of contacts per positive case was in excess of 20. On Tuesday night that number was down close to 5 contacts per person.

What that statistic really signifies is that social distancing is working and starting to pay dividends – most people are following the rules most of the time. If Ireland continues down this path we will be in a position to flatten this curve that everyone is talking about. Probably quicker than most countries. We need to keep it up though.

The second bright spot is the statistics that the HSE are producing as a result of all the testing and contact tracing. They are excellent and information is power in this unfolding drama. And I say that as someone that looks at statistics from a wide range of countries and states. Ireland’s are up there with the best in my opinion. The danger in times like this is that government agencies sugar coat reality and we have seen a number of countries attempt to do this across the globe. They don’t all begin with the letter C either.

OK so from the picture above the statistic we are most interested in is the total numbers admitted to ICU, the data is up to and including March 24th. The current reported total is 47 and this number has been rising steadily over the last week. Keep a very close eye on that figure over the next couple of days. If that number is rising in line with the steep curve upwards in people that have died today then our frontline staff will be under severe pressure very shortly.

Remember we have a TOTAL of 250 ICU beds with the hopes of increasing to 500 by the peak. The key requirement is to buy a little more time. Remember also that these ICU beds were pretty much at full capacity to begin with. Life goes on outside coronavirus land. People haven’t suddenly stopped getting heart attacks and all the other vicious diseases that these wards normally cater for in peacetime.

Another key statistic I keep an eye on is the number of health workers that have been infected with coronavirus.

While the bare number of 321 health workers testing positive is stark, in percentage terms this has thankfully been dropping over the last number of days and currently stands at 23%. It is vital that we have the PPE equipment in place to protect our health professionals and ensure this number continues to fall. It is a most welcome development that the first delivery of that equipment from China is due on Saturday or Sunday with over 50 plane loads due to follow it.

We entered a different stage of the fight today when those 10 poor souls lost their lives. It is doubtful that deaths will be coming in the one’s and two’s any longer. The surge will come first on the Dublin and then Cork hospitals where almost two thirds of the cases are located. Dynamic use of satellite hospitals in other regions may be required to cope. While today’s data is troubling there are reasons to be hopeful. The frontline professionals are rising to the surge rather than crouching away from it. The round of applause in the Dail yesterday was well deserved. When the pubs reopen perhaps the first day should be reserved for all of them. And the drinks should be on all of us.

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