WITH just weeks to Christmas, and in the region of 650 cases of Covid-19 being reported every day in Co Cork and Co Kerry alone, the acting director of public health for the HSE South region, Dr Anne Sheahan, says there is a real need to protect hospitals from becoming overwhelmed so that the people who really need care from non-Covid illnesses can be treated.
Latest weekly figures show that 3,364 cases of Covid-19 were reported in Cork in the seven days to November 20, and Dr Sheahan says that community transmission of the virus is being seen across the region in rural and urban areas and in all age groups.
Cases of the virus are being seen across a range of settings, but Dr Sheehan said that it is evident there is a spread where people are mixing more readily.
Cases linked to social gatherings and weddings have been seen in the region with Dr Sheehan saying that lots of cases of the virus have also been identified in college-going age-groups, which she said could be “as a result of socialisation”.
Of particular concern to public health teams is a phenomenon where people with symptoms of the virus are not self-isolating or opting not to get tested for Covid-19, but are continuing to socialise.
For some, they are not getting tested, she said, because they don’t want to have to restrict their movements, or be the reason someone is identified as a close contact. For others, they feel because they have had the vaccine, it won’t be Covid.
“We see people that are positive and they say ‘oh ya, I had a head cold and I had a sore throat but I said, you know, I’ll be fine’ and then two days later they say I’d better get tested and lo and behold they are positive. There is a lot of that. Once upon a time, if you had a bit of a sore throat, a bit of a head cold, you’d say, ‘I’m only meeting a crowd and I’ll go’ and you did and it was fine. But this is different. And that’s the difference,” she said.
Pandemic fatigue is also undoubtedly impacting and Dr Sheahan said people are somewhat understandably tired of “hearing the same thing, tired of seeing the same face on television, listening to the same voices saying the same thing”.
“It’s very hard to continue to sell the same message because the message hasn’t changed,” she said.
In recent weeks, public health experts have appealed to people to reduce their social contacts and Dr Sheahan said that, while people are tired from this messaging, that she would implore people to consider “not being enthusiastic about having a good time.”
“Try to reduce your number of contacts and your social engagements just a little bit. We don’t need to go out and kiss and hug everybody. We need to be careful just for a while. Some of this is to protect our hospitals from being overwhelmed so that the people who really need care from non-Covid related illness, like people with a heart attack, people who have a breast lump who can’t get seen, that’s what is going to kill people... people with a lump in their thyroid who end up with stage four thyroid cancer because they were delayed getting to the hospital. It is frightening.”
Significant numbers of cases are also being seen among school-aged children. However, Dr Sheahan said a lot of that exposure is happening because children are being exposed in their families, that their older siblings are positive, and because they are mixing.
While 94% of people aged 12 and over in the region are vaccinated, the acting director of Public Health for the HSE South said that they are particularly concerned about the spread of the virus in vulnerable groups and in particular in those who have yet to receive the vaccine.
“We’re seeing a steady stream attending the vaccination centre for the first time. These people are coming and these are the people we need to try and get them in because everyone who goes in and goes and gets vaccinated is potentially protecting our hospitals and our hospital beds from being overwhelmed,” she said.
“Until you get very high numbers of people vaccinated, it is very hard to stop the spread,” she said.
The disproportionate number of unvaccinated patients receiving care for Covid in hospitals is a concern.
“The concerning thing is a lot of the people who are ending up in hospital, relatively speaking, the people in hospital represent the unvaccinated much more so than the vaccinated.
“95% of the population are vaccinated, the 5% of the unvaccinated represent the higher [proportion in hospital],” she said and, “people need to think about themselves and think of protecting themselves if they are unvaccinated and I don’t know how we can actually make that message strong enough.”
There are also fears that in groups of people who are unvaccinated, there is a risk of mutations arising.
Dr Sheahan says that social media has helped with getting out public health messages around the virus, but it has also been a hindrance.
“Social media has been good in some ways but it has also been destructive because a lot of the myths and a lot of the fake news and the scaremongering isn’t helping,” she said.
The acting director of public health said people need to be aware of the impacts of Covid and know that long Covid, while rare, is a very real issue.
“Some people are very affected afterwards. Some people are exhausted for months and months and months on end. And it’s terrible to see somebody that was previously fit and healthy, to get an infection and then to be that unwell for that long.”
She said that while fewer people with the virus are dying, people will still be hospitalised and will continue to die because of Covid-19. The results of vaccination, and of boosters, are already being seen, Dr Sheahan said.
“If we look at the age bands, we’re seeing a reduction in [cases] in the age bands in the over 85s, over 70s and we’re now starting to see some reductions in the over 60s, and I think that’s very much reflective of what’s actually happening in the vaccination booster programme.
“The other positive thing in relation to that is where we had the big surge last January, where the nursing homes were over-run, and they were decimated and we had a lot of deaths and a lot of hospitalisations, we’re not seeing the same picture at all this time.
“Yes, we’re seeing cases. Yes, we are seeing outbreaks, but generally [there are] quite small numbers in those outbreaks and while some are admitted to hospital, many have minor symptoms and now that the boosters are kicking we are seeing less of that.”
In fact, Dr Sheehan said that in the preceding days, no new outbreaks had been reported in nursing homes in the region, which she said was “very positive - especially when there is so much community transmission.”
She said this was also down to a lot of the good work that is being done by the frontline staff in nursing homes.
“These people have gone through a phenomenal amount in the last 12 months to two years. We don’t want to start restricting visiting to them, we need to get back to normal visiting in nursing homes. That’s another reason why we are encouraging people, if they want to visit their loved ones in nursing homes, they should be vaccinated,” she said.
While ongoing community transmission of the virus is undoubtedly a source of concern for the region’s public health department, the virus itself isn’t their only worry.
Almost two years after the first case of Covid-19 was identified in Ireland, the broader public health impacts of the pandemic are also to the fore. For Dr Sheehan, the need to address the public health issues which are starting to arise is something she is very aware of.
These issues include the emergence of the ‘Covid stone’ and its potential impacts, as well as Covid- related alcohol dependency.
While Covid-19 is undoubtedly a major focus for her department, she says there is still a need to look for ways of improving the health of the population, and that one of the areas that needs to be addressed is the growth of the population.
Weight gain, she says, is not just a risk factor for Covid but for many other conditions too, including diabetes, heart disease and cancer.
An increase in alcohol dependency is also a source of concern.
“People are drinking more. That’s a huge message that needs to be addressed,” said Dr Sheahan. “You will see in the hospital they’re certainly seeing more alcoholic-related fatty liver disease.”
She said while “we might not see it today or tomorrow”, that alcohol dependency and dependency on other drugs will become a problem.
“This virus isn’t just ‘that virus’, it’s the impact it’s going to have across society that we as public health physicians need to start thinking about how we are going to address those. People need to start living healthier lives out there to make everything better for us all.”