A Year in Covid

There were almost 270,000 confirmed cases of Covid-19 in Northern Ireland in these 12 months.

Measured by specimen date, the figure is 268,987.

Of course, over the entire year there were times when we saw very few cases and other times when we had very high numbers of confirmed cases in a day.

The general story for cases in Northern Ireland over the course of the past year is as follows – rising cases in December 2020, with a peak over the Christmas and new year period; gradually falling to low numbers in late spring and early summer; then cases rose in mid July to a high level and have stayed high, eventually rising again in November.

The first half of that story mimicked what was seen in Great Britain and in the Republic of Ireland.

But while other places saw spikes in July which subsequently fell, Northern Ireland saw no such fall.

In fact, Northern Ireland has had an elevated number of cases for five months.

True, the numbers have fallen in places over that time, but they have never been low.

The seven-day rolling average went above 1,000 expected cases per day on 15 July. It has never fallen below that level.

In fact, the rolling average has risen in December to its highest rate ever in the entire pandemic.

Northern Ireland has had the highest prevalence of Covid-19 in the UK over the pandemic, according to UK government data.

It’s measured by positive cases per 100,000 people.

Northern Ireland is the only part of the UK to have seen more than 18,000 cases per 100,000 people since the beginning of the pandemic.

For the year up to 30 November 2021, Northern Ireland had a higher prevalence of positive Covid tests than not just Great Britain, but also the Republic of Ireland.

The prevalence of positive tests per 100,000 population for the year was as follows:

Since December last year, the Mid Ulster District Council area had the highest prevalence of coronavirus infections in Northern Ireland.

Ards and North Down had the lowest.

The following are infections by 100,000 population in each of the 11 council areas in Northern Ireland for the year up to 30 November 2021:

Towards the end of 2021, we have been carrying out more tests than ever for Covid-19 in Northern Ireland.

Over the course of the year up to the start of December, almost four and a half million tests for the virus were carried out - meaning the positivity rate was 6%

Another way of putting this is that for every 17 tests taken one was positive.

Since December 2020, there have been times when our hospitals have been under acute pressures because of coronavirus.

This was most notable in early January.

At one point, one in three patients in hospital had the virus.

This was, of course, at a time when most people were not vaccinated.

The pressures have ebbed and flowed somewhat over the course of the year, but have always been there in some shape or form.

For three months, between mid-August and mid-November, the number of Covid-positive patients in Northern Ireland’s hospitals was consistently between 400 and 500.

This was despite a fairly high level of vaccination.

Over the course of the 12 months up to 30 November, there were 10,338 admissions to hospital of people with coronavirus.

The story of those hospitalisations mirrors that of the overall cases as outlined above.

By early December 2020, hospitalisations had begun to increase.

But that increase accelerated dramatically over the Christmas period last year, eventually peaking at more than 1,000 Covid-positive patients in January.

By mid-February, the number of Covid-positive hospital inpatients had dropped to about 500.

And it kept dropping.

During the early parts of the summer, the numbers in hospital with the virus were quite low – around 20 at one point.

This was reflective of the spread of virus in the community at the time, which was very low.

However, with that rise in cases in July, the numbers in hospital began to creep back up.

Between mid-July and mid-September there was an elevated number of younger adults (under 40) in hospital with the virus – mainly unvaccinated.

But these numbers fell away by mid-September.

Consistently, throughout the pandemic, the vast majority of hospitalisations have been among people aged 60+.

The other important thing to note about the pressure on our hospitals over the past year is the fact that since mid-August there have been more patients in hospital than beds.

Routinely – and for a period of four months – Northern Ireland’s health system has been operating at over-capacity.

The number of patients requiring intensive care (ICU) treatment has risen and fallen over the past year.

In non-pandemic times, Northern Ireland’s ICU bed capacity would usually be between 70-75.

During the peak at the start of the year, there were as many as 74 Covid-positive patients in ICUs.

This eventually fell to the point where there weren’t any Covid patients in ICU for about three weeks during June.

Again, with the increase in cases in July, this changed – it rose sharply by the end of July.

It was September before there was any meaningful drop.

There have been between 30-40 people with Covid in ICU since then.

Like the rest of the UK, Northern Ireland began its vaccination programme early and quickly.

And in fact, it’s worth stopping to reflect just how impressive Northern Ireland’s vaccination has been, especially in the early stages.

To date, almost 3,500,000 vaccine doses have been administered in Northern Ireland.

The first vaccine dose was given out on 8 December 2020 – to nurse Sister Joanna Sloan.

By early February, a quarter of a million people in Northern Ireland had had a jab – and by the end of the month that figure was more than 500,000.

By mid-May, Northern Ireland’s millionth first dose was given.

Likewise, the rollout of second doses was quick.

However, by the summer, Northern Ireland’s rate of vaccination began to slow.

We fell behind the rest of the UK in first dose vaccinations.

The Republic of Ireland, which had a later and slower start to its vaccination programme, caught up, eventually overtaking Northern Ireland.

It remains the case that Northern Ireland is behind the rest of the UK in uptake of first, second and third/booster doses as we approach 2022.

That said, the gaps between Northern Ireland and Great Britain have been slowly closing in the last two months of 2021.

The following were the uptake rates of first doses by 1 December 2021 (percentage of population aged 12+):

It’s worth noting that Northern Ireland’s rate of first dose vaccinations began to speed up dramatically in November – a trend that has continued into December.

With the advent of the Omicron variant towards the end of the year, booster jabs became central to the fight against the virus.

Northern Ireland’s roll out of booster jabs had been slower than GB’s.

Health officials said this was because of the strategy in Northern Ireland to ensure the elderly and those in care homes were offered a booster dose at the earliest possible opportunity.

The uptake of booster doses started to increase in November and the existing gap between Northern Ireland and Great Britain started to close.

Uptake of booster doses by 18 December 2021 was as follows, again based on the percentage of population aged 12+:

Over the course of the year, the effect of vaccination on the hospitalisation and death rates became apparent.

For example, on 17 January 2021, and according to Department of Health data, Northern Ireland recorded 601 new cases; 29 Covid-related deaths; just over 125,000 people had a vaccine; there were 1,046 Covid-positive inpatients recorded; the number of people in ICU with the virus was 67.

It was the highest daily death toll associated with the virus.

Case numbers rose in the few days after 17 January, but soon began to fall.

The next time they rose to similar levels was July.

On 7 July – again according to Department of Health data Northern Ireland recorded 630 new cases; no Covid-related deaths; by that stage almost 1,180,000 people had a vaccine; there were 93 Covid-positive inpatients recorded; the number of people in ICU with the virus was four.

The major contributory factor to fewer hospitalisations and deaths was the vaccine.

It continues to be so.

According to Department of Health figures, there were 1,865 Covid-related deaths in Northern Ireland between 1 December 2020 and November 30 2021.

This number represents deaths within 28 days of a positive test for the virus.

Most of these deaths were in the three months between the start of December 2020 and the end of February 2021 – the period of time which encapsulates the peak of last year’s winter surge.

There were 1,042 deaths in this time window.

Of those 1,865 deaths over the course of the 12 months we’ve been looking at, the vast majority were in hospital, with most of the rest in residential or care homes.

Likewise, most deaths were among the older population – 92% of them being in people aged 60+.

The age breakdown of the deaths for the year up to the end of November 2021 is as follows:

Breaking the death figures down by council area in Northern Ireland reveals that Mid & East Antrim; Armagh City, Banbridge & Craigavon; and Mid Ulster had the highest Covid-related death rates over the course of the 12 months.

Derry City & Strabane had the lowest.

The following figures show deaths by 100,000 population in each of the 11 council areas for the 12 months up until November 30 2021:

While it would be reasonable to expect areas with high infection rates to have high levels of death, this is not always the case.

Mid Ulster does indeed follow this trend, but both Derry City & Strabane and Mid & East Antrim buck it somewhat.

Derry City & Strabane had one of the highest prevalence of Covid cases over the year, but one of the lowest death rates.

Conversely, Mid & East Antrim had the third lowest prevalence of the disease in Northern Ireland, but the highest death rate.

These apparent discrepancies could be explained by other factors such and the age, the previous health condition and the vaccination status of the people getting the virus.

Despite having had the highest prevalence of positive tests for the virus, a lower vaccination rate – and at times over the past year, the highest infection rates in the UK – Northern Ireland has actually had the lowest death rate.

But the Republic of Ireland had a lower death rate than Northern Ireland.

Adjusted for population, these are the death rates in Britain and Ireland for the 12 months up until 30 November 2021 (expressed per 100,000 population):

The noticeably higher rates for England and Wales were affected by particularly elevated death rates between mid-December 2020 and mid-February 2021.

After that point, the death rates in the various parts of the UK were more or less similar.

And while Northern Ireland had the lowest rate overall, it had the UK’s highest death rate for a prolonged period between late-July and mid-September, and again during periods in November.

In any case, the death rate in Northern Ireland is dramatically reduced in comparison to this time last year when most people were unvaccinated.

The drive to give as many people as possible a booster dose of vaccine will aim to keep the most significant Covid number of all – the death toll – as low as possible.

The arrival of the Omicron variant has forced politicians, health officials and medics to reassess the approach to the pandemic.

The World Health Organization has urged people to use caution over Christmas and new year celebrations.

While research into the latest variant continues, booster doses have become central in the fight against the virus.

Accordingly, health authorities will be encouraging as many people as possible to get a booster dose – and in turn keep the number of hospitalisations and deaths as low as possible.