How many will die of Covid-19, Taoiseach?

Leo Varadkar’s alarming prediction of likely deaths in Ireland from coronavirus only raises more questions, writes Eilis O’Hanlon

THE Taoiseach’s “I need to speak to you about coronavirus” speech in Washington was eloquent, measured and statesmanlike, calming nerves across the country ahead of what may be a time of national emergency.

That doesn’t mean the actions and statements of the Taoiseach should be immune from scrutiny and criticism. If anything, it’s all the more important as we move to a new phase of crisis management to ensure that everything which is said and done to halt the spread of coronavirus is properly explained to people and backed with evidence.

The Taoiseach would appear to agree, having moved to reassure people earlier last week that decisions would be taken only on the basis of “science and evidence and public health advice from the CMO [Chief Medical Officer] and the National Health Emergency Team”, and not made “on foot of pressure from business or politics or media or social media”.

But what if the information coming from government sources is itself unclear or misleading?

That dilemma has arisen in recent days in light of some startling predictions in the media for how many people are expected to die in Ireland as a result of Covid-19. Asked about the likely outcomes earlier in the week, Leo Varadkar’s response went as follows, and is quoted in full in order to be scrupulously fair to the Taoiseach:

“Our modelling work is still being done, and that work is ongoing, and it will never be exactly right, you know. It will have to be updated every couple of days, every week, as we learn more and more about the virus.

“But what we’ve seen from other countries, and what we’ve seen from what is available at the moment, is that we know we could easily have 50, 60pc of the population contracting Covid-19 — for whom the vast majority this will be a mild illness, maybe even asymptomatic, maybe you won’t even know you have it.

“But there will be a significant proportion who will require critical care and a percentage that we don’t honestly know yet — it could be 1pc, it could be as much as 3pc, or 3.4pc mortality, we just don’t know that yet with any degree of certainty.

“But when you’re talking about one, two or three per cent of half the population, those are very big figures and not the kind of thing we’ve seen in a very long time.”

To begin with then, it seemed as if the Taoiseach was referring to those who, having contracted coronavirus, went on to “require critical care”, which, as he pointed out, would be a minority of patients, since most people are not expected to be severely affected. However, he went on to talk about the possibility of “one, two or three per cent of half the population” dying from Covid-19 and it was at this point that the stakes were raised considerably.

It was this latter part of the statement which was picked up by the media, who duly reported the impending prospect of tens of thousands of deaths. What journalists did was calculate “half the population”, before working out one, two, and three per cent of that total to estimate the number of likely deaths in the many tens of thousands. One staggering estimate even put it as high as 120,000.

The figures were repeated regularly. On RTE’s News At One on Thursday, George

Lee again reported them without qualification.

“In this country in a total in a year you might have 30,000 people deceased.

The numbers they’re talking about are absolutely astronomical.”

To put that in context, it would exceed the total number of registered deaths in Ireland from all causes (31,116) in 2018.

Reports of casualties on this scale naturally create anxiety but one crucial question went unanswered, indeed unasked, all week: Did the Taoiseach really mean that “one, two or three per cent of half the population” might die?

Or did he mean one, two or three per cent of confirmed cases?

Or, for that matter, one, two or three per cent of those who go on to require critical care?

Depending on the answer to that question, the figure for likely Covid-19 deaths in Ireland varies hugely.

It would still greatly exceed the number who die each year of flu but would, mercifully, be far behind “one, two or three per cent of half the population”.

The death rate of 3.4pc, mentioned by the Taoiseach, has its root in the most recent global statistics from the World Health Organisation (WHO); but that mortality rate is for “reported cases” or “confirmed cases”.

It’s not a proportion of all those who are expected to be infected because that figure remains unknowable and probably always will. Most people with mild or no symptoms don’t see a doctor and will never appear in official figures.

The mortality rate also goes down the more tests are carried out. South Korea has now completed more than 200,000 Covid-19 tests, of which just under 8,000 (4pc) were positive. The ratio of deaths to cases is correspondingly lower.

This is explained by the WHO itself, who caution that the case-fatality ratio (CFR) is “naive” and “can be misleading” and is

“often overestimated in the early stages because case detection is highly biased towards the more severe cases. As further data on the spectrum of mild or asymptomatic infection becomes available… the CFR is likely to decrease.”

All this is quite technical but it’s important to get it right to provide a sense of perspective.

While it’s only responsible for the government to prepare for worst-case scenarios, the Taoiseach also needs to be absolutely clear what he means when he quotes figures — especially ones with a capacity to provoke alarm.

The WHO provides ongoing figures on a daily basis as they come in. The Taoiseach was asked instead to make a prediction, and left a grimly vivid impression in the minds of Irish people that “one, two or three per cent of half the population” could die.

If that is what the Government’s modelling is currently indicating, it would be astonishing. If replicated in China, where the disease began, it would equate to a death toll of between seven million and 21 million people.

The current tally is just over 3,000 and is believed to be past its peak.

But if that’s what Leo is really being told, so be it, we need to know the cold truth.

Likewise, if the Taoiseach didn’t mean exactly what his words say, that needs to be cleared up, too — not least because he is a doctor, so his word on these issues is likely to be taken more earnestly than that of medically untrained ministers.

In non-scripted situations such as press conferences, politicians will misspeak, and everyone understands that — especially at a time like this.

But there was no attempt subsequently to clarify the Taoiseach’s statement or to issue a press release fleshing out what he meant.

That could be because no journalists bothered to ask for confirmation or it could be that the Government simply doesn’t think it’s important enough to clear up.

Efforts to contact the Department of the Taoiseach for clarification on what the Fine Gael leader meant have so far proved fruitless.

The first email went unanswered. A second email went unanswered.

So did the third.

It was the run-up to St Patrick’s Day. Perhaps they were all too busy. The coronavirus, though, is far more urgent than a bowl of shamrock. What matters now is that people do not panic or get unduly anxious but trust the Government to give them regular and reliable information about the virus.

It is unhelpful, to say the least, for the Taoiseach himself to make statements which are open to misunderstanding.

The reason the Taoiseach has a press office is to improve communication of vital messages of public interest. Silence from that quarter on a matter of such serious national concern is not at all reassuring.

‘While it’s only right for the Irish Government to prepare for the worst-case scenarios, the Taoiseach needs to be absolutely clear what he means when he quotes figures’