The Pandemic One Year on: Trends and Statistics Between Three Waves of the COVID-19 Pandemic in Ireland

Valesca Lima, UCD Geary Institute

Key Point

Statistics on the COVID-19 pandemic in Ireland show that younger people, particularly those aged less than 45, are less likely to be hospitalized when they are infected, and less likely to die due to COVID-19. The number of cases increased dramatically between the first and the third wave the virus, and the increase was particularly marked among younger people. However, the percentage of those who died with the virus dropped from 5.3% of infected cases in the first wave to 1.7% in the third wave.

Introduction

The first case of COVID-19 was diagnosed in Ireland on 29th February 2020 and the first death by Coronavirus on 11th March, the same day WHO (World Health Organisation) declared the COVID-19 outbreak a global pandemic. One year later, as of 15 February 2021, Ireland has endured three waves of the COVID-19 pandemic, with 209,582 cases and 3,948 confirmed deaths. This article presents updates on recent trends and statistics in COVID-19 cases and deaths, including analysis of coronavirus waves in Ireland, cases and mortality trends by age and gender group, and most affected counties.

Timeline of COVID-19 Outbreak – A Closer Look at The Three Waves of Infection

First Wave – February to August 2020

Table 1 – Timeline of the First, Second and Third Waves of COVID-19 infection in Ireland

Waves (weeks)	Dates
Wave 1 (weeks 10-31)	01/03/2020 – 01/08/2020
Wave 2 (week 32-47)	02/08/2020 – 21/11/2020
Wave 3 (week 48 onwards)	22/11/2020 onwards

Between March 2020 and February 2021 Ireland has undergone three waves of COVID-19 cases. In the First Wave (February to August 2020) cases increased significantly, from 8,089 in early April to 24,990 (+16,901) in late May. Expressed as per 100,000 of the population, the rate of COVID-19 cases increased from over 160 in April to almost 460 per 100,000 people in May 2020. Deaths by COVID-19 increased between April – May, from 85 to 1651, according to data from HPSC (Health Protection Surveillance Centre). Additional data show that 3,283 COVID-19 cases required hospitalisation by the end of May, of which 408 cases were admitted to ICUs (Intensive Care Units). The data also suggested younger people, particularly those aged less than 45, were less likely to become infected, less likely to be hospitalized when they are infected, and less likely to die due to COVID-19 (see Malone, 2020).

Table 2 – Overview of COVID-19 cases and deaths (First Wave)

Time period/cases/deaths	30-Mar	30-May	31-Jul
Total Confirmed Cases	2,677	24,924	26,027
Rate Per 100,000 of the Population	n/a	523	546.57
Total Deaths	64	1,390	1,506
Number Hospitalised	703	3,283	3,352
Median age of cases	47	48	47

New cases persisted from early June to late August, as cases increased from 25,062 to 28,758 (+3,696), already signalling a decrease in the daily number of cases compared to the previous period as lockdown measures started to be relaxed by mid-May. Table 1 presents an overview of cases and deaths in the First Wave.

Second Wave – August to November 2020

The Second Wave of coronavirus infections was the less deadly of three waves, characterised by a series of regional outbreaks and restrictions. In the first week of August, a three-week regional restriction was enforced in counties Kildare, Laois and Offaly, three counties displaying a considerable rise in confirmed cases, largely concentrated in meat processing plants. Other regional lockdowns were imposed, such as in Donegal, Monaghan and Cavan in September but most counties remained in restriction level 2 (Department of the Taoiseach, 2020). In this period, the cumulative number of confirmed cases increased from 26,027 to 70,559 in late November. Similarly, the number of deaths rose from 1,506 to 1,763 in November 2020 with hospitalisation increasing 50% during the same period, including 167 more people who needed ICU treatment.

Figure 1 presents the weekly new confirmed COVID-19 cases from August to November 2020. Following the First Wave, there was an overall decline in the number of new daily cases reported, especially during summer months, when the number of cases were low but the virus did not disappear. A new rise in the number of cases from September to November  was observed, when the total of confirmed cases amounted to 70,580 and the national cumulative incidence of confirmed cases per 100,000 population was 1,479.

Figure 1 – Number And Cumulative Number of Confirmed COVID-19 Cases

Congregated settings such as direct provision centres and meat factories emerged as places of significant cases of infection in the Second Wave (see Figure 4 below). The surge in the number of cases leading to a regional lockdown measures in Kildare, Laois and Offaly was closely linked to meat processing plants and food production companies located in these areas – a pattern that was also experience in other countries. A report presented to NPHET in August 2020 found that 1,047 notifications of COVID-19 were identified as being associated with meat processing plants in Ireland by (Department of Health, 2020c). This suggests a 7% infection rate of the 15,000 employees in meat factories. There were 313 cases of COVID-19 reported in Direct Provision accommodation centres for asylum seekers, which  represents 4% of all Direct Provision residents in Ireland (Ombudsman for Children’s Office, 2020). These numbers caused widespread concerns about living conditions in direct provision centres and the meat industry workers’ cramped housing conditions.

Third Wave – December 2020 to present day

The Third Wave of COVID-19 followed the relaxation of new restrictions implemented in December for the Christmas holiday period, and entailed a new surge of coronavirus cases and deaths, resulting in the reintroduction of a nationwide lockdown level 5 to contain the spread of the virus after the holiday break. The Third Wave also marks the initial stages of the implementation of the National COVID-19 Vaccination Strategy, with the first person getting the COVID-19 vaccine on 29 December 2020 and the vaccine rollout starting in nursing homes in the first week of January. By 15 February 2021, the final day of reference for the present paper, Ireland reached 211,402 cases and 3,948 deaths. The 45 days period from 1st January to 15th February 2021 concentrates over 40% of all deaths and over 50% of COVID-19 cases in the country. According to the Office of the Chief Medical Office, the COVID-19 high mortality rate in the Third Wave is explained by remarkably high levels of community transmission, resulting in higher numbers of people with severe illness who require hospitalisation and/or admission to intensive care (Department of Health, 2021).

Figure 2 – Number of confirmed COVID-19 cases by notification week and epidemiological week in Ireland between Feb 2020 to Feb 2021

Figure 2 shows the cumulative 14-day incidence rate of confirmed COVID-19 cases per 100,000 population from February 2020 to February 2021. The number of cumulative cases by 15th February 2021 was 209,581 (red bar), while the incidence rates was 126.9 (purple line), meaning that among 100.000 people in Ireland, there were 126.9 new cases of the disease per 100.000 people.²

During the months of March to May 2020, the total number of reported new cases from COVID-19 rose steadily to a peak of 5,599 on the week of 16th April. From there, the number of cases declined to double-digit cases in June. A second peak took place in mid-October, when the highest number of cases in the Second Wave of COVID-19 reached 7,398 confirmed cases. As seen in Figure 2, in the Third Wave, numbers of cases increase dramatically, an upwards curve not seen in the two previous two waves. In only three weeks, over 160,000 cases were confirmed, as Ireland went from one of the European countries holding the lowest coronavirus infection rates to one of the highest in the world. The sharp increase in cases may be attributed to increased socialisation during the autumn and the Christmas period and also the influx of visitors from abroad over the Christmas holiday period.

Figure 3 – Daily and 7-day moving average number of deaths among COVID-19 cases

Figure 3 shows the daily and 7-day moving average number of deaths among COVID-19 cases from February 2020 to February 2021. The trend in coronavirus deaths echoed the trend in the number of cases through the year. According to HPSC (2021), since February 2020, 1924 (48.7%) people who were hospitalised died, of which 311 (7.9%) has been admitted to the ICU and 1613 (40.9%) were not admitted to ICU but died. 3,267 (82.8%) of the people who died had underlying conditions. The most common underlying medical conditions among those who died by 14^th December 2020 were: chronic heart disease, chronic neurological disease, chronic respiratory disease and hypertension.

Clusters

In the First Wave, as of April 30th, 2020, there were a total of 630 of COVID-19 outbreaks. According to the Department of Health (2020a), outbreaks are chains of transmission that can spread through a community. Examples of that are outbreaks in a workplace that has led to multiple outbreaks in families and other work settings, and these ultimately lead to a higher incidence in the community and threatens the most vulnerable to COVID-19.  The number of outbreaks increased to 866 at the end of May. The number of newly confirmed cases of COVID-19 increased in specific clusters augmented substantially, such as in nursing homes and residential institutions.³ By July, this number increased to 2,307. At the end of that month, the highest incidence of COVID-19 clusters took place in nursing homes at 34.8%, followed by residential institutions (19.4%), private households (13.5%), hospitals (13%), the workplace (4.6%) and community hospital/long stay units (4.4%). The remaining proportions of COVID-19 outbreaks (‘other category’) occurred in the community, hotel, travel and public house.

Figure 4 – Share of cluster/outbreaks in all settings in the First And Third Waves

In the Third Wave, 3,076 outbreaks have been reported from week 48 onwards (week beginning 22th November 2020). The key outbreak locations are as follows, as reported by HPSC (2021): 1,509 (49%) were in private houses, 174 (5.7%) were reported in hospitals, 211 (6.9%) were reported in nursing homes, 246 (8.0%) were reported in residential institutions, 936 (30%) were reported in a range of other settings (‘other’). Figure 4 presents a comparison of cluster/outbreaks in all settings in the First and Third Waves of COVID-19 in Ireland. It is apparent from Figure 4 that in the First Wave, congregated settings, such as nursing homes and residential institutions, presented higher levels of infection if compared to other settings. Therefore, it seems co-living models offer higher risks of transmission among persons living in this type of setting.

In the First Wave, by the end of July, infection in private homes stood at 14%. This number increased to 49% in the Third Wave (mid-February), indicating clusters among families are now much more frequent (see Figure 4). Conversely, outbreaks in nursing homes stood at 35% in the First Wave, and declined to 7% in the Third Wave. A possible explanation for the substantial decrease in nursing homes infections were the implementation of measures such as visit restrictions, daily temperature checks and designated staff members in each nursing home working full-time, as well as the release of a financial package of temporary assistance payments to support nursing homes affected by the coronavirus pandemic. (COVID-19 Nursing Homes Expert Panel, 2020). Family outbreaks reached an all-time high in the Third Wave, in mid-November.

COVID-19 Cases by Age Group, Gender and County

Age Group

The age profile of people infected by COVID-19 has varied since the beginning of the pandemic. In the First Wave, in March, the median age of cases was 47. By mid-February 2021, this median was 38, indicating that a higher number of younger people were infected in the current wave. While the age profile of cases is distributed across the large cohort between 15 to 64 years old, most of the deaths occur among people over 65 years of age, with a median age of 83 on the week of 8th of February 2020.

Table 3 – Total number of COVID-19 cases by age group, entire pandemic (to 13 January 2021)

Age Group	Total Population	Cases Wave 1	Cases Wave 3	Increase in %	Total Cases Per 100,000 by age group Wave 1	Total Cases Per 100,000 by age group Wave 3
0-4	315,200	119	3,835	3,122	38	1216
5-14	693,700	252	9,459	3,653	36	1363
15-24	618,100	1,582	28,490	1,784	256	4609
25-34	620,000	3,707	28,259	662	598	4557
35-44	776,900	3,919	24,613	528	504	3168
45-54	661,600	4,111	23,236	465	621	3512
55-64	539,700	2,958	17,838	503	548	3305
65-74	404,100	1,661	8,789	429	411	2174
75-84	214,900	2,136	6,235	191	994	2901
85+	77,300	2,200	4,781	117	2,846	6184

Table 3 presents the total number and rate of COVID-19 cases by age group for the entire period of the pandemic up to 11^th January 2021. As of 8 May 2020, the greatest number (2,200 cases) of people in the older population infected by COVID-19 were aged 85 years (see Malone, 2020). In comparison, in the Third Wave, by 13^th January 2021, the age cohort between 15-24 held the highest number of infections with 28,490 cases, closely followed by the 25-34 years-old cohort, with 28,259 cases. In other words, more than 36% (56,749) of cases of COVID-19 in the Third Wave involve people between the ages of 15 and 34. According to the Department of Health (2020b), the high number of cases of infected people in this age group is explained by the fact they are more likely to be at work, attending school or university and keeping key services running. An additional factor may have been greater levels of socialising among young people, as evidenced by the number of COVID-19 fines given to under-25 year-olds,  53% of those who received lockdown penalty notices issued by An Garda Síochána for breaches of COVID-19 regulations were between the ages of 18 and 35 (McGreevy, 2021). This data suggests some young adults have a false sense of confidence regarding their safety and taking more risks (John Hopkins, 2020) and  so may be driving the surge of new cases in the Third Wave.

When expressed as per 100,000 of each age group’s population, the 85+ years has the highest rate of confirmed cases Covid-19 in the Third Wave. The second highest case by 100,000 population is concentrated on the 15 to 34 group. Conversely, the rate of confirmed COVID-19 cases was lower for the very young population aged 0-4 and 5-14 years at 38 cases and 36 respectively per 100,000 people. By January 2021, these numbers had increased 335% in each of those age cohorts, again another indication younger people are the most affected people in the Third Wave of COVID-19.

Table 4 – Total Number of COVID-19  Hospitalisations by Age Group, Waves 1 and 3 (to 13 January 2021)

Age Group	Total Population	Cases Hospitalised (n) Wave 1	Cases Hospitalised (n) Wave 3	% of Diagnosed hospitalised by age group Wave 1	% of Diagnosed hospitalised by age group Wave 3
0-4	315,200	18	82	15.1	2.13
5to14	693,700	17	74	6.7	0.78
15-24	618,100	65	298	4.1	1.04
25-34	620,000	179	518	4.8	1.83
35-44	776,900	240	614	6.1	2.49
45-54	661,600	404	924	9.8	3.97
55-64	539,700	436	1,085	14.7	6.08
65-74	404,100	524	1,409	31.5	16
75-84	214,900	676	1,712	31.6	27.4
85+	77,300	425	1,068	19.3	22.3

Table 4 shows the total number of hospitalisation per age groups. Younger people are less likely to be hospitalised. This is an important difference in the proportion of those diagnosed with COVID-19 who need medical attention. This number suggests the elderly are much more vulnerable to the virus and face high risks of health complications. Comparing the First and Third Waves, it is possible to observe the % of diagnosed hospitalised by age group has declined in all age cohorts, except among those 85+. However, it must be noted that young people do get coronavirus infections requiring hospitalization and may develop severe and lasting symptoms, particularly if they are living with obesity, diabetes or hypertension (John Hopkins, 2020).

Table 5 -Total number and rate of COVID-19 deaths by age group, Wave 1 and 3 (to 18 January 2021)

Age Group	Total Population	Total Deaths (n) Wave 1	Total Deaths (n) Wave 3	Increase in %	Total Deaths Per 100,000 of population age group Wave 1	Total Deaths Per 100,000 of population age group Wave 3
0-24	1,627,000	2	<5	150	0	0.3
25-34	620,000	5	7	40	1	1.12
35-44	776,900	10	14	40	1	1.8
45-54	661,600	21	45	114	3	6.8
55-64	539,700	51	117	129	9	21.6
65-74	404,100	176	397	125	44	98.2
75-84	214,900	411	896	118	191	416
85+	77,300	527	1,136	115	682	1469

Table 5 -Total number and rate of COVID-19 deaths by age group, Wave 1 and 3 (to 18 January 2021)

Table 5 compares the total number and rate of COVID-19 deaths by age group. As of 18^th January 2021, the highest number of deaths associated to COVID-19 were among people aged over 85 years-old, with 1136 deaths, and those aged between 75-84 years, with 896 deaths. These numbers are also associated with the rate of hospitalisation, since hospitalisation numbers are higher for those over 65 (see Table 3). In comparison, there were far fewer deaths among the younger population aged between 0-24, less than 5 deaths since March 2020. Despite the high number of cases among young adults (see Table 3), this group displays a very low number of hospitalisation and deaths. The total number of deaths expressed per 100,000 of the population age group again suggests the population over 65 is at a greater risk of death when contracting COVID-19 than other age groups. Figure 5 illustrates the differences in the number cases and deaths between the First Wave and  the Third Wave.

Figure 6 – Differences in the number of deaths between First and Third Waves

Overall, these results make clear that cases increased by a greater proportion among younger people (15-34) in the Third Wave (see Figure 6), but in the same period the mortality rates have increased relatively equally for the majority of age groups, except to the 25-44 cohorts (see Table 4). In addition, the total number of deaths among confirmed cases in the First Wave (late July 2020) was 5.78%, meaning that from all people who contracted the virus, 5.78% died. In the Third Wave, the mortality rates among confirmed cases decreased threefold, to 1.76% (HPSC, 2020, 2021). This reduction can be plausibly explained by the spread of the virus among young adults, who face less risks of contracting severe forms of the disease or die of it.  

Gender

Studies have also shown that gender and sex influence a person’s exposure to coronavirus with negative health outcomes potentially skewered against women (Oireachtas L&RS, 2020). By 15^th February 2020, according to HPSC (2021), Ireland had 209,581 cases and 3.948 deaths confirmed, of which 110,289 (52,62%) were women and 99,232 (47,35%) were men. Inversely, more men died due to Covid complications, 2063 or 52,25% of deaths affected men.

Figure 7 presents the sex-disaggregated data among men and women. The larger proportion of confirmed cases among women and death among men confirm some international trends showing that women are more likely to contract the disease but less likely to die of it. This trend, however, has changed since the First Wave in Ireland. In mid-June 2020, 57% of the cases were female and 43% were male, a trend that still holds in the Third Wave. But in relation to deaths, mortality rates were higher among women in the First Wave (50.65%) and lower in the Third Wave (47.3%). The data in Figure 7 illustrates the differences along the lines of sex and gender, and show that COVID-19 has affected men and women differently.

Figure 7 – Sex-disaggregated data on cases and deaths among men and women (%)

The disparity in cases and mortality between the male and female patients still lacks definitive scientific answers, but there are potential explanations that includes a combination of factors (Oireachtas L&RS, 2020;  CSO, 2016; BMJ, 2020):

• Immune system differences among men and women;
• Higher levels of risky behaviours and co-morbidities among men and lower levels of health-seeking behaviour among men;
• 80% of health workers in Ireland are women, therefore more women are exposed to the virus than men;
• A higher proportion of women between 80-100 years-old live in nursing homes or congregate settings;
• Women have a longer life expectancy compared to men;
• Women’s low representation on health policy decisions affecting men and women.

In the long-term, it is necessary more gender-oriented research to increase the understanding of the reasons why some people are more vulnerable than others and thus build policy evidence to support health system sensitive to those differences.⁵

County level

Figure 8 and 9 show the incidence rates of confirmed cases of COVID-19 per 100,000 population notified in Ireland during the First and Third Waves by county (HPSC, 2020, 2021). In the First Wave, high incidence rates were concentrated on the Border, Dublin, and Midland East regions. In early August 2020, Cavan had the highest number of reported Covid-19 cases at just over 1150.0, followed by Monahan (882.9) and Dublin (931.5). Wexford and Waterford had the lowest number of confirmed cases of Covid-19, with incidence rates of 149.6 and 142.9, respectively. By late October 2020, in the Second Wave, Border counties (Cavan, Donegal and Monaghan), had the highest 14-day incidence rate per 100,000,according to HPSC (2020). The considerably high rates in those areas seems to be associated with a sharp rise in the number of cases in Northern Ireland.

Figure 8 – Cumulative incidence rates of confirmed cases of COVID-19 per 100,000 population notified in Ireland at the end of the First Wave

Figure 9 – Cumulative incidence rates of confirmed cases of COVID-19 per 100,000 population notified in Ireland in the Third Wave

In the Third Wave, trends have changed towards incidents rates driven by a significant increase in the number of confirmed cases, but this time not so concentrated in the Border, Dublin and East Midlands regions, but also spread to the West and Southeast of Ireland. These changes are likely associated with the roughly synchronised cross-border COVID-19 measures and restrictions. Nevertheless, in mid-February 2021, the highest incidence of COVID-19 per country was found in Monaghan 451.2; followed by Dublin (368.2), Carlow (347.8), Offaly (347.6) and Galway (330.2).

References

BMJ Global Health (2020). Sex, gender and COVID-19: Disaggregated data and health disparities. Available at:  https://blogs.bmj.com/bmjgh/2020/03/24/sex-gender-and-covid-19-disaggregated-data-and-healthdisparities/

COVID-19 Nursing Homes Expert Panel (2020). Examination of Measures to 2021. Report to the Minister for Health [online]. Available at: https://www.gov.ie/en/publication/3af5a-covid-19-nursing-homes-expert-panel-final-report/

CSO, Central Statistics Office (2021). Census of Population 2016 – Profile 3 An Age Profile of Ireland.Available at: https://www.cso.ie/en/releasesandpublications/ep/p-cp3oy/cp3/agr/

CSO, Central Statistics Office (2016). Annual Population Estimates (Persons in April). Available at https://statbank.cso.ie/px/pxeirestat/Statire/SelectVarVal/Define.asp?maintable=PEA01 &PLanguage=0

Department of the Taoiseach (2020). Resilience and Recovery 2020-2021: Plan for Living with COVID-19. Dublin, Ireland.

Department of Health (2020a). Statement from the National Public Health Emergency Team Thursday 28 January. Available at: https://www.gov.ie/en/press-release/3d6d7-statement-from-the-national-public-health-emergency-team-thursday-28-january/

Department of Health (2020b). Statement from the National Public Health Emergency Team 22^th September 2020. Available at: https://www.gov.ie/en/press-release/d1a69-statement-from-the-national-public-health-emergency-team-tuesday-22-september/

Department of Health (2021). Statement from the National Public Health Emergency Team 29^th January 2021. Available at: https://www.gov.ie/en/press-release/54e42-statement-from-the-national-public-health-emergency-team-monday-18-january/

Department of Health (2020c). Investigation into a Series of Outbreaks of COVID-19 in Meat Processing Plants in Ireland. Report presented by HPSC to NPHET on the 6th August 2020. Dublin, Ireland.

Health Protection Surveillance Centre (2020-2021). Epidemiology of COVID-19 in Ireland [online]. Available at: https://www.hpsc.ie/a-z/respiratory/coronavirus/novelcoronavirus/

John Hopkins Medicine (2020). Coronavirus and COVID-19: Younger Adults Are at Risk, Too. Online blog. Available at: https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/coronavirus-and-covid-19-younger-adults-are-at-risk-too

Malone, P. (2020). Recent trends and statistics in Covid-19 Cases, Testing, and Deaths. Research Paper, publicpolicy.ie.

McGreevy, R., (2021). More than half of COVID-19 fines given to under-25s. The Irish Times. Available at: https://www.irishtimes.com/news/crime-and-law/more-than-half-of-covid-19-fines-given-to-under-25s-1.4489990

Ombudsman for Children’s Office (2020). Direct Division Life in Lockdown: Children’s views and experiences of living in Direct Provision during the COVID-19 pandemic. Report. Dublin, Ireland.

Oireachtas Library & Research Service (2020). L&RS Note: Anticipating the gendered impacts of COVID-19. Dublin, Ireland.

Notes

¹ The epidemiological date, or ‘epi-date’ for a case is based on the earliest of dates available on the case and taken from date of onset of symptoms, date of diagnosis, laboratory specimen collection date, laboratory received date, laboratory reported date or event creation date/notification date on CIDR, as defined by HPSC.

² Incidence rates are measures of frequency. They refer to the occurrence of new cases of disease or the number of new cases in a community, per unit of population.

³ COVID-19 outbreak case definition according to HPSC: an outbreak of infection or foodborne illness may be defined as two or more linked cases of the same illness or the situation where the observed number of cases exceeds the expected number, or a single case of disease caused by a significant pathogen. Outbreaks may be confined to some of the members of one family or may be more widespread and involve cases either locally, nationally or internationally.

⁴ The full breakdown in the number of deaths in the age cohort between 0-24 was not available in the HPSC weekly reports for the period, possibly because the mortality in this group is low. In addition, cases were measured to Jan 13 and deaths to 18 Jan (the only dates for which full age breakdowns were available), so this might slightly overstate ratio of deaths to cases for the Third Wave.

⁵ Gender breakdown data on hospitalisation and ICU admission on in Ireland was not available at the time of writing.

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