A general overview of COVID-19 in Ireland 

• Some comparisons with Italy
• The BCG and COVID-19

A lot of our members have been asking CFI about the experience of COVID-19 in other countries and its impact on those with CF?

The short answer is that we just don’t know yet, because little reliable research has yet been published.

CFI will let you know when these studies become available.

CF Europe is currently gathering data on COVID-19 experiences of people with CF from a number of European Countries and Cystic Fibrosis Ireland are contributing to this. 

The CF Registry of Ireland are also compiling data.

The following are the main reported characteristics of all those with COVID-19 in Ireland (the general population).

• More women than men have contracted COVID-19 (46% are male and 54% are female)
• More men than women die from COVID-19. Figures from the Health Protection Surveillance Centre (HPSC) show that men account for less than half (46%) of all confirmed cases, but 71% of deaths.
• Many COVID-19 outbreaks are associated with clusters of cases [such as the widely reported cases in nursing homes]
• More than one quarter of those with COVID-19 (26%) have been hospitalised [higher than the 20% that was predicted in the early days of the pandemic]
• There have now been 174 COVID-19 related deaths in Ireland [6 April].
• The median age of deaths in Ireland is 81 years. There are now 5,364 confirmed cases of COVID-19 in Ireland [6 April]
• The median age of those who have contracted the virus is 48 years in Ireland
• Few people below the age of 25 have been hospitalised (3.6% of total who have been hospitalised)
• Dublin has the highest number of cases at 2,692 (55% of all cases) followed by Cork with 362 cases (7%). 

Main source

CFI understands that a small number of people with CF are being tested for COVID-19, but there are no more details available at present. 

There is a UK media report of 21 year London-Irishman with CF who contracted COVID-19 who had a low lung function, but has since made a full recovery in a London hospital. 

Source

COVID-19 in Italy

A report from the Italian National Institute of Health is one of the few COVID-19 research reports to date. Unfortunately like most studies to date it contains no information on CF and COVID-19. 

This report analysed 355 fatalities in Italy and found:

• Only 3 patients (0.8%) who died had no prior medical conditions 
• 99% who died had one pre-existing health condition.
• 49% had three or more health conditions
• 26% had two other ‘pathologies’
• 25% had one. 

The most common problems in the 355 who died were:

• 76% high blood pressure
• 36% diabetes
• 33% ischemic heart disease
• The median age of deceased and COVID-19 positive patients in Italy was 80.5 years, which is very similar to Ireland (81 years)
• The median age of those infected in Italy was 63 years of age, which is much higher than Ireland (48 years of age).

Source

More men than women deaths reported from COVID-19

In Italy, which has the highest number of deaths from the disease, men account for 58 per cent of all hospitalised cases and 72 per cent of all deaths. In Spain, men account for 59 per cent of all hospital admissions, 72 per cent of intensive care unit admissions and 65 per cent of all deaths. In China, where the virus first started, 64 per cent of fatalities have been men. In Ireland, men account for less than half (46%) of all confirmed COVID-19 cases, but 71% of deaths. 

Source: Irish Times 7 April 2020

COVID-19 deaths in other countries in the European Economic Area with a similar population to Ireland?

The total number of cases and deaths related to COVID-19 varies considerably, even across Europe. If you take 4 other countries in the European Economic Area (EEA) that have roughly a similar population to Ireland (between 5-6m people), it would appear the numbers of deaths in Denmark and Ireland are quite high compared with the similar population sized countries of Norway, Finland and Slovakia. There could of course be a lot of factors that would explain this difference, including under-counting or poorer surveillance in other countries. 

For example, some countries are only counting Covid-19 deaths where it is the main cause of death, so if a patient had COPD and poor lung function for example but then caught Covid-19 and passed away, their death is not included in the national statistics. It would make an interesting study to see why there is variation in the reported COVID-19 deaths between European countries. There are some media reports that Denmark was going to relax some of its COVID-19 measures. There is clearly no rationale for them to do so from these figures.

Note:  Ireland (HSE) to its credit follows best practice guidance from the WHO and counts anyone who has tested positive for Covid-19 and passed away in mortality statistics. Not every country follows WHO good practice, so there could be much under-reporting in the table below in other countries, so few if any conclusions can be drawn at this stage

Sources: (varied) 

COVID-19 and BCG Research 

A study from John Hopkins University indicating that the BCG vaccine for tuberculosis could help to protect against Covid-19 is “a potential game-changer” in global efforts to curb the pandemic, according to a leading immunologist.

The research indicating that countries whose populations have high levels of BCG vaccination had significantly fewer Covid-19 deaths was the most significant development since the virus has spread, said Prof Luke O’Neill, who has specialised in study of the vaccine at Trinity College Dublin.

While he stressed the research was largely a statistical one and so came with caveats, there was a case for authorities moving to provide a BCG vaccine top-up for everybody age over 70. “This is feasible and should be considered. It doesn’t mean we change behaviour, such as physical distancing and washing your hands,” he said. However, children currently aged five and under in Ireland will not have the vaccine. BCG vaccine is given to protect babies against TB but Ireland has had no BCG vaccine since May 2015 and no children have been vaccinated since then, the HSE confirmed.

Source: Irish Times 4 April 2020

Another study of 178 countries by an Irish medical consultant working with epidemiologists at the University of Texas in Houston shows countries with vaccination programmes – including Ireland – have far fewer coronavirus cases by a factor 10, compared to where BCG programmes are no longer deployed.

This translates into a death rate up to 20-times less, according to urologist Paul Hegarty of the Mater Hospital, Dublin.

Source: Irish Times.com 6 April 2020