In recent days, some attention has been focused on the fact that in Ontario, Canada, almost half of all hospital admissions of people suffering with Covid 19 are “incidental”. That is to say, the people admitted to hospital with Covid 19 were not actually admitted because they are suffering with Covid 19:
New data indicates that 46 per cent of people currently in Ontario hospitals with COVID-19 were admitted for reasons other than the virus.
The Ontario government released the data after indicating for some time that it would begin differentiating between those who were admitted for COVID-19-related illness and incidental admissions.
“We are updating Ontario’s public reporting to distinguish patients hospitalized due to #COVID19 from those admitted for other reasons with COVID-19,” Health Minister Christine Elliott tweeted Tuesday morning.
In the UK, a similar pattern has been detected, per the Daily Telegraph:
In the Midlands, true cases of Covid are currently just 55.3 per cent of cases and fell to a low of 53.8 per cent on Monday.
It means nearly half (46.2 per cent) of those included in the figures had been admitted for a different reason, but tested positive on arrival or shortly afterwards.
For some time, people in Ireland have been wondering about that figure in Ireland. If it is almost half in Canada, and almost half in the UK, what could it be in the Republic? Yesterday, at a NPHET press conference, we got an answer: 30%
NPHET briefing:
97.8% of cases returning in Ireland now are the Omicron variant, per latest estimate from NPHET.
Also clarify that, while they now make up up to 30% of general hospital admissions, ‘incidental’ admissions to ICU are very rare.
— Mark Coughlan (@Mark_Coughlan) January 12, 2022
What accounts for the almost 20% difference?
Well, the answer is that it is accounted for by how the HSE classifies an incidental case.
In most of the rest of the English speaking world, the definition of an incidental case is “somebody who was admitted to hospital for a reason other than covid 19”. In Ireland, the definition is different. Here’s Mark Coughlan, of RTE, again:
The ‘incidental’ mentioned is, according to NPHET/HSE definition of ‘incidental’ previously given: ‘asymptomatic/non-infectious.’
It’s not the ‘primary reason for admission’ data sometimes described as ‘incidental’ elsewhere.
Now, back to avoiding the word and using the defs.
— Mark Coughlan (@Mark_Coughlan) January 12, 2022
So, the difference here is this: In Ireland, you are counted as an incidental case of covid 19 if you are regarded as asymptomatic or non infectious. But not if you are infectious and sick, but admitted to hospital for a different reason.
Let’s take the example of two people who break their leg, and have covid. Both are going to hospital because of the broken leg. One of them has no other symptoms of any kind, but tests positive for covid in hospital. That person is regarded as an incidental case.
The other person has a broken leg, and some mild covid symptoms: A temperature, a cough, and a lack of smell. That person also tests positive. But they are not counted as an incidental case. They are counted as a full covid hospitalisation. Even though, of course, they are not in hospital because of covid.
The HSE, in their defence, regard this as a distinction with meaning: They would point out that a person with symptomatic covid needs to be fully isolated, put in a covid protocol, and treated for that illness as well as their broken leg, so they do add extra pressure to the hospital system.
This, however, is unconvincing. The fact remains that such a person has not been admitted to the hospital because they have covid 19. The covid 19 is simply a complicating factor that the hospital must deal with.
The statistic might have genuine meaning for the hospital, but this ignores the impact of the statistic on the public. When we hear that somebody has been admitted to hospital because of covid, and that covid was not an incidental factor, we automatically think of that person as being sick and in hospital because of covid. But with the way Ireland records these figures, that is not, always, true.
This has the net effect of inflating the covid hospitalisation figures, and, therefore, the public sense that covid is the root cause of problems in the hospitals.
For example, as of 8am this morning, the HSE reports 1,011 people in hospital for or with covid. That includes 30% – more than 300 people – who are asymptomatic, or not infectious. So right off the bat, we can say that the true figure for covid hospitalisation – people in hospital due to covid – is closer to 700 than 1,000.
But that 700 also includes an unknown number of people who are there primarily for other reasons. If Ireland is broadly similar to the UK, and Canada, where these figures are recorded, then this figure might account for another 14-16% of all patients.
So the true number of people in hospital because of covid might be something much closer to 500 people than 1,000.
This is not widely known, or widely discussed. In part because of the HSE’s general reticence, for a very long time, to provide these figures. And in part because even now, their way of counting these figures might fairly be described as misleading. It is misleading because there are some people in hospital with symptomatic covid who are not there because they have covid, but because of some other calamity, and yet the figures suggest they are there due to the virus.