Ireland must learn lesson from last Christmas as we face Omicron threat

We can only be certain about the future after it has become the past. Last Christmas we left it too late to prevent the damage caused by the third wave of Covid. This year, although we have vaccines, our situation has suddenly become more volatile and uncertain due to the new Omicron variant.

We are still learning about Omicron. We know it is rapidly becoming the dominant cause of Covid in many countries, and this seems to be due to its ability to evade much of the immunity acquired by vaccination or previous infection. It is also highly transmissible, and we know it can cause hospitalisations and deaths. Those who are doubly vaccinated are not well protected from infection by Omicron.

Thankfully, vaccine boosters seem to provide significant protection from the Omicron variant. So we clearly need to accelerate the booster rollout. But boosters alone will not suffice. Laboratory studies suggest that three vaccine doses are slightly less effective at immunising for Omicron than two vaccine doses were for Delta. And, we don’t yet know about how immunity for Omicron will wane.

Faced with uncertainty, a 'wait and see' approach is a natural reaction. The problem is that Omicron is spreading too quickly for us to wait

Even with our best efforts, it will take time for much of the adult population to be inoculated and for immunity to be enhanced. Children are still completely exposed, and their vaccination will not be complete until February at the earliest. A strategy that relies on boosters alone is not a strategy.

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Any effective strategy for dealing with Covid has to be pragmatic. There is much uncertainty, and our tools are imperfect. Possibly our most precious resource is time.

Faced with uncertainty, a “wait and see” approach is a natural reaction. The problem is that Omicron is spreading too quickly for us to wait. It doubles in number every two to three days.

If, say, we have 2,000 new Omicron infections today, we may have 4,000 on Monday, 8,000 on Wednesday, 16,000 on Christmas Eve, 32,000 on St Stephen’s Day, 64,000 on December 28th, and potentially 128,000 on New Year’s Eve.

Based on our testing capacity, our limit of detection is about 8,000 cases per day. Hospitalisation rates lag the number of Covid infections by a matter of weeks; if we wait for Omicron to overwhelm our hospitals then it will already be too late.

Lesson not learned

We should have learned this lesson from last Christmas, when the Government committed two major errors. It chose to allow a burst of indoor socialising, enabling the airborne virus to spread in an unvaccinated population. The second blunder was the delay in responding to the crisis at the time.

One year ago today, on December 18th, 2020, the Taoiseach acknowledged that significant restrictions would be required. But they were not put into action until December 27th. We chose to give the virus a nine-day head start. More than 2,700 people lost their lives to Covid as a consequence of our third wave, and we all suffered a five-month lockdown.

The uncomfortable fact is that the vast majority of infections happened after December 17th last year, and an early intervention would have dramatically reduced the size and length of our third wave, potentially preventing up to 2,000 of those deaths.

It is crucial that quick and decisive action comes from the Government for three reasons

The Omicron variant is unlikely to be significantly milder than Delta. Its effect on infected individuals may be weakened by previous immunity, although this is far from certain. And the exposure to the population is immense in terms of the sheer number of infections. Let’s suppose the Omicron variant is effectively one-third as deadly and slightly more infectious. That might place it in the same zone as Delta. However, if the variant is half as deadly and five times as transmissible, then we end up in a very dangerous place due to overwhelming infection numbers.

We have to use our time while we have it.

Why should we act now? To save lives, first. Then to reduce the cost of long Covid, and the knock-on effects on non-Covid-related care. To reduce the impossible burden on our healthcare workers. And, to reduce the extent and duration of restrictions for all into 2022.

Reducing transmission

What must we do? Protect people from the Omicron variant by reducing transmission in the community as much as possible. This buys us time. Time to wait for the boosters to be rolled out and take effect. Time to vaccinate children and make schools much safer. Time to allow healthcare workers to manage their load. Time to properly resource and deploy our testing/tracing infrastructure and public health strategy.

How do we do this? In the short term we are in damage control. This means temporarily reducing indoor socialisation to a minimum, preventing large gatherings, reducing non-essential travel, wearing higher-grade masks in public (N95, KN95 or FFP2), closing schools a few days early, and working from home. In the medium term, Ireland needs to transition to a preventative and strategic, not emergency, response to Covid-19. This means investment in air hygiene standards and regulation, increased capacity for testing and tracing, and adopting new methods for real-time disease surveillance.

It is crucial that quick and decisive action comes from the Government for three reasons. First, leadership is necessary to inspire trust and co-operation. Second, personal responsibility could not beat Delta, and it will not beat Omicron. Even when taken as seriously as it has been by the Irish people, individual behaviour is insufficient when dealing with a community problem. Third, mandatory rather than voluntary closures for the public health benefit force the State to adequately compensate economic sectors that are worst affected.

Looking to the long term, there seems to be only two endgames. Either we accept Covid as endemic, which could kill many thousands of people in Ireland each year, with ensuing human, social and economic effects, or, we move towards Covid’s progressive elimination via a globally co-ordinated and equitable vaccine-plus campaign, as we have for smallpox. In the meantime, this virus will take every advantage it can get. Let’s not make wasted time one of them.

Tomás Ryan is associate professor in the Trinity College Dublin School of Biochemistry and Immunology and Trinity College Institute of Neuroscience