Summer is over, the kids are back in school, the rain has returned – and it’s time to say hello again to Covid-19.
For many of us, the last three months have been a fantastic holiday from the worries of the pandemic. The virus has retreated, no new variants have arrived to queer the pitch and life has, largely, returned to normal.
Covid has continued to exact a toll on society, picking off the most vulnerable and adding to the existing problems of the health service. Large numbers of people continue to suffer the after-effects of previous infection, with one estimate putting the number of long Covid sufferers at 300,000.
For most people, though, thanks to the protection provided by vaccination or previous infection, the virus is now an irritant rather than an existential threat.
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The wheel is beginning to turn once more as we head for winter, the most vulnerable season when it comes to respiratory complaints. There are signs case numbers have bottomed out and may be starting to rise again. Test positivity is also rising, and this is before the full impact of the return to school is felt.
With significant flu likely to return after a two-year absence, the health service is in for a bumpy ride over the coming months. Conditions are already difficult, with staff exhausted after the pandemic and waiting lists as long as ever, despite €350 million being spent to reduce them this year.
“The health service is worse than I have ever seen it,” says Anthony Staines, professor of health systems at Dublin City University. “People are terrified. We don’t know what is going to happen, but the betting is on infections continuing at a high level.”
As of now, the burden exerted by Covid on the health system is greatly reduced. There were 251 patients with the virus in hospital on Friday, compared to more than 1,000 a month ago, and barely one-third of current patients were there because of Covid. The rest are asymptomatic, though they still require infection control procedures that may entail closed beds.
Covid-related deaths
The figures show where the greatest risk lies. Unsurprisingly, two-thirds of those in hospital are aged 65 or over. One-quarter are not fully vaccinated, far higher than the share of unvaccinated people in the population.
Covid-related deaths continue to mount. There were 163 such deaths in July, about five a day. No breakdown is available to indicate for how many of these cases Covid was the main cause of death.
There are plenty of reasons to be optimistic, or at least more optimistic than in recent winters. BA.5, the currently dominant variant of Covid, is not leading to respiratory failure to the same extent as previous variants.
Although Covid continues to mutate at an alarming rate, no significant new threat has emerged over the summer. “Omicron/BA.5 is so infectious, nothing else is getting a toe hold,” says Staines.
In the meantime, the scientific world has almost caught up with the virus, with adapted vaccines that protect against the original strain and Omicron on the way. The first nasal vaccines have also been developed, which could provide longer protection against infection.
Infectious diseases consultant Prof Sam McConkey says: “I’m cautiously optimistic. There will be multiple more waves over the next few years but we’ll be hoping they are milder and don’t kill so many people.”
There is a “small chance” of a more lethal new variant emerging but he says the world should be able to react to such an event more quickly than before. Vaccine technology is well-developed and can be adapted quickly to tackle a new strain of the virus, preventative strategies have multiplied and treatment options continue to improve.
Staines, a prominent figure in the zero-Covid lobby during the pandemic, believes the Omicron family of variants poses just as much a threat as previous variants. The risk of suffering long Covid after infection is undiminished, he argues, though there is some evidence that vaccination reduces it.
“It hits all of you. It goes right through your body, sticking to all types of tissue and hitting the immune system in a way not previously seen.”
This is a description that 26-year-old Fáinche Deeney could relate to, having suffered a constellation of post-viral symptoms since contracting Covid-19 at the very start of the pandemic. “I have gone from being fit and healthy to the opposite. I have tried everything to combat it: I worked through it, I exercised through it, I ate various different healthy diets. I have a pillbox full of supplements to take every morning.”
Deeney’s symptoms include fatigue “crashes”, post-exertional malaise (“a fancy phrase for ‘the consequences of overdoing it’”), migraines, vertigo, gastrointestinal issues, weight gain, “brain fog” and feeling faint when standing for too long.
Long-Covid clinics
“There are times when my boyfriend is talking to me and I can’t understand him. It’s terrifying. At the beginning, when my symptoms were at their worst, I couldn’t even watch TV because it gave me motion sickness.”
The Health Service Executive is setting up a network of long-Covid clinics but infectious diseases consultant Prof Jack Lambert of the Mater hospital has argued that its model is flawed because it focuses on respiratory symptoms rather than neurological or inflammation-related ones.
“All I keep hearing from medical professionals is ‘rest’ and ‘avoid stress’. It’s been 29 months for me. I think the ‘time heals’ would have happened by now,” says Deeney, who has been on an MRI waiting list “for months” and says testing is needed for cognitive issues for long-Covid sufferers.
“It is ludicrous that the HSE is setting up only six long-Covid clinics when so many people are affected,” says Miriam Cullen of the Long Covid Ireland support group. “Every day, new people are suffering long Covid, yet we are being ignored.”
Flu has traditionally been the biggest winter challenge for the health service, but it disappeared over the last two winters due to the protective measures then in place.
Forecasters traditionally look south for indications of what the coming flu season might look like. Australia has just had its worst flu season in five years, and one that came earlier in their winter season, though there was less pressure on hospitals than some had expected.
It therefore seems likely that Ireland will experience significant flu activity this winter, for the first time in three years. But what can be done this winter to counteract the risk posed by Covid-19 and the flu?
Booster shots against Covid are the first option. The new, adapted boosters are likely to be offered first to higher-risk groups.
“We should do what we can at a systems level that doesn’t rely too much on personal agency,” suggests Prof Ivan Perry of the school of public health at University College Cork.
He suggests people should be encouraged to wear masks on public transport and in some work sites. He also wants the use of masks standardised, so the default choice is a surgical-grade mask.
“We need to continue optimising ventilation in order to reduce the risk of infection spread, to remind people with symptoms not to come in to work and we should maintain a high tolerance of working from home. In that way, we would dilute the number of people at work, and travelling to it.”
While for many Covid has become a distant memory, Perry believes we are no further than the middle of this crisis. “I don’t think anyone knows what will happen. There are so many species that can harbour this virus; it would take a brave and confident person to say something new won’t emerge.”
