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Within days of a budget that sought to chart a route into the post-Covid-19 world comes a bracing reminder that the pandemic remains a crisis of the present, not the past. Daily case numbers have broken from the stable trajectory of recent weeks and increased substantially. With this has come a higher demand for testing – typically an early sign of rising incidence in the community – as well as increasing hospital admissions. The standard indicators are manifestly going in the wrong direction. But quite how much concern that should cause will not be clear for at least another week, by which time the data will have shed more light on the dynamic of the disease.
The key question is why the Republic, despite having one of the highest vaccination rates in Europe, also has one of the highest incidence levels. Public health officials will be looking for signs of rising breakthrough infections and examining whether waning vaccine effectiveness may be a factor. To that end, it would help if the Department of Health were to provide more detailed breakdowns of daily case numbers so as to make clear how much of the recent increase is due to transmission among the unvaccinated and how much is accounted for by breakthrough illness.
At the very least, the upward case count underlines the importance of public information campaigns aimed at the estimated 300,000 people who have yet to take a vaccine and the smaller number who, perhaps out of complacency, have not had a second dose. It would not be surprising, given widespread weariness 19 months into the pandemic, if the resumption of normal social and economic life in recent months had resulted in a wider creeping complacency towards basic hygiene and distancing measures. It will be a constant challenge to keep up adherence to those important measures.
While stating his concern at the recent trend, Philip Nolan of the National Public Health Emergency Team (Nphet) has rightly said that for now it will require a measured rather than an emergency response. The Government is not due to decide on the latest easing of restrictions until next week; by then more data should clarify whether the recent increase in cases is a blip or the start of a longer-term trend.
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Regardless of what that data reveals, however, it is clear that a vaccine booster programme will have to be widened beyond the current eligible cohort of elderly and medically vulnerable individuals. International evidence consistently shows declining vaccine effectiveness over time – a study at Imperial College London this week suggests that decline is apparent after three months – even if vaccine protection against hospitalisation and death is far more robust. The sooner an expansion in the national booster programme is approved the better.