Who is most responsible for spreading Covid-19 in Ireland? Somebody McSomebody.
Among the acts of genius in Anna Burns’s great novel Milkman is the way the narrator names people without naming them. One nasty character is called Somebody McSomebody. As it happens, the same reprobate is the villain of our Covid story. He/she/they is to blame for the stubbornly high levels of transmission of the coronavirus.
In the medico-political discourse that dominates our lives, Somebody McSomebody goes by an alias: community transmission. The term is defined by the Cambridge Dictionary as “the process of infectious illness spreading through a large group of people in a general way so that the source of the infection in a particular case is not known”.
As Prof Anthony Staines put it in The Irish Times last week, community transmission, or "community spread" as Nphet likes to call it, is "no more than a socially acceptable version of 'We have no idea where this infection came from'. "
We don’t know because we don’t ask. We don’t ask because we have not, more than a year into the pandemic in Ireland, built a system of contact tracing that is remotely capable of figuring out how, when and where a chain of infection got going.
Consider two pieces of official advice to us, the general public. The HSE explains: “The incubation period for Covid-19 is on average five to six days, however, it can be up to 14 days. It is now known that during the incubation period, those infected can spread the virus to other people.” The HSE also explains: “If you test positive and have symptoms, the contact tracer will ask about people and places you have visited 48 hours before your symptoms started and until you started self-isolating.”
So: you may have been spreading the virus for 14 days, but we’re going to ask you about the two days before you became symptomatic. You don’t have to be an epidemiologist to see the problem here. We have a time machine but it doesn’t travel back far enough to see where any outbreak started.
Why? Because that’s the way we’ve built it. In October, as the second wave was really hitting us, a total of 300 people were working as contact tracers. Everybody knew this was grossly inadequate.
DIY tracing
By October 22nd, by which time there were 500 tracers, the system was in meltdown. That weekend, people who tested positive got text messages from the HSE asking them to forward the message to their own contacts and urge them to arrange a test – DIY tracing. Minister for Health Stephen Donnelly said, "This was a one-off situation where demand outstripped supply and a one-off operational decision was made to reset the system."
It wasn’t a one-off situation. At the end of December the system was so overwhelmed that the basic protocols for tracing had to be dumped. The agreed procedure had three stages. First, if you tested positive, you got a call from a medical professional. Then you got a call from a tracer. Then the tracer followed up with your close contacts. To avoid the complete collapse of the system, this was telescoped into a single call from a tracer, who then texted the contacts to urge them to isolate.
So we know that the tracing system has come close to implosion twice in the past six months. It now has 873 staff – a significant improvement, but not remotely enough to trace infections back to their origins in Ireland.
We’ve chosen to stick to the known unknown. But the problem is that this absence of evidence is claimed all the time as evidence of absence.
Whenever it suits its purpose, any given group can claim that what we don’t know is actually a form of proof. Look, they say, there is hardly any evidence of transmission through schools, or pubs, or restaurants, or church services, or international travel, or construction sites, or whatever.
Of course there bloody well isn’t. We just don’t do that kind of tracing. Beyond the mates or family members you met in the past 48 hours, there’s just Somebody McSomebody who got Covid from Somebody McSomebodyelse.
No point
What the people in charge will say is that there is no point in doing this deep tracing because it would simply overwhelm the system. This is entirely true, but it’s also self-fulfilling. We never had the will or the urgency to build a system that would not be sunk if it pulled too hard at the hidden roots of infection.
This matters because the countries that have managed this pandemic best are the ones that have used contact tracing to do what we don’t: hunt the virus down to the clusters that are spreading it and move in ruthlessly to suppress it. This allows most ordinary life to go on without lockdowns. It’s the difference between playing whack-a-mole and shutting down the whole funfair.
Or, to use the famous analogy, between the fox who knows many small things and the hedgehog who knows one big thing. We chose to know one big thing – lockdown – and not to know the many small things that make up the Irish pandemic. As a result, we’re stuck in hedgehog mode, curled up and bristling.