Ireland stands again at a crossroads. The coronavirus pandemic has killed many, sickened far more, and twice nearly overwhelmed our hospital system. The economic losses are large, though perhaps not beyond calculation. The personal losses, the deaths alone, the missed celebrations, the absence of sports and music, missed opportunities for education and fun for our children, the mental health stress of interminable lockdowns, are truly incalculable.
Whatever happens it is very likely, though not certain, that vaccination will bring this phase of the pandemic to an end in our country. By the middle of autumn this year, it should be possible to largely reopen our society, with a full return to work, to school, to reopened shops and restaurants, to sporting events, and cinemas.
We remain, by deliberate choice, largely ignorant of the actual routes of transmission of disease
We face two policy options until then, the same two choices we have had since the beginning of the pandemic in March 2020. The first is to use lockdowns, essentially to stop the collapse of the health service. The second is to control infection, using the full range of public health measures open to us.
We have faced this choice before, and each time the “lockdown and reopen” choice has been made, cheered to the echo by certain economic commentators. Each time, the virus has rebounded, causing more deaths, more sickness and more losses, both personal and financial.
Last March, the World Health Organisation pointed out that lockdowns are no way to control a pandemic. Yet we have persisted in their use, largely to the exclusion of more adequate and less intrusive measures. We have had all the costs of society-wide restrictions but we have failed to use the time they give us to institute working public health controls. We have copied the failed UK response to tracking and tracing, by establishing large call centres detached from regional public health.
We remain, by deliberate choice, largely ignorant of the actual routes of transmission of disease. The National Public Health Emergency Team’s (Nphet) chosen term “community spread” is no more than a socially acceptable version of “we have no idea where this infection came from”.
We are doing woefully inadequate contact tracing, in most cases not going back to the time of infection (Nphet’s view was that such retrospective community tracing was of “academic interest” only). Dogmatic and ill-informed statements about “schools being safe” and “children not being infected by new variants” are a poor substitute for considered, evidence-based guidance.
We know there are at least three strains of the virus in circulation globally, which are relatively resistant to current vaccines. Two of these commonly cause more severe disease. There will be more. The longer case numbers remain high here, the greater the risk of a new variant coming in and spreading rapidly. This has already happened with the UK variant (B.1.1.7 or the “Kent” strain), which became the dominant strain here in just under four weeks over Christmas.
The alternative is to use the lockdown we have. We spin up regional public health, and rapidly hire and train several thousand contact tracers
Our choices now are simple. We can continue as is. Vaccination is going well, despite much carping from some quarters. The HSE deserves great credit for this. Supply is a real issue, and will slow us down. The AstraZeneca vaccine, which had been paused because of safety concerns, resumed in some countries in Europe on Friday following the European Medicines Agency’s decision of last Thursday.
At the moment, it looks as if we are on track to vaccinate most people by October or November of this year.
Once this is done, the virus will be less of a problem. There will still be cases, there will still be deaths and there will still be long Covid, but the worst will be over. I believe that our society will largely open up. Even without any new strain, the price of this is another lost summer for tourism, and the loss of more jobs, more businesses, especially in rural Ireland; as well as more cases, very likely at least one more wave of the virus, and more deaths. With the wrong new strain, things could get much worse, very fast.
The alternative is to use the lockdown we have. We spin up regional public health, and rapidly hire and train several thousand contact tracers. We do proper contact tracing, so we can break the connections along which the virus spreads. We do proper source investigation, so we know quickly and in detail where each case comes from. We support people on lower incomes, in crowded housing or insecure employment, to isolate.
If we control the virus now, and keep it under control, it matters little which strains are circulating outside Ireland
We use local knowledge and local community interest to bring the virus under control quickly county by county, and we manage our airports and sea ports to reduce imported cases. We work with Northern Ireland to manage our joint border fairly (not the ridiculous suggestion occasionally made of “sealing the Border”), allowing people who live close to it to live their lives as usual, including freely crossing the Border. We make specific arrangements allowing essential workers, and goods, to cross freely.
The price of this is extra temporary staffing for public health. The benefit is a rapid reduction in case numbers, rather than the agonisingly slow and uncertain decline we see now, with a very good chance of reopening most of our domestic economy in June. This will save the Irish tourist industry, especially the indigenous industry, the small family-owned hotels, bars and restaurants.
It also reduces one large and unspoken risk. There is a real concern, and some evidence, that existing vaccines will give only limited protection against some newer strains. These have already been isolated in people living in Ireland. Should they spread, there is a serious risk of another major wave, perhaps worse than that at Christmas, flooding the health service and preventing any real reopening. This could easily postpone a return to normal life, and normal economic activity, until some time in 2022.
This economic harm will not be a response to any Government policy, but to levels of infection. Whatever Nphet advises and the Government decides, people will not go out, they will not travel and they will not spend and invest, unless they believe it to be safe to do so. We do not have to take this risk. If we control the virus now, and keep it under control, it matters little which strains are circulating outside Ireland as we can control small outbreaks before they cause further job losses, further business closures, more illness and more deaths.
Time to choose.
Anthony Staines is professor of health systems at Dublin City University