The whole of Europe is in a disastrous second wave of Covid-19 and a second lockdown. On past experience, it is likely to head into a third wave and third lockdown in January, which will bring further and unimaginable damage to us all, and a collapse of confidence in our medical advisers and governments.
Vaccines and anti-virals will not arrive in time to avoid this catastrophe, and any talk of significant relaxation of guidelines for Christmas is highly irresponsible. We must go further and face the fact that the European policy of living with Covid-19 is wrong.
Ireland should now take the lead in Europe, and adopt the policy of zero Covid, that has worked in several countries. However, I doubt that the National Public Health Emergency Team (Nphet) as at present constituted can provide the proper advice. The Government has found it cannot oppose Nphet, which must be substantially reformed.
Hospital Report
There are fundamental reasons why we have failed to deal with Covid-19. Our health system has been underfunded with no spare capacity in any of its services, many of which are outdated. In any case, there was no pandemic plan. Doctors working in public health were paid less than their peers in other areas of medicine.
The Health Protection Surveillance Centre (HPSC) responsible for reporting continuously on illness, for example on flu, did not provide a tabulated report on Covid-19 until March 22nd. This was fully three months after the disease had begun to spread from China, and nearly two months after the first Irish cases had arisen on February 4th. We were not well-informed, we did not react soon enough, and we have never got on top of the virus.
Another fundamental reason for our failure is the structure and composition of the emergency team. More like a convention than a committee, Nphet has 35 members of whom 31 are administrators or managers in government departments or agencies. It is not surprising that it has failed to provide good advice to government or indeed to reorganise our capacity to deal with Covid-19 or to develop new policy – it has almost no expertise in the relevant sciences.
‘Expert’ committee
Remarkably a new Covid-19 Expert Advisory Group has just been set up to advise Nphet. The new committee has 38 members, of whom 30 are members of the Health Service Executive, the Health Information and Quality Authority or other government agencies. This is an “expert” committee which like Nphet itself has almost no relevant scientific expertise; it should be disbanded. How can we explain the systematic exclusion of top scientists from leading roles in combating Covid-19?
What should we do differently from what we did in May and June to avoid the third wave? The science is clear.
In the first place we must adopt a zero-Covid policy. This has been shown to work in China, Taiwan, Hong Kong, Singapore, in the seven separate states of Australia and in New Zealand. We do not need to reinvent the wheel – just do more or less what has been done in Victoria, as one easily understood example.
There is no alternative but to rigorously regulate and minimise travel from non-zero Covid regions and countries
There are two phases. First, we must get the case numbers down to a few tens per day – that is achieved by a tough lockdown, which we did in March to May. That will need a reorganised test and trace system to be focused on high-risk people, all frontline workers, in nursing homes, schools, food-processing factories, home clusters, etc, and on borders. We must be able to make contacts, test them and report the test results to the people within 24 hours of identification.
Suspected and infected people must self-isolate by law. Most people should be within 10km of a test station – pop-up centres work well – tracing must be carried out locally and self-isolation must be monitored locally, possibly with the support of the Army. Those self-isolating should be compensated for financial losses.
Ten cases a day
We can go into the second phase when we get to about 10 cases per day – but there is much more to be done before significant relaxation. We must pursue the virus relentlessly. At this stage, the test and trace system will focus on borders and the small number of community cases. New cases must be identified quickly and accurately, their contacts traced and tested, leading to the second ring of contacts, testing them, running down every “chain of transmission” to zero.
Testing at the borders is a big issue. There is no alternative but to rigorously regulate and minimise travel from non-zero Covid regions and countries. The North poses a special problem but as long as case numbers are much higher there, we must address it, as Australian states did at their state land borders. There must be no non-essential travel from and to Northern Ireland. Essential travel for business can still continue across the Border, regulated by a Covid-19 passport system – frequent essential travellers will have tests every few days and be required to minimise and record their contacts on both sides of the Border. Entry at air and sea ports by frequent essential – and even occasional – travellers should also be regulated by a Covid-19 passport. All arrivals should be temperature- or antigen-tested and further tested for the virus if suspected. Any positive cases – including Christmas travellers – should be quarantined under mandate and at the travellers’ expense.
Economic damage
As the only new cases become sporadic and go close to zero, and as positivity of testing runs close to 0.01 per cent, then and only then can we begin to relax significantly. If we reach that goal in regions, counties or provinces, we may be able to relax locally. Our case numbers are at about 400 per day at the moment with 3 per cent positive tests. There is a long way to go.
Businesses and employment will, of course, suffer and must be protected as much as possible – but the evidence is clear that countries that have taken strong measures to eliminate Covid-19 are suffering less economic damage. Our short-term policy of living with Covid will do greater damage in the long run.
If Ireland aims for and achieves zero Covid, we will have shown the way for Europe.
David McConnell is fellow emeritus in genetics at Trinity College Dublin. He is a former chairman of The Irish Times Trust