People in affluent countries like Ireland have little experience of living with the long-term reality of serious infectious diseases. Covid-19 has changed that for the foreseeable future. We have been in a new phase for a few months, in which Covid-19 protective measures are largely lifted, but Covid-19 continues to circulate. We can do that better in Ireland. What should we aim for?
The first thing that needs to be clarified is what “living with the virus” really means.
Many people have died and we have reached the staggering death toll of 7,000. Many families are struggling with infections – half the house gets Covid-19 and some time later the other half follows. This leads to a significant disruption of daily life. Many people become reinfected and long-term immunity is limited. This appears to be an unfortunate feature of the biology of Covid-19. While vaccination greatly reduces the worst consequences of this disease, neither vaccination nor previous infection, or both, confer complete immunity from re-infection.
Uncertainty is inevitable. What we can say with confidence is that Ireland’s government protection from Covid-19 is very limited
As a result, we may continue to have large numbers of people unemployed at the same time and then have to deal with the post-Covid-19 fatigue that is disrupting the economy and life in general. We do not yet know the full impact of Covid-19 reinfection on people or the population. However, the long Covid, which is affecting around 125,000 people here (an estimate based on UK figures, to the shame of our health officials), may result in further significant economic losses as some people are forced to move into new jobs or leave the total workforce.
Uncertainty is inevitable. What we can say with confidence is that Ireland’s government protection from Covid-19 is very limited. Tracking the intensity of government action at Oxford University puts Ireland ahead of Mongolia (bottom of 185 countries) in the intensity of protective measures to prevent the spread of Covid-19 here.
dr WHO’s David Nabarro called the Irish government’s lifting of its citizens’ Covid-19 protective measures “brutal”. We know that Covid-19 singles out the poor, the elderly and those with existing illnesses for the worst outcomes. We have no plan for these people as we are ‘living with Covid’. Antiviral drugs can be helpful, but their overall effects remain uncertain.
It is quite clear that transmission cannot be contained by appeals to individual responsibility. The government’s strategy of lifting all Covid-19 protective measures at once (except for the vaccines already administered) has ensured this. Litigation is the inevitable reaction to the failure of this policy approach. A worker at a meat plant is suing over the injury he sustained from a Covid-19 infection at work, and a legal battle is expected over the desperately lonely deaths in care homes.
The WHO is rightly concerned about the risk of another wave possibly coming from the new Omicron group variants
Some of the consequences will fall to the government, others will hit small and large commercial enterprises. It is questionable to what extent this expenditure will benefit the health of the Irish population.
We don’t know what will happen next with Covid-19. The WHO is rightly concerned about the risk of another wave, possibly caused by the new variants of the Omicron group (BA.4, BA.5) or possibly by a new variant of the original virus (BA.2.12.1) which both are now spreading rapidly in different parts of the world.
Recent work suggests that all of these are fairly resistant to current vaccines and that even recent infection with BA.1 or BA.2 (the “original” Omicron) offers little protection. Better vaccines may help in time, but they may not be possible. With the uncertain risks posed by new strains, long Covid and repeated infections, our current approach offers only limited protection, be it for people, jobs or the economy at large.
We need further investment in Ireland’s public health infrastructure – the people, systems and research capacity needed to ensure we can detect and respond quickly and appropriately to new Sars-CoV-2 variants and other pathogens, but we also need to Plot.
There is an alternative that costs very little – certainly a lot less than we paid each month during lockdown and certainly less than the personal and economic costs outlined above. The alternative is simple and doable: keep the tried-and-tested protective measures that have served us very well – vaccines and masks – and invest the modest sum required to maintain excellent indoor air quality.
Mask use has fallen below what it should be, but masks are cheap and surprisingly effective
Covid-19 is an airborne virus and good air hygiene is a crucial tool in managing its transmission. Concretely, this means pushing up the uptake of vaccines as much as possible; Wearing FFP2/N95 masks in crowded indoor spaces – retail, schools, workplaces, public transport; and ensuring good ventilation wherever possible, including air filtration in schools, pubs, theatres, nightclubs and other indoor spaces where large numbers of people congregate, as is now common in Belgium. Mask use has fallen below what it should be, but masks are cheap and surprisingly effective, with recent Irish data suggesting they can reduce transmission by more than 40 per cent.
This approach is compatible with a more or less normal life with minimal disruption and an active economy – living as best as possible with Covid.
Anthony Staines is Professor of Health Systems at DCU and Daniel Carey is Director of the Moore Institute, NUI Galway