The death this week of Dublin City University lecturer Greg Foley after contracting Covid highlights the continuing vulnerability of those most at risk from the virus.
While the rest of society has moved on from the Covid pandemic now that vaccines are widely available, thousands of people with weak immune systems remain at extremely high risk. For many of them, the vaccines don’t work and treatment options are extremely limited.
Prof Foley (59) had cystic fibrosis, received a double-lung transplant 20 years ago and was on dialysis after the donated organs eventually failed. His were the kind of “underlying medical conditions” we read about in the pandemic statistics.
‘Extraordinarily lucky’
Until succumbing to Covid he lived a full and varied life. A gifted student, he was a former UCD Newman Scholar and also went to Cornell University in the US on scholarship. An engineering lecturer at DCU’s school of biochemistry, he was an expert in designing membrane systems and in pedagogical approaches to learning, and was also the proud father of 14-year-old Leo.
He considered himself “extraordinarily lucky” to have survived so long, he told The Irish Times last November, having been told by a doctor when he was a young child that he wouldn’t see his 10th birthday.
However, the Covid pandemic altered his life and, ultimately, the virus was “the straw that broke the camel’s back”, said his wife Julie Dowsett. “Covid changed everything,” his wife recalled. “For a long time, he never left home. He did lectures from his bed in dialysis. Eventually, we went back into work due to ‘cabin fever’ but it had taken so much out of him.”
He fell ill just after Christmas, shortly after celebrating the 20th anniversary of his transplant. “We were surprised he had avoided Covid for so long, but once he caught it he couldn’t clear it,” said Ms Dowsett.
In his final days, after he had been admitted to the Mater hospital, he laid bare on social media the awful reality of extreme Covid. The virus “hit me like a ton of bricks,” he tweeted.
Among patients with no protection against Covid due to a poor vaccine response are people with specific medical conditions and those who have had a transplant or are taking immunosuppressant drugs. Not everyone in these categories is affected, but none of these patients can afford to take the risk of contracting Covid.
Options for these patients in Ireland are particularly poor. The Health Service Executive lists just two treatment options for people at the highest risk from Covid, Paxlovid and Xevudy (sotrovimab), though the latter is no longer recommended.
Millions of doses of Paxlovid, which needs to be taken within five days of infection, have been dispensed in the US, but in Ireland that figure stood at just 1,500 last October.
A preventative drug, Evusheld, is available in more than 30 countries, but not in Ireland or the UK.
The National Centre for Pharmacoeconomics last month rejected Evusheld on cost grounds. It said the drug would cost more than €5,000 per patient per year, adding an annual €100 million to the overall drugs bill.
One of the challenges faced by drug manufacturers is the rapid mutation of the virus. The European Medicines Agency says Evusheld, Xevudy and other monoclonal antibodies are unlikely to be effective against the Omicron variant, though Paxlovid will continue to offer protection.
This lack of medical options is one reason why the death toll from Covid remains so high. There were 129 deaths of people with Covid in October, 116 in November and 85 in December.
There were 410 admissions of patients with Covid to intensive care last year; 170 of these patients died and 233 were discharged alive. Some 88 of these patients are listed as being immunodeficient. One patient was in intensive care for 119 days before dying.
‘Human suffering’
Online, Prof Foley remained a scourge of anti-vaxxers and conspiracy theorists to his last days.
“There are numerous grifters, and serious academics, out there who seem to think if the fatality stats are not that bad, then Covid is no big deal,” he wrote just last week.
“But what’s behind the numbers? Human suffering of course which can be alleviated by vaccines but which persists. Covid sceptics who live in their garden sheds plotting graphs don’t get this.”
He then detailed the experience of Covid patients needing respiratory support in order to breathe and posted pictures of himself wearing breathing apparatus.
“There are occasions when I just want to rip it off,” he said of the mask he wore when on a CPAP (continuous positive airway pressure) machine, a form of ventilation where air is pumped into the body through the nose and mouth.
Shortly after, he was sedated and intubated in intensive care. He never recovered and died on Tuesday.