As we exit this week from restrictions due to the Covid-19 pandemic, the question on everyone’s mind is: “Will there be a surge of cases as we come out of lockdown?”
The June 29th milestone should be seen as end of the beginning but not the beginning of the end of the coronavirus pandemic. We are a long way from an effective vaccine and there are no drug treatments for the virus on the horizon, so the best we can hope for is a gradual step-by-step reduction in infection.
One of the country's leading infectious disease specialists, University College Dublin's Prof Paddy Mallon, certainly punctured any immediate optimism when he told the Oireachtas health committee "it is inevitable that we will experience a resurgence of cases as we relax restrictions and permit more travel".
I am more concerned about the second stress point: the onset of seasonal influenza
Almost certainly, the level of coronavirus circulating in the community will begin to rise this week. Recently most clusters of infection have occurred within private houses, suggesting community transmission has been corralled by a combination of lockdown and our ability to test and trace contacts of those infected.
But from this week on, we are relying more on personally rigorous social distancing, as well as a recommitment to careful respiratory hygiene practices.
Even with renewed personal commitment, local outbreaks are inevitable. Coronavirus cases are resurging across Europe as countries ease restrictions. But with prompt contact tracing and a regional lockdown, it should be possible to avoid a countrywide lockdown for the next three months or so.
Our ability to stamp out local outbreaks will depend on how concentrated they are. In Daegu, South Korea’s fourth-largest city with 2½ million people, most cases were concentrated in a single church congregation and the outbreak was controlled. However a more recent pulse of clusters has affected many areas in the capital city Seoul leading to a reimposition of some lockdown measures, with health experts warning a blanket lockdown is needed. This experience suggests that should there be an outbreak in a number of districts in Cork or Dublin, a full lockdown of a metropolis will be required.
Stress points
Prof Mallon pointed to two separate stress points over the coming months. “The first stress test for Ireland’s capacity to deal with a resurgence in Covid-19 cases will be in August when people decide if they’re going to travel overseas or not, because we will inevitably have imported cases coming back into the country.”
He warned that if we get a large number of people returning to the country from overseas and a wide geographical spread of community transmission “and you can’t test and contact trace efficiently, the only way that you’re going to control that is by returning to mass lockdown”.
I am more concerned about the second stress point: the onset of seasonal influenza (anytime from October to March). People with flu will present with symptoms that are mostly indistinguishable from Covid-19, which will require a surge in testing to distinguish one disease from the other. And there are so many unknowns around what will happen next winter: how virulent will the influenza virus be; how much will the Sars CoV 2 virus have mutated by then – and will the mutation make the resulting infection more benign or more severe; and perhaps the biggest question of all: how will the human body cope when it is co-infected with influenza A or B and Sars CoV 2?
A recent study from China has given us some clues: it found some 57 per cent of Covid-19 cases were co-infected with influenza. And patients co-infected with the SARS-CoV-2 and influenza B virus were more likely to be sicker and have a poorer outcome.
We have a few months to get our health system prepared for the next onslaught. Gaps in public health and occupational medicine, in particular, must be urgently addressed.