The Government urgently needs to reboot its policy on tackling Covid-19 if a grim winter is to be avoided.
It faces an immediate problem of controlling the transmission of the disease and cutting case numbers that continue to rise despite weeks of restrictions.
There is also the longer-term challenge of crafting policies that keep the virus at bay after the current wave has been dealt with. Otherwise, we are doomed to a repeat cycle that sees cases rise every time restrictions are lifted.
Hospital Report
The environment in which it attempts to operate is becoming more difficult, with growing divisions in scientific opinion and the emergence of substantial groups of the population that are either indifferent to public health advice or antagonistic towards it.
The Government first needs to ensure transmission of the disease is reduced. Cases are still rising nearly everywhere; parts of Donegal have twice the incidence of Spain, Europe's worst-affected country.
This will almost certainly mean a rollover of existing restrictions, something that will not go down well with many people.
Tánaiste Leo Varadkar is right to suggest there is more to the analysis of this situation than case numbers. Of the measures monitored by the European Centre for Disease Control (ECDC), Ireland is stable for four – hospital admissions, ICU admissions, testing rates and the proportion of positive test results. Four are rising – case numbers, the proportion of cases among over-65s, hospital bed occupancy and ICU occupancy.
Crucial metrics
The health service has yet to publish projections of the number of hospital and ICU beds that will be needed for Covid-19 patients over the winter. These are crucial metrics that should inform our response to the virus over the coming weeks.
The ECDC figures tells us capacity is an issue in Irish hospitals, and that too many older people are being exposed to the virus. We need to get on with the provision of extra beds promised in the winter plan as quickly as possible and we need to be strict in ensuring the virus does not get into nursing homes.
We lost the summer, when transmission fell to low levels, in a fog of complacency and understandable weariness. Changes in people’s behaviour went undetected, testing was too slow and outbreaks in meat plants went unchecked for too long. Community transmission stayed too high even when case numbers fell. Workforce planning and a revamp of the testing service were placed on the long finger.
We are now playing catch-up at the same time as fire-fighting on cases. But there is still much Ireland can do to up its game and hold the disease in check. We are doing plenty of testing but the turnaround could still be faster. With the World Health Organisation last month giving the thumbs-up to antigen testing, we should be planning to put in place a high-volume system of rapid and cheap testing to complement the existing system.
Worst spreaders
Belatedly, we are investing more in retrospective investigation of cases and clusters. By going back to the causes of outbreaks we can learn more about high-risk environments, and do more to make them safer or rule them off-limits. We can also learn to identify the minority of infected people who spread most of the cases, and understand what gives rise to this version of the 80:20 rule.
Instead of shutting things down, we need to be allowing them to happen – restaurants and travel, for example – under strict rules. Controlled environments are good; uncontrolled ones are bad.
Why shouldn’t restaurants in Dublin reopen under strict rules and with prompt investigation of outbreaks should they occur? Surely the problem is with the alcohol on sale not the food? Did the delay in reopening “wet” pubs not push people into drinking in uncontrolled environments?
Now is the time to start planning for a proper resumption of overseas travel. That will need more testing and, at times for some travellers, a proper quarantine system.
We can simplify the rules on social gatherings, promote outdoor environments and, where that is not possible, encourage good ventilation in indoor settings. Penalties should be proportionate – a €2,500 fine for not wearing a mask is not – but they should also be enforced.
By providing clarity, consistency and hope, the Government can still plot a way out of our current predicament.
