Regardless of whether you think the country should be on Level 3 or Level 5 restrictions, there is much we can do to bend the curve of Covid-19 infections.
As the experience of other countries shows, there is nothing inevitable about the rate of transmission once countries implement well-resourced and thought-through strategies. And while the graph line of case numbers may not always be your friend, the more important metrics of ICU admissions and deaths look more favourable than during the first surge.
The worst thing that could happen in the aftermath of the disagreement between the Government and Nphet would be for an air of fatalism to take root.
Hospital Report
At this stage, we know what works to limit transmission on an individual level, and have a fair idea on a societal level; the challenge is to implement them in a dynamic, joined-up fashion.
The move to Level 3, while not as drastic as the change sought by Nphet, marks a considerable upping of restrictions for most of the country.
Building on this, we initially face two main tasks: cutting community transmission and ensuring hospitals can deal with a rise in cases.
One in four cases currently involve community transmission, meaning the origin is unknown. High levels of community transmission have been an issue in Ireland through this pandemic. The solution lies in better testing and tracing.
We are now doing plenty of testing, with one of the highest rates in Europe, but is it happening fast enough and in the right locations? More pop-up testing in the vicinity of outbreaks would be good, as would alternative faster tests.
Ireland has been slow to adopt new testing technologies. Such caution might have been justified earlier in the pandemic, but not any more as techniques improve and costs fall.
Contact tracing needs to be better resourced and focused more on investigating the causes of clusters. It isn’t just about tracking down possible cases; we need to do more to identify the locales where outbreaks occur.
To be fair to public health doctors, many are doing this work within available time and resources but it might be productive to do more to publicise outcomes, even to identify the location of outbreaks.
ICU beds
The second priority is to ensure hospitals are not overwhelmed. At present, there are just over 20 Covid-19 patients in ICU and just under 40 free ICU beds. At least another 20 or so beds can be brought on stream as surge capacity and 12 new beds are due by the end of the year. The numbers suggest it may be tight. There was no shortage of ventilators during the first surge and there is unlikely to be this time either.
The ban on visiting care homes may help stem the rise among older people, but the root of this problem lies elsewhere. Over the past fortnight, there have been 325 cases among healthcare workers and 150 cases acquired in a healthcare facility. Alarm bells should be ringing over these figures.
Anyone who has had to self-isolate will know how hard it is. Countries that are successfully controlling the virus tend to have good quarantine facilities. Could we be doing more to break the inevitability of intra-family transmission by giving people the option of living alone for the two weeks ?
Finally, public health doctor Una Fallon last week aptly summarised the drivers of infection as "proximity, congregation and alcohol". Is it not time we tackled the "elephant in the room" – the unfettered sale of alcohol in off-licences right through this pandemic?