Sir, – Everyone will welcome the decision to test, isolate and of course treat, as necessary, all residents and staff of long-stay care homes. More than 50 per cent of these homes are “asymptomatic”, which is a huge credit to the staff who have protected them. With this new policy we now have a chance to protect all their residents and staff from Covid-19 and to minimise and treat illness in homes that already have the virus.
The policy of testing, isolating and contact tracing must now be applied to the whole country as soon as possible, as prescribed by Dr Tomás Ryan ("We need mass testing for coronavirus. This is how to do it", Opinion & Analysis, April 16th). Dr Ryan has written an incisive prescription for an exit strategy from the coronavirus lockdown. It is straightforward – instead of waiting for cases to pop up here and there, we must set up a massive search and destroy operation, based on PCR testing for the virus, isolating everyone who tests positive and following up on their contacts. We should start with symptomatic people and test their contacts, not once but repeatedly. Some will test positive and should go into isolation with their immediate family and other close contacts for 14 days. We should quickly test the contacts of these positive people, some of whom will in turn test positive, and in turn be isolated. And we must repeat the process in ever widening circles, until no new positives are identified. Until then we have little option but to maintain most of the lockdown.
It is vital that the Government put this test, isolate and trace strategy into general operation as soon as possible – there has been talk of testing but until I saw this new strategy for long-stay care homes there was not enough to convince me that it might become central to Government thinking which has been dominated by lockdown.
Let us also think of how to assess the response to the Covid-19 epidemic in most western countries. It has been naive and contrasts alarmingly with the responses of China, South Korea, Taiwan and Singapore. New Zealand, Australia and Finland have also done well, benefitting from relative geographic isolation which should have helped us too. Germany, where the importance of testing was recognised in January, has done quite well.
The most valuable comparisons are with the democratic societies of South Korea and Taiwan, which are close geographically, socially and economically with China, the origin of Covid-19. Their death rates per million from Covid-19 are 20 to 1,000 times less than many western countries, including Ireland. Taiwan with a population of 24 million has had six deaths due to Covid-19; South Korea with 51 million people has had 232. Ireland (population five million) has had 530, by no means the worst in Europe, as we know. The Taiwanese and Koreans feared new epidemics (as we should have too) and they were prepared (Europe was not). They knew that the best strategy was test, isolate and trace contacts. The first suspect case in South Korea was identified on January 8th. The genetic sequence of Covid-19 was published on January 9th. The South Korean research institutions and pharmaceutical industry was ready to use knowledge of this sequence rapidly to develop, verify and mass-produce a PCR test. This was deployed in association with a government policy of rigorous selective isolation of positives and contact tracing. The policy, brilliantly administered, was immediately successful and was highly regarded internationally by late February.
The first Irish case was identified in February 29th, by which date Korea had already found more than 3,000. The Korean epidemic went through its peak (more than 800 cases per day) around March 3rd and is now petering out with about 20 cases per day. Lockdown measures were minimal. Korea has a capacity for 15,000 tests per day. Approximately 400,000 tests were completed by the start of April. By early April, 121 countries were seeking support from South Korea.
There is no doubt that the European lockdown policy has saved lives and it may have been the best that could be done given our lack of preparedness. We must and do applaud the dedication of all those who have cared fro us. But it was not the optimum strategy. It has done untold damage to our social fabric, to national and international economies, to international relations and to global health. We must make sure that in the future we have a better way than massive lockdown. We need a European commission of enquiry with a brief to explain why South Korea and Taiwan (and others) succeeded in avoiding the lockdown that was our only immediate practical response.
In Ireland we must at last move on to nation-wide targeted PCR testing, isolation and contact tracing as the most effective strategy for getting out of lockdown. And we must establish a modern emergency response system to deal with other epidemics. – Yours, etc,
DAVID McCONNELL,
(Fellow Emeritus
in Genetics,
Trinity College Dublin),
Dublin 2.