People in wealthy countries such as Ireland have little experience of living with the long-term reality of serious infectious diseases. Covid-19 has changed that for the foreseeable future. We are a few months now into a new phase, where Covid-19 protective measures are largely removed but Covid-19 continues to circulate. We can do better in Ireland. What should we be striving for?
The first order of business is to establish what “living with the virus” really means.
Many people have died, and we have hit the grim figure of 7,000 deaths. Many families are tandeming through infections – one half of the house gets Covid-19 and some time later the other half follows. This makes for extensive disruption to daily life. Many people are being reinfected, and long-term immunity is limited. This seems to be an unfortunate feature of the biology of Covid-19. While vaccination greatly reduces the worst outcomes of this disease, neither vaccination, nor previous infection nor both give full immunity to reinfection.
Uncertainty is inevitable. What we can say with confidence is that Ireland's State protection from Covid-19 is very limited
As a result, we may continue to have large numbers of people out of work at the same time, then dealing with the post-Covid-19 fatigue disturbing the economy and life in general. We don’t yet know the full impact on people, nor on populations, of Covid-19 reinfection. However, long Covid, which affects about 125,000 people here (an estimate based, to the shame of our health authorities, on UK figures), may lead to further substantial economic loss, as some people are forced to shift into new jobs or out of the workforce altogether.
Uncertainty is inevitable. What we can say with confidence is that Ireland’s State protection from Covid-19 is very limited. Tracking of the intensity of government measures at the University of Oxford puts Ireland above Mongolia (bottom out of 185 countries) in terms of the intensity of protective measures in place to prevent the spread of Covid-19 here.
Dr David Nabarro from WHO described the Irish Government’s removal of its citizens’ Covid-19 protective measures as “brutal”. We know that Covid-19 singles out poor people, older people, and people with existing illness for the worst outcomes. We have no plan for these people as we “live with Covid”. Antiviral medications may be helpful, but their overall effect remains uncertain.
Inevitable litigation
It’s very clear that transmission cannot be stemmed by appeals to individual responsibility. The Government strategy to remove all Covid-19 protective measures at once (save for the vaccines already given) has ensured this. Litigation is the inevitable response to the failures of this policy approach. A meat plant worker is suing for the injury suffered through Covid-19 infection at work, and litigation over the desperately lonely deaths in nursing homes is expected.
WHO is, quite rightly, concerned about the risk of another wave, possibly coming from the new variants of the Omicron group
Some of the consequences will fall to the Government, others will hit small and large commercial enterprises. It’s doubtful how far this expenditure will benefit the health of the Irish population.
We don’t know what will happen with Covid-19 next. WHO is, quite rightly, concerned about the risk of another wave, possibly coming from the new variants of the Omicron group (BA.4, BA.5), or perhaps from a new variant of the original virus (BA.2.12.1), both of which are now spreading rapidly in different parts of the world.
Very recent work suggests that all of these are quite resistant to current vaccines, and that even recent infection with BA.1 or BA.2 (the “original” Omicron) provides little protection. Better vaccines may help in time, but they may not be possible. Given the uncertain risks of new strains, long Covid and repeated infection, our current approach provides limited protection, whether for people, for jobs, or for the economy as a whole.
We do need further investment in Ireland’s public health infrastructure – in the people, systems and research capacity that are needed to ensure that we detect and can respond quickly and appropriately to new Sars-CoV-2 variants and other pathogens, but we also need to act.
Proven measures
There is an alternative, which costs very little – certainly much less than we paid every month during lockdown, and surely less than the personal and economic costs outlined above. The alternative is a simple and actionable one: keeping the proven protective measures that have served us very well – vaccines and masks – and investing the modest amount needed to maintain excellent air quality in indoor settings.
Mask use has fallen below what it should be, but masks are cheap and surprisingly effective
Covid-19 is an airborne virus and good air hygiene is a crucial tool in managing its transmission. Specifically, this means pushing vaccine uptake as high as possible; wearing FFP2/N95 masks in crowded indoor settings – retail, schools, workplaces, public transport; and ensuring good ventilation wherever possible, including air filtration in schools, pubs, theatres, nightclubs, and other indoor venues where large numbers of people come together, as is now policy in Belgium. Mask use has fallen below what it should be, but masks are cheap and surprisingly effective, with recent Irish data suggesting they can reduce transmission by more than 40 per cent.
This approach is compatible with a more or less normal life with minimal disruption, and an active economy – living as well as possible with Covid.
Anthony Staines is professor of health systems at DCU and Daniel Carey is director of the Moore Institute, NUI Galway