AN ADVISER TO the World Health Organization says Ireland should allow Covid-19 to spread in a “controlled” way among people under 60.

Addressing the Dáil Special Committee on Covid-19, Dr Johan Giesecke, former Chief Epidemiologist in Sweden said the government should protect the elderly with frequent tests of staff and residents in care homes.

He said Sweden never had a herd immunity goal, but a goal of protecting the old and the vulnerable. This group should minimise their contact, adhere to social distancing and stay at home if ill, even more so than the general population.

Giesecke was one of a number of experts to discuss with the committee the strategic options for using the government plan to eliminate community transmission of Covid - 19 in Ireland.

He said intensive contact tracing and testing of contacts is key to getting on top of the virus.

He warned against building a Covid strategy on the imminent advent of a vaccine.

“We might have to wait for it and it may not be very effective in those who need it most,” he said.

Prof Kirsten Schaffer, Consultant Microbiologist St.Vincent’s University Hospital, Clinical Professor University College Dublin and President of the Irish Society of Clinical Microbiology, told the committee that more granular detail is needed on where the virus is spreading.

She said the epidemiological data is not clear, stating that while she agrees with the government’s roadmap, she believes some of the measures imposed on some sectors are blunt instruments.

She also advised against “crude recommendations” stating that measures should be based on the outbreaks identified.

No clear epidemiological evidence

The current epidemiological evidence does not clearly show what is needed or necessary, she said.

Currently, if someone tests positive, they are not asked if they were at a restaurant, they are not asked if they went to a house party recently, said Schaffer.

“The information about where the cases originate is not available… when a person is diagnosed with Covid-19, Public Health Ireland will ask them about the contacts they had in the preceding 48 hours.

“It will not ask where the individual thinks they have acquired the infection. It does not ask whether they have been to a restaurant or attended a house party,” she said.

“It is crucial that we start trying to collect such information so we can show the data and use it to state the reasons why, for example, house parties with more than ten people attending are forbidden, and if it happens, then the Garda will be called and the house parties will be shut down,” said Schaffer.

“We need some data to argue with, and currently it is not there. I know from Germany, because such data is collected there, that increasing rates there are strongly associated with house parties and family gatherings, where people congregate and do not adhere to social distancing rules,” she said.

When explaining the rationale behind the decision to ban indoor dining in restaurants and pubs, Professor Philip Nolan said last week that resources and data are not available, stating that “public health would track down the source if they had the resources to do so, but they don’t and must prioritise the management of cases”.

Keeping community transmission low to allow hospitals to operate is what Schaffer advocates for, stating that the economy needs to be allowed to open up.

She is not in favour of herd immunity, stating that the “price would be too high”, but said there should be a level to keep community transmission at, and hospital cases also.

Giesecke also told the committee not close to schools, and warned against “authoritarian, undemocratic decisions by the authorities”.

The committee was also told that the government should wait until at least a year before starting to make comparisons between countries and the different strategies used.

Schaffer agreed, stating: 

Stop aiming for a Covid-free Ireland or even levels as low as in July at the end of lockdown.

She said now is the time to change tack. There is a divergence in society between the young and older generations – and there is a risk of losing public buy-in, she said.

Nursing homes 

Discussing nursing homes, experts told the committee that it is difficult to keep the virus out of nursing homes, but rigorous testing is very important. 

The situation now is very different now as compared to March, said Schaffer. 

In March and in the early days of the pandemic, PPE was not used, which is “why we had terrible outbreaks in the nursing homes”.

She said we now know that masks have to be used, PPE must be worn, and we must test asymptomatic healthcare workers.

Giesecke said it was similar in Sweden, stating that high cases in nursing homes were due to the lack of availability of PPE.

“The situation is very different now,” he said.

Schaffer said the testing and tracing time period is very important, stating that it can take up to 48 -72 hours to get a test appointment, and another 24 hours to get a result,  with a variable close contact tracing rate.

She raised concerns about only contacting 50% of close contacts at day 7 – this is too long, she said.

More transparency and detailed data are needed as to where the outbreaks are happening. She said the authorities need to show the percentage of contact tracing that is happening both inside and outside Dublin.

Speaking about after-effects of Covid-19, Professor Sam McConkey, head of the Department of International Health and Tropical Medicine at the Royal College of Surgeons in Ireland (RCSI) said the data is no available as of yet, stating that while it is being discussed a lot in the media, “no one knows”.

He called for an elimination strategy and then extremely limited travel between all countries.

Travel 

On travel, Schaffer said she spoke to public health yesterday and they are not aware of any outbreaks associated with travel.

There is little risk on a flight, she explained, as mask-wearing is mandatory.

What people do on their holidays might be the issue, she added.

Schaffer said if someone travels to Italy or Greece “to get some sun”, and they wear a mask on the flight, they wear a mask inside, and adhere to social distancing while abroad, they would be at a lower risk of transmission “than being in Ireland and going to a house party”. 

She argued for a red list, rather than a green list for travel, stating that the authorities could actively follow up on people arriving in from those countries, and it would create more buy-in from the public.

A review of the terms of reference for NPHET should also be carried out, said Schaffer, who also called for a review of the governance and communication of Ireland’s strategy.

Asked about mask-wearing, Giesecke said masks are not mandatory in Sweden and are not required in schools. In his view, the evidence for mask-wearing is “thin”.

McConkey said “if we fracture we won’t succeed”, stating that it has been underestimated how divisive this pandemic has been.

People Before Profit TD Richard Boyd Barrett said some people are afraid to have a debate of this sort, stating that some believe it undermines the government’s message. He said political control should not overshadow the views of some experts.

Concluding, Schaffer welcomed today’s discussion at the committee, stating:

“We haven’t had enough debate on what facts are out there and where we want to proceed from here.”

Giesecke concluded by warning against emergency legislation being introduced when it may not be needed, stating that the majority adhere to advice when asked. He said this virus will be with us “for a long time to come”, and had doubts that a vaccine would be found before Easter.