“THIS IS NOT unexpected” was the quote provided to newsrooms by then chief medical officer Tony Holohan on 29 February 2020.
“We have been preparing for this eventuality for many weeks now.”
It was contained in an email, sent to newsrooms shortly before 9pm that evening, announcing that the first reported case of Covid-19 had been confirmed in Ireland.
The details were scant: the patient was a male in the east of the country, was receiving medical care, had been identified and tested in line with established protocols at the time, and had just returned from an affected area in Northern Italy.
The nation had been watching the situation spiral out of control in countries like Italy.
The first case brought home the reality that, as many had warned, Ireland was not immune to the spread of this new virus.
It had been a month since the first cases started popping up in Britain, and just two days since one was diagnosed in Northern Ireland. Ireland would be in what we now know as lockdown by 27 March.
Today marks the first leap day since 2020, and so The Journal has spoken to four experts in the area of Covid – familiar voices from the past few years – to get their take on the past four years in respect of the virus, and to look ahead at the next four:
De Gascun said by that early stage of 2020, it was already clear that the small window that existed to contain the virus had passed, and that it was spreading widely.
But in terms of repeated waves and the evolution of the virus, the four years panned out broadly as expected. One positive was that mortality was lower among the general population than experts initially feared, and a negative was the extent to which the virus grew to be more transmissible.
But De Gascun said one factor was crucial: “What we didn’t anticipate was the fact that vaccines were available so quickly.
I think when we started out in spring 2020, most optimistically we were thinking 18 months before a vaccine became available, mid-way through or towards the end of 2021. We had a small number in arms before the end of 2020.
“It wasn’t luck either,” he added, as sequencing data was shared quickly in the early stages of the pandemic and companies were armed and ready after years of research into vaccine technology.
Loscher echoed this: without the development of vaccines, the past four years could have gone a lot differently.
And while there were concerns over the speed at which mRNA vaccines were developed, Loscher said this was coming off the back of preparatory work on the technology, and that the speed was testament to what happens when massive funding and resources are put into a project like this.
She said the virus has gone through an “expected journey” in that it has become more transmissible, but it was important to stress that it only became less severe when global immunity started to be “ramped up”.
Mills said that “nobody could have predicted where we are today”.
The two crucial factors he cited were the effectiveness of the vaccines and how much the virus varied. The fact that a preventative measure was available was a key part in how the eventual restoration of normality, but it wasn’t clear at first just how much the virus itself would evolve, which has led to less durable immunity and meaning that the virus “still lingers” on today.
McConkey compared the progress made to the fallout from the Great Recession: “I remember asking a friend if this would be sorted in a year or two, and was told no, it’s probably going to be nearly a decade. I nearly fell off my chair, but it was only 2017, 2018 when we got back on track.
“I expected Covid-related disruption to go on for between three and seven years, but it was sorted quicker than I expected and I’m very pleased about that.”
He said that while Ireland had positive outcomes, such as favourable mortality rate compared to other countries, there were also important learnings, citing the negative impact of removing young children from education.
Mills noted that “there is a certain amount of fatigue”, citing the falling uptake of the booster vaccine among the general population, although it does remain strong amongst those most at risk. There is also the debate around whether anyone beyond these groups still needs to get a booster.
The virus has also evolved to currently present more as an upper respiratory tract infection rather than lower and in the lungs, the latter of which caused the level of severe illness that was more common in the earlier years of the pandemic. The risks for healthy people – due the combination of the changing nature of the virus, the effectiveness of the vaccine, and prior immunity – is now far lower.
McConkey highlighted concerns that a small percentage of the population are “socially scarred”. When society reopened, they didn’t embrace getting out again to meet people and take part in their hobbies or passions: “We should encourage folk who were socially and physically active to get back and do those things.”
Loscher said: “I think it’s great that we’re sitting here and most people don’t think about Covid from one day to another, but it hasn’t just happened by accident.”
She highlighted again the success of Ireland’s vaccination programme, but also cautioning that for people at high risk of severe illness that it can remain a threat, like other pathogens.
In the wider world, the European Centre for Disease Control has no variants of concern listed, and dozens of previous variants have been de-listed.
“It’s time to make sure that we remember that almost 7 million people died of Covid in the world. So it hasn’t been insignificant. When we’re out the other side of it, it’s very easy to go ‘grand, it’s just something very mild now’, and there’ll be lots of people that will say, ‘I told you COVID wasn’t a big deal’. Sure, it’s only mild now, it wasn’t always that way.”
De Gascun touched on the improved etiquette around respiratory illness that was witnessed during the pandemic in terms of how people behaved when sick, and how that might be waning: “There’s still an awareness of Covid, people are more inclined to get an antigen test if they feel unwell, [but] it’s a little disappointing that people who are symptomatic are drifting back into the workplace and social situations, probably slipping back into old habits.”
At the same time, that increased awareness of viral infections persists, with De Gascun citing how RSV features in conversations far more now than it ever did before.
Mills said that work is still ongoing to develop better vaccines and this will continue well into the future. His own work has highlighted that nasal vaccines offer a promising method of more effectively stopping infection, and is where further development is likely to take place.
“No matter how much work we do in terms of getting a better quality of vaccine, the virus will keep evolving,” he cautioned. “We won’t have eliminated the pathogen [in 2028].”
Loscher expects annual boosters for both flu and Covid, tweaked to target the latest variant, will become the norm.
However, she urged for more research to be carried out into the ‘Covid Hangover’ of Long Covid, and that the needs of people with lingering symptoms may have “fallen between two stools” as life returned to normal for the majority of people.
But will Covid become a problem again?
“We’re really at the mercy of the virus. So let’s not forget that a huge amount of this is dictated by what the virus does next. I think we’re well armed to be able to respond [...] I don’t expect that there’s going to be a variant that comes out of nowhere, that has completely different behaviour.”
McConkey repeated the need to make sure that people stuck in “Covid-like” routines are helped get out of it, but also that as a country at large, there should be learnings in terms of how to increase resilience in areas like energy and supply chains, so that when another shock comes along, we’re better equipped.
Although people might not like to hear it, De Gascun said preparedness for whatever might be coming down the line is key. And that doesn’t necessarily mean Covid, (in fact, while some interviewees touched on potential resurgents of the virus, none went as far as mentioning new restrictions or massive pressure on health services, although some wondered about the impact of successive years of vaccine fatigue).
“There are obviously other concerns – housing, cost of living, the knock-on impact of Covid on the health service – so there is a danger that pandemic preparedness maybe falls down the agenda a little bit. I do think people are more focused on that in terms of the health service, and the response to measles is a good example in terms of how quickly that response was set up.
“But I still think that would be a concern: if this happened again, are we in a much better position than before? That’s a difficult question to answer. A lot of hospitals are still old. We are probably still short on beds, isolation facilities, single rooms [...] but at the same time we know the health service has lot of challenges going on at the same time.
“That will be one of the things to look at over the next four years, how we develop that infrastructure for pandemic preparedness in parallel with meeting the day-today needs of users of the health service.”
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