WE ARE ALMOST a year since I said the worst-case scenario model for Covid in Ireland was that if we didn’t take action against the virus, we could see tens of thousands of deaths. I took no joy in saying that a year ago and I take no joy today in raising issues around where we are now.
It is absolutely to be applauded that we have not lost between 80,000 and 120,000 people to this disease and that is down to the hard work undertaken by the Irish people, our healthcare workers, public health decisions of government and all on the front line of this pandemic.
The notion of “Zero Covid” has been ridiculed as impossible by some and unnecessary by others. Yet, from what I see and hear, there are many people in Ireland who believe in both the necessity and opportunity of a Zero Covid strategy.
The very simple truth is that every industrialised country that has committed to eliminating Covid-19 has eliminated or virtually eliminated the virus. New Zealand is one example.
Countries that have undertaken massively disruptive interventions, without the goal of elimination, have reaped minimal benefit and continue to accrue massive cost. Ireland, sadly, is one of those countries.
Fail to prepare…
We simply weren’t prepared for the pandemic in the way New Zealand, Australia and many countries in Asia were, with SARS control plans in place. Our lack of preparedness was compounded firstly by innumerable problems in our public health infrastructure stemming from a dearth of investment, and secondly because we have not been sufficiently ambitious in our response.
My real fear is that if we continue to pursue the present strategy, we are certain to continue to alternate between levels three and five, with all of the consequences for businesses, education, mental health and non-Covid illnesses.
If, on the other hand, if we choose a brave national strategy of elimination of transmission of Covid, then it’s very possible that our domestic-facing businesses could look forward to reopening once we get through a period of enhanced restrictions and once we are certain the processes are in place to allow for the strict management of people with SARS CoV2, their contacts, and incoming travellers.
I strongly believe that a shift from national restrictions on everyone to targeted and focused restrictions on people and places where Covid is being transmitted will be welcomed by most of the population.
With the following ten actions, led and managed by a well-resourced and well-staffed population health executive, I think we can set ourselves up for a much swifter return to normality and we can give the vaccine programme the greatest chance of success.
1. We will not succeed without addressing the issue of travel into Ireland. As Australia has done, we could ask and insist that all travellers coming into Ireland quarantine in supervised quarantine facilities for 14 days. The border with Northern Ireland can be dealt with through special permits or bubble zones for cross-border workers, who will have to take other precautions instead. A system of permits and frequent antigen tests could be established for freight drivers.
2. We need to implement full Covid related sick-pay so that people across every sector of the economy do not feel like they have no choice but to go to work when they are sick.
3. We need to make it easier for people to access GP care, by providing telephone translators for migrant workers, for example.
4. Backwards contact tracing needs to happen. We need to identify who the virus was contracted from and who it was passed on to.
5. To successfully break the chains of transmission, we need rapid local and national outbreak investigations and outbreak management that expands in ever-increasing circles around infected people to ensure that all the people that they got the virus from are known, and that all of the people they might have transmitted it to are in strict isolation.
6. Where housing or circumstances do not allow for safe, or reliable, self-quarantine, both cases and close contacts should be offered local options for supported isolation and quarantine away from home (e.g., in local hotels).
7. When people who have Covid-19 do not self-isolate after being advised and encouraged, then legal enforcement is needed.
8. We can help people to do the right thing by providing organised financial support and voluntary practical support for those in isolation or restricted movements, to help with childcare, family caring, shopping, loneliness and isolation.
9. Local teams of outbreak management staff at village and town or parish area could visit households where outbreaks have occurred, to offer support, and provide pop-up testing in those areas. They could also investigate businesses where outbreaks have occurred, and provide education and encouragement for change to businesses where outbreaks are suspected.
10. We should establish sector-specific working groups with each industry, sport, religious and cultural groups to plan the staged opening of safe activity at each level.
Being the first country in Europe to choose and to achieve a near-zero Covid outcome would bring much-needed relief to the people and businesses of Ireland.
It would also be an excellent political outcome for the government as showing a dramatic example of successful leadership, which other countries and regions in Europe are likely to follow.
Professor Sam McConkey is Head of the Department of International Health and Tropical Medicine at the RCSI University of Medicine and Health Sciences.
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