‘The concern is immunity may be waning’: GPs urge caution with Covid cases high

A high-profile GP has said vaccinated people should stay away from unvaccinated people in indoor settings unless that person is a wearing a mask.

Dr Denis McCauley, the chairman of the GP committee of the Irish Medical Organisation, advised the vaccinated to have "one rule" when it comes to meeting unvaccinated people indoors.

“If they are not wearing a mask, say ‘goodbye or good night’. Get out,” he said.

Dr McCauley works in the Millbrae Surgery in Stranorlar, Co Donegal. The county has consistently had the highest rates of Covid-19 in the State for some time.

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He said poor compliance with public health measures in Northern Ireland is contributing to the high figures in Donegal. He believes allowing unvaccinated people to dine indoors in the North is a major factor in spreading the virus.

While the number of people getting Covid-19 in Donegal is similar to the numbers in the North, the levels of death, hospitalisation or ICU admission are double in the North because of poor compliance, he believes.

As a result of a growing number of fully vaccinated people getting Covid-19, “herd immunity is off the agenda”, he said.

GPs who spoke to The Irish Times have noticed rising cases of the virus in recent weeks among both vaccinated and unvaccinated people.

Dr Illona Duffy, a GP based in Monaghan town, said the Delta variant was "exceptionally infectious" and most patients presenting to doctors were from clusters.

“When it gets into a place, it infects everybody,” she said. “When it gets into a family and one person gets it, you know everybody in the house will get it.”

She added that cases were rising “very fast” but the situation in January was “way worse” with greater numbers and sicker people.

‘It could deteriorate’

Dr Mary Favier, a GP in Cork city, said there was considerable variation in Covid-19 numbers across the country, with numbers lower in the south than in the north, but there has been an "uptick in numbers in the last week or two which GPs are noticing. There is a lot of anxiety that it could all deteriorate over the next couple of weeks."

Dr Madeleine Ní Dhálaigh, a GP in Castlerea, Co Roscommon, said she had seen a rise in people who are self-referring, testing positive for Covid-19 and then asking for advice.

“In January we would be referring people for tests. The difference is now people are letting us know that they are positive and they are asking for advice,” she said.

Vaccinated and unvaccinated people are both testing positive, “but symptoms appears to be less severe in vaccinated people. The concern is that immunity may be waning. I’m sure Nphet will be looking at that.

“There are plenty of vaccinations in the country. We are not out of the woods. My advice is not to go into crowded, poorly ventilated areas. Remove yourself from a situation and mitigate your risks as much as possible.”

Dr Ronan Boland, a GP in Blackpool, Cork, said he has experienced a similar situation with people referring back to the GP surgery for advice having tested positive for Covid-19.

He is aware of a few HSE facilities in the Cork area where fully vaccinated staff members have tested positive in recent days. “Vaccines are not fully bullet-proof,” he said.

Dr Philip Crowley, the HSE national director for strategy and research and a GP based in Dublin, said the situation now would be as "bad as Christmas" given the infectious nature of the Delta variant and the opening up of society in recent weeks were it not for high vaccination rates.

“It was quite striking how steep the case rises when the Delta variant took hold here. We were at least lucky that vaccinations were under way and that we had those tools in place,” he said.

“The nature of this virus is that we have to be ready for other variants, which we can expect because so many people in the world are not vaccinated.”

Bypassing GPs

Dr Tom O'Dowd in Tallaght said his experience did not match the national picture, with small numbers presenting with Covid-19. However, this may be a factor of people bypassing GPs and going straight to the testing centre.

“Patients may be going directly themselves for testing. The testing is really excellent now. It is a very well-developed service,” he said.

“Things are returning to a kind of normal for us so we are doing phone calls and in person face-to-face. It’s much more normal than it has been for the last 18 months.

“We have had a very active vaccination programme. It has been very successful.”

He said only one or two of his elderly patients refused to be vaccinated. “There might have been hesitancy but there were very few refusals.”

Cahir-based GP Dr John Farrell, chairman of the Irish College of General Practitioners, said "we have seen less Covid in the last few weeks for sure".

He puts it down to very little vaccine hesitancy in the local population with all but two of 800 patients in his practice over the age of 70 getting vaccinated.

"We have been lucky in our part of Tipperary. It has not been nearly as bad as it was in January," he said.

“We have had a small number of people who are fully vaccinated getting Covid. Often they were a contact of somebody else and developed symptoms afterwards from people who were not vaccinated or were partially vaccinated.”

Dr Tadhg Crowley, a GP in Kilkenny city, said there had been a number of local outbreaks in recent weeks from "mainly social gatherings".

Two of his patients with just one dose of the vaccine and tested positive for Covid-19.

“They weren’t spending long in people’s company. They had met the person for a short time and unfortunately were infected. Delta is so easy to get. It seems to be so rapid,” he said.

“We have to go back to some of the basic precautionary measures that we had while we are trying to get the whole population vaccinated. If we can keep the numbers lower in September and October, we have a better chance of getting the vaccine programme completed.”