Jennifer O’Connell: Are we becoming an accidental Sweden?

Is Ireland at risk of becoming an accidental Sweden?

The restrictions introduced this week were not like the short, sharp shock of March – instead they were a hodgepodge of tweaks, compromises and some mind-bending Covid maths. If 50 people at Mass is the equivalent of six people in a garden, 15 sitting outside a restaurant and 50 at a wedding, then how many can congregate in a theatre? How many politicians can squeeze into room at a golf event? Does dividing the room in two halve the risk?

The new rules were "clear and unambiguous" Minister for Education Norma Foley insisted on Friday morning – a bold bit of wishful thinking just slightly undermined by the fact that, mere minutes earlier, Minister for Agriculture Dara Calleary had resigned over his apparent failure to grasp them.

If you were looking for evidence for why the Swedish approach would never work in Ireland, it wasn't the viral video of gleeful youngsters necking shots at Jay Bourke's "baked brunch" that provided it. It was sensible, middle-aged Dara Calleary, EU commissioner Phil Hogan and Senator Jerry Buttimer, plus their 78 or so golfing buddies, who included Supreme Court Justice and former attorney general Seamus Woulfe. They knew what the rules were – Calleary was one of those who signed off on them less than a day earlier. They just decided that those rules didn't apply here. Or as Woulfe put it, "ended up in a situation where breaches may have occurred".

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They knew what the rules were – Calleary was one of those who signed off on them less than a day earlier

Despite the sometimes hysterical commentary, the much-maligned Swedish approach was never about letting the virus rip. It was supposed to shield the vulnerable and allow a controlled spread among the rest. It relied on personal responsibility and compliance. Long story short: it didn't work out like that. Sweden had a more protracted outbreak, suffered more deaths per capita and higher rates of hospitalisation than its neighbours. But at least there was an ideological framework to it, and people mostly did what they were supposed to.

Lack of ideology

Here we are, stumbling into a strategy that might be called “accidental Sweden”, a phrase that was first coined by the online health news website Stat to describe the hamfisted US response. Now, it seems like a good way to describe the Irish approach, which is leaning heavily – slightly too heavily, it seems – on luck, people’s judgment and sense of personal responsibility, without any of the ideology. An approach based on appealing to people’s better instincts rarely works in Ireland. If there’s a loophole anywhere, someone will be finding a way to squeeze through it.

And yet, we do have to find a way to, as the increasingly tiresome buzz phrase of the summer puts it, "live with the virus". It's not just the members of the Oireachtas Golf Society who could do with a bit more clarity on what this is supposed to mean in practice. What is expected of us? What can we expect from the State in return? Why this strategy over other possible approaches? What is an acceptable level of virus in the community? At what point might we decide it's not working?

There is another way, one that is neither Sweden nor New Zealand. It was first mooted by the Nobel prize-winning economist Paul Romer back in May. Test everyone, and test them often. He suggested bimonthly testing for the entire population. "To control the pandemic, we need to get a reasonable majority of the people who are infectious into a quarantine, and then we're good," he said. Job done. Life and golf dinners can go on.

Data collected last week shows that Ireland is doing reasonably well on the international testing league tables. We are currently conducting 1,590 tests per one million population – slightly less than the United Kingdom; slightly more than Germany or France; well shy of Denmark and New Zealand. But there are worrying signs that the testing and tracing machinery might be slowing down at precisely the moment we need it to ramp up.

Test delays

As virus cases surged recently, testing turnaround time slipped to nearly three days, the outer limit of the Health Service Executive's own target. Tracing centres were put under "unbelievably intense" pressure by the numbers of contacts that now need to be traced, a process that was taking an average of 1.8 days. There was some disagreement about whether these numbers were pretty bad or actually quite good under the circumstances. But as Bill Gates has pointed out, there are diminishing returns from any test that takes more than 24 hours to come back in a pandemic.

There are diminishing returns from any test that takes more than 24 hours to come back in a pandemic

The HSE boss, Paul Reid, has said it "wouldn't be thanked" for keeping swabbing centres open seven days a week when there were just a handful of Covid-19 cases. Why not? Hospitals don't close when patient numbers go down, because they know the numbers will go back up. Here, the Covid numbers are going only one direction.

Testing only those who turn up at their GP with symptoms is not going to turn that around. At the O’Brien Fine Foods plant in Kildare, just three out of 86 positive cases in the recent outbreak had any symptoms at all. Not one of them was picked up in the on-site temperature scanner. To stop the virus, we have to target people who don’t know they’re sick, and take them out of circulation. Plans to serial test people in high-risk settings like nursing homes and direct provision centres should be extended to schools, and any workplace with large numbers of employees where social distancing is difficult. It would be costly – each test is about €98 – but not as costly as another lockdown.

That’s what a “clear and unambiguous” strategy might look look like. Not our current set of tweaks and fudges that even some of those who signed off on it can’t, or won’t, follow.