Ireland is having a Covid summer: Should we mask up once again?

It felt slightly surreal to see the positive result of the antigen test. Covid-19 had finally caught up with me almost 2½ years after the pandemic was first declared. I had a head cold and felt more tired than usual for a couple of days and took the test as a precaution before visiting my elderly mother, the day before my brother and his wife were due to fly into Ireland for their first visit from Australia in three years.

The visit to my mother was cancelled, as was the Australian guests’ sleepover due to happen at my place before they travelled on to her house. I was grounded for the next week and also had to cancel plans for a long-anticipated weekend away in the west of Ireland with friends to celebrate a 60th birthday. I tested negative eight days later but meanwhile had passed the virus to my husband but not to our two adult children living with us.

Now, three weeks later, I clearly see that I was part of what has become the Covid wave of summer 2022, which spread from South Africa through Europe in mid-June, rising to a peak in early July and is – hopefully – in decline now.

Many people have had to change their plans, cancelling long-overdue catch-ups with relatives and friends both at home and abroad due to Covid. Those who have not yet gone back to offices have soldiered on in their home offices with mild symptoms but some theatre productions and concerts have been cancelled, as have flights when beleaguered airline companies could not crew aircraft at a time when people are back travelling at near pre-pandemic levels during the busy summer holiday season.

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This current Covid wave has been dominated by the new Omicron subvariants BA.4 and BA.5 which, although highly transmissible, bring less severe disease for most people. This is the third wave of Omicron since it became the dominant variant of concern around the world in November 2021.

The high number of cases, according to Dr Cillian de Gascun, director of the National Virus Reference Laboratory at University College Dublin, is partly due to the fact that the BA.4 and BA.5 variants are “sufficiently different” from the B.A1 variant that caused a very large spike in cases in December 2021 and January 2022 in Ireland, meaning that those infected at that time do not have protection against these new subvariants and can get Covid again. People who got the virus in March or April when the B.A2 variant was dominant will, however, have some protection during this current wave.

Since there is no longer widespread PCR testing and little incentive to report a positive antigen result, we do not know how many people in Ireland currently have Covid. There were more than 13,500 confirmed PCR cases reported in the week ending June 29th, an increase of 36 per cent from the previous week. There were just over 17,600 positive antigen test results reported to the Health Service Executive in the week ending June 29th, which was a 21 per cent increase on the previous week.

However, earlier this week, the interim chief medical officer Prof Breda Smyth said that since the virus is now endemic, or widespread in the population, it was no longer necessary to identify every case.

“We are in the mitigation phase of the virus, which means protecting the more vulnerable members of the population,” said Prof Smyth. In this phase, the HSE Covid tests are targeted at people with underlying conditions and those aged over 55 who are not fully vaccinated rather than the population as a whole.

Dr Ray Walley is an associate professor at UCD School of Medicine and a GP in north Dublin, which has seen some of the highest levels of Covid in this current wave.

“GPs in north Dublin have been busy with Covid in the last three to four weeks, but it has slowed down a bit now. We have also had high numbers of Covid in the three teaching hospitals [the Mater, Beaumont and Connolly] in north Dublin,” explains Dr Walley.

He says that the majority of people have head cold-like symptoms, a cough, headache, aches and pains, and sometimes diarrhoea. “Some people are getting it for the first time but others have had it two or three times already. There are also elderly people with Covid who have dropped their guard and stopped wearing masks. Some people think they just have a simple cold but then when asked to take an antigen test, it comes up positive,” he says. The problem is that, by then, many people will have passed the virus on to several other people either at work or during social engagements.

Dr Walley says that the medical advice is to stay at home and look after yourself if you have symptoms and/or test positive for Covid on an antigen test. “Drink 2½ litres of liquids a day, eat regular meals, try to sleep [mostly] at night and take paracetamol up to four times a day and use ibuprofen as a back-up if you have aches and pains and a fever,” advises Dr Walley. Giving yourself adequate time to get over it is also advisable. “The big healers are a good night’s sleep, sunlight and fresh air,” he says.

Self-isolation

Currently, the Department of Health recommends that anyone diagnosed with Covid should self-isolate for seven days from date of onset of symptoms or, if asymptomatic, from the date of first positive test. Children should also be kept at home if they show symptoms of Covid. Those exiting self-isolation on day seven should continue to follow public-health measures, such as mask-wearing and observing social distancing – particularly from vulnerable family members or friends.

Close contacts of those with Covid are no longer required to restrict their movements but the public-health messaging on mask-wearing has increased again. For example, the most recent HSE video makes the point that while we do not always know who is at risk we do know how to protect them. It could be someone with diabetes working in your local shop, a pregnant chef in the restaurant you are eating in or someone about to begin chemotherapy who is travelling next to you on public transport. While masks and social distancing are no longer mandatory, the message is that it is everyone’s responsibility to keep others safe, as well as ourselves. Vulnerable people are advised to wear well-fitting disposable FFP2 surgical masks.

So, how did Ireland succumb to another wave of Covid after all the public-health advice absorbed over the last 2½ years?

The most recent behavioural study from the Economic and Social Research Institute (ESRI) gives us some clues. This survey – the 36th and final round of records of the public response to the risk of Covid infection and guidelines since January 2021 – clearly points to high levels of social activity, along with intercounty and international travel in June this year.

In fact, the ESRI survey found that in June people were visiting shops, other people’s homes and restaurants/bars within Ireland at the highest levels since these surveys began in January 2021. People here are also travelling abroad at the highest levels since the pandemic began – the massive queues at Dublin Airport were already testament to this latter finding.

This most recent data from the ESRI shows that six in 10 adults surveyed said they now rarely or never engaged in so-called mitigation behaviours, such as wearing masks and keeping two metres apart. Meanwhile, compliance with public-health advice – recommended rather than mandated wearing of masks on public transport and in medical settings – was at its lowest since these surveys began.

Dr Walley says that people should not feel discriminated against for wearing masks in crowded indoor places and on public transport. “There are between 140,000 and 200,000 immunocompromised people in Ireland and I’ve met people who are annoyed about not being supported to wear masks. We should wear masks in crowded spaces in solidarity with those who need to wear them,” says Dr Walley.

New waves

So had pandemic fatigue set in or were we lulled into a false sense of security, assuming the virus would not spread as easily during the summer months?

Dr Gerald Barry, associate professor of virology at UCD, said in a recent Irish Times podcast that new waves of Covid could be expected every few months. “Covid is not seasonal like flu which disappears during the summer months but it’s likely that its ability to spread is reduced during the summer so it’s a bit seasonal. There is a new variant in India which is picking up pace. We predict that will probably hit in and around September/October,” says Dr Barry.

As these Covid waves continue, health officials remain most concerned about people with underlying conditions catching the virus, as Covid can bring complications to these underlying conditions or precipitate another illness due to lowered immunity following ill health from coronavirus.

Dr Catherine Motherway, intensive care consultant at University Hospital Limerick, says Covid is a bit like any other viral illness in that it can make underlying conditions worse. “It’s not as bad as it was originally. It is not causing the same damage to respiratory function as before and we have a high level of vaccination in this country which is protecting people from severe disease but we are encouraging anyone who is eligible for the second booster to get it,” she says.

There has been a fivefold increase in patients in acute hospitals with Covid from the end of May to the end of June. About half of these patients were hospitalised due to Covid and three-quarters were aged 65 or over.

It is still unclear who is more likely to suffer from long Covid, although Prof Jack Lambert, consultant in infectious diseases at the Mater hospital and clinical professor at UCD School of Medicine, told an Oireachtas committee on Wednesday that his research has found up to 30 per cent of people who get Covid can go on to be affected by long Covid to some degree. “We need to get the message back out there that we need to continue to be careful about catching it because the consequences are still unknown. You can become immune-compromised from Covid. It can reactivate other infections and [we have to ask] if brain inflammation will be a long-term effect in some patients,” he said.

The summer wave has brought a new push on booster doses of the Covid vaccine for those who can get it. These include a second booster for those aged 65 and over and anyone over the age of 12 with a weakened immune system. Anyone who was infected with Covid at the end of 2021 or in early 2022 is now also eligible for their first booster vaccine.

Current estimates suggest that only about half of over-70s have gone for their free second booster, compared with 95 per cent who got the first booster at the end of 2021. The World Health Organisation (WHO) recommends a second booster for older people and those with underlying conditions as well as those at high risk of getting infected. In Ireland, the National Immunisation Advisory Committee is currently weighing up the evidence before it makes a decision whether to extend the second booster vaccines to other groups such as healthcare workers.

Meanwhile, scientists are working on the next generation of vaccines, which they hope will offer protection against several coronaviruses in the one vaccine.

“Currently, vaccines are protecting us from severe illness but they are not protecting us from infection and we don’t know if they will protect us from a very different variant in the future,” Dr Soumya Swaminathan, chief scientist at the WHO, explained at a question-and-answer session this week. She is optimistic that current research into so-called pan-coronaviruses will bring positive results.

“The chances of getting pan-coronaviruses vaccines are good. Researchers are using mRNA [the technology which brought us Pfizer and Moderna vaccines] to include the spike proteins of various coronaviruses to create broad [spectrum] vaccines. Research is also ongoing into nanoparticle-based vaccines and inactivated vaccines. In the next one to two years, we will see a lot of advances to protect us against multi-coronaviruses,” said Dr Swaminathan.

The first trial of mucosal vaccines is also about to begin with the hope that these nasal vaccines might be able to protect against infection in the future.

These developments are important as scientists have already predicted that it is highly likely another pandemic will hit in the not-too-distant future. Meanwhile, we have also been warned that new variants of Covid-19 might not be as benign as Omicron. “Mutations of viruses don’t necessarily get weaker. They can get more severe and more dangerous. The virus is changing but humans are acquiring more immunity too. We expect Covid will settle into an endemic condition, causing outbreaks and surges, but hopefully not leading to the situation that we had in 2020 and 2021 because of the immunity we have developed from vaccines and natural infection,” Dr Swaminathan said.