Tomás Ryan: Are we ready to get serious about eliminating Covid-19?

Vocal opponents of a ZeroCovid strategy betray a basic insecurity: they have no strategy

 

I am confused. We are faced with high and growing numbers of infections, while struggling to achieve a stalemate scenario of living with the virus. Things are getting worse, but we’re not changing course. We have been appeasing the virus, allowing it the time and space to multiply and return to unmanageable levels.

The narrative played out in the media is becoming distorted. We hear near-Trumpian platitudes from some quarters that deny facts both about the virus itself and the private wishes of people. The realities are that the virus is just as dangerous as it was in April and that, as of October 12th, over 60 per cent of the population want further restrictions (beyond Level 3) while 15 per cent don’t know. The National Public Health and Emergency Team (Nphet) have recommended, more than once, that the Government enact Level 5 restrictions. But, for some reason, there is a disconnect in our decision-making process.

Naysayers of an elimination strategy tend to dispense free-floating criticisms in order to suppress the conversation

As a result, we’re all living in reactive mitigation with no end goal in sight or event articulated. The Government’s Plan for Living with Covid-19 is a good framework, but it’s not a strategy. It does not give us a way of attaining suppression of the virus and transitioning to Level 1 restrictions or better.

An alternative approach has been offered by the Independent Science Advocacy Group for Covid-19 in Ireland (ISAG). The group is composed of volunteer public health experts, epidemiologists, scientists, science communicators and modellers. The proposed strategy is aggressive suppression with a goal of zero community transmission.

The ZeroCovid idea is being met with vocal resistance from some politicians, commentators and special interest groups. Naysayers of an elimination strategy tend to dispense free-floating criticisms in order to suppress the conversation. What about the economy? Have we not considered the mental health of young people? What about delays in non-Covid healthcare? How can we regulate travel into one of the world’s most globalised countries? What about the North?

Inconsistencies

Discussion and debate is appropriate, but there are two interesting features about the resistance to ZeroCovid: its internal logical inconsistencies and the emotional nature of the criticism.

It is asserted that an elimination strategy is bad for the economy, despite the fact the low-Covid and ZeroCovid countries are ranking highest in business confidence, lowest in GDP decline, and have a self-evidently booming domestic economy and social life.

A legitimate concern is that the focus on Covid-19 comes at the cost of non-Covid-related healthcare. This is true, but critics of ZeroCovid neglect to explain how rising virus infections is an effective response to this issue.

Similarly for mental health concerns, driving the virus down to low numbers is what allows people of all ages to get back to a normal social life with predictable economic conditions. And, working together towards a clear community strategy is much more meaningful than floundering in purgatory.

A good deal of the opposition to ZeroCovid centres around the importance of open travel, and the significance of our airports in our island reality. This is an interesting inversion of the fact that our island status gives us unique power over travel into the country, and allows an enviable position to decide on our destination.

In the absence of a widely available vaccine, or time travel, a return to the world of 2019 is not possible

The Border with Northern Ireland is often seen as the main obstacle towards suppression of the virus, despite the fact that the pandemic has provided the single greatest incentive for cross-Border co-operation in our history.

The incoherence of the opponents to a ZeroCovid strategy betray a fundamental insecurity: they don’t have a strategy. They appeal to vague notions of “balance” or “proportion”’, without defining what that means. Then there is the often-visceral manner in which ZeroCovid is criticised. But if it is such a ridiculous strategy, then why the need to be so defensive towards it?

Crucial feature

The answer may be that elimination is the only approach that has had its actual benefits and costs laid bare. Herein lies the crucial feature of the opposition: it is not just about ZeroCovid, it is also motivated by an unwillingness to face reality.

Some voices oppose ZeroCovid, even though they are not advocating for any specific alternative suppression strategy. They are advocating for 2019. They want to believe that with minor behavioural adjustment, the virus can be more or less ignored and we can get back to last year. This is Arcadian thinking, and it is dangerous. In the absence of a widely available vaccine, or time travel, a return to the world of 2019 is not possible and the country does not have to fall in with this charade.

We are in a position to be a European leader in opening up society fully by eliminating the virus

Some of our leaders-in-waiting have said that the goal of elimination is unattainable. That the cost of attaining it is too high. But they fail to account for the costs to the population of cycling in and out of restrictions indefinitely, and they may lack either the vision or the mettle to seize the broader, unprecedented opportunities for improving both the country and cross-Border relations.

The World Health Organization’s special envoy for Covid-19, Dr David Nabarro, has stated that ZeroCovid is a very reasonable goal for Ireland. That is, provided we can first get the current situation under control, and suppress the virus down to levels that are manageable for our public health infrastructure. If we don’t have the competency to suppress outbreaks when cases numbers are low, then we cannot expect to maintain suppression or elimination after enduring a period of lockdown. There may be much to learn from the Australian situation on how to pursue and maintain a ZeroCovid goal in a practical manner.

The Covid-19 crisis is surely intimidating for any government, but the possibilities it creates are the real test of leadership. The pandemic opens new avenues for changing how we manage our health service. More than that, we are in a position to be a European leader in opening up society fully by eliminating the virus. But whatever the strategy, it can only be effective as an all-Ireland project. What serious politician would not relish these opportunities?

Tomás Ryan is associate professor in the School of Biochemistry and Immunology and Trinity College Institute of Neuroscience at Trinity College Dublin

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