Should Covid restrictions return? Three doctors share their opinions

Covid numbers are continuing to rise across the country, prompting some to call for the reintroduction of restrictions, including mandatory mask wearing in indoor settings.

With the BA.2 variant proving to be more transmissible than the previous strain, the Irish Nurses and Midwives Organisation (INMO) are among those calling for measures to be taken as hospitals come under pressure.

So is reintroducing restrictions the way to go?

Dr Lisa Cunningham Guthrie: ‘Is it overwhelming the health system? No’

Dr Lisa Cunningham Guthrie, consultant in emergency medicine, doesn’t think the restrictions need to be put back in place. “The restrictions were put in place to help the patients, the population health, and also to stop the overwhelm in the health service when they were unvaccinated,” she says.

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“We are now vaccinated. Covid is not having the significant burden on patients’ health as it did have before and it is not having the significant burden on our health system as it did before… I think it’s being used as an excuse for the overwhelm that’s in the hospital system which is not directly attributable to the disease of Covid.

“In the ED [emergency department], we are definitely not seeing the amount of patients presenting with Covid symptoms. The patients that are coming to the hospital are, in majority, coming in with other illnesses or conditions that are not associated with Covid and when they’re being swabbed for admission, they are discovering that they have Covid.

“For example, somebody who’s coming in for a queried appendicitis, that needs to come into hospital – they’re getting swabbed and they’re coming back as a positive.

'Is Covid transmission affecting and overwhelming the health system – no is the answer'

“There are the few people that are still there that have Covid symptoms and are coming in with respiratory symptoms but they are very much in the minority.

“We are definitely overwhelmed and we are overwhelmed from the hangover of services not being put in place as a result of Covid, from the chronic conditions that are still ongoing in the community. It’s not Covid-related that we are seeing the huge rise of patients that are coming to the emergency departments; it’s all the other hangover effects that are going on with Covid.

“We’re seeing such a huge rise in patients presenting to the emergency department with potentially non-emergency conditions, but urgent conditions that cannot be dealt with elsewhere because the facilities aren’t there or because they’re overwhelmed as well.”

On the question of mandatory masks, Dr Cunningham Guthrie says that “we have mandatory masks in the hospitals, but I don’t feel that the public should have mandatory masks. I think it should be optional. There is no doubt that the transmission of the disease can be reduced with masks, but the effect of that transmission is what’s important. Is it affecting and overwhelming the health system – no is the answer.

“There are people that will benefit from it, immunocompromised etc, so give it as an option for people to protect themselves.

“This won’t ease the pressure on the hospitals because it is not Covid-induced pressure ... The reasons [elective surgeries] are being cancelled is not as a result of Covid, in my opinion. It’s because we don’t have the staff.”

Prof Clíona Ní Cheallaigh: ‘People aren’t getting really sick’

Prof Clíona Ní Cheallaigh, infectious diseases consultant, says her main concern now is “not about people when they get Covid, getting really sick and needing ICU because we are seeing very, very, very little of that. My concern is about long Covid ... and we just don’t know the long-term effects of Covid”.

“I think the way we’re going now everybody is going to get it,” she says, adding that an important conversation needs to take place. “There needs to be an open and honest discussion about ‘right are we just saying it’s a cold ... get over it, or are we trying to stop it spreading. Because if we are, we’re not really doing that.

“I think what’s very difficult for the public to comply with, and what’s very difficult to understand, is halfway measures: where families aren’t allowed to visit their relatives in hospital or in nursing homes freely, but pubs are open.”

Prof Ní Cheallaigh says that during her immunology research she has “seen a lot of data that shows Covid does these weird things to your immune stem and to your blood vessels and your brain”. It’s why she has tried her best to avoid getting Covid herself.

She believes improving the ventilation in public buildings, including hospitals is essential. “There’s no downside to it – we’ll get less colds, we’ll get less flus …to protect normal life almost. It’s like investing in sustainable energy now that there’s a fuel crisis. It may happen in time for this crisis, but we’ll definitely have it in place for the next time”.

Prof Ní Cheallaigh accepts that the fear around Covid is not the same. “People aren’t getting really sick and losing their ability to breathe and ending up in ICU, so I think losing the fear of the acute, severe Covid, getting Covid, getting really, really sick, potentially dying, that doesn’t seem to be happening now at the moment so I think it’s reasonable that people aren’t afraid of that. So if people aren’t afraid of getting long Covid, it makes sense not to wear a mask”.

But if we are to reintroduce restrictions, including masking, Prof Ní Cheallaigh says, “I think we probably do need to make it mandatory because we’re all social animals, so we won’t want to be the odd one out’”.

“I wouldn’t bother mandating social distancing. I don’t think it works”, she says.

'I don't think mandatory masking will make a huge difference at this point'

However, mandatory vaccination is something Prof Ní Cheallaigh says she has no issue with. “Seat belts are mandatory, not smoking on buses is mandatory, not smoking in pubs is mandatory. There are lots of things that are mandatory… if you want to get a behavioural shift you can’t just rely on advising people.”

“It’s a really contentious issue but I think human beings don’t make logical decisions, and I think we have to accept that. We see plenty of evidence of that all the time and I think that sometimes that’s okay and we just admit it and make things mandatory. I personally would have no philosophical objections to mandatory vaccinations at all.”

When it comes to considering a mandatory mask mandate Prof Ní Cheallaigh says if something is deemed necessary, then it needs to be mandated. “Did we need mask mandates back with Delta, absolutely 100 per cent yes ... Do I think we need to mandate masks now? No.

“Do I think if you do not want to get Covid yourself, should you wear a mask? Absolutely; you’re walking into a soup of Covid. But we’re letting a Covid soup happen now so wearing or not wearing masks will not affect the soup.

“If you mandate masking on the bus and in shops, you still have pubs and restaurants open – you cannot wear a mask and eat or drink at the same time so you’re still going to have people congregated in an indoor space.”

“I don’t think mandatory masking will make a huge difference at this point.”

Dr Colman Noctor: ‘Hope is hugely important ’

Child and adolescent psychotherapist Dr Colman Noctor says he’s seen an impact already from the easing of restrictions. “The major difference is that it has provided an injection of hope for people, especially children and young people getting back to seeing their pals’ faces again – a real relishing in that freedom and that experience”.

“He’s concerned what the impact of a return to restrictions could mean for people’s mental health. He compares the pandemic to a game of snakes and ladders, the hope from the vaccines giving us a ladder up and the arrival of Omicron and return to restrictions before Christmas as a snake down.

Any talk of a reintroduction of restrictions feels a bit like “another snake which is going to hit us again”.

Hope “is hugely important to children’s mental health. Children and young people and adults are constantly in a position of being braced for the next disaster and are almost resigned to the fact that good things don’t last and that bad things are coming.

“That’s why I think the reintroduction of mitigation measures or restrictions would just give that hopefulness another dent, and it’s the last thing children need at the moment between the global conflict and everything else that’s going on. They’ve so much to be worried about and feel responsible for.

“The lifting of restrictions was something really positive. It seemed to lift everyone and there was a hope of some light at the end of the tunnel, and I would worry about closing off that light again and what it would do to their emerging sense of hope and optimism.”