Watching the rather confusing relaxation of Covid-19 controls in the pub and entertainment sector is like watching a car career down a hill, yet again.
One feels like shouting out: surely, this time, we know what is likely to happen when alcohol-fuelled socialising is encouraged, without having agreed and put in place adequate measures to minimise the risks?
This shout-out is directed in particular at the parents of school-going children, and is an appeal on behalf of Ireland’s health workers. Because those who work in our health services and schools, and those who most need these to function through to next spring, will bear most of the brunt of Ireland’s swelling Covid wave.
Emerging evidence from the Amárach surveys suggests that the Government may be behind society, yet again, in its trajectory towards greater relaxations as Covid-19 cases grow.
The slow suffocation of our health services is not getting the Government or societal response that it deserves
The boom of high vaccination coverage and top ranking in Bloomberg's country league for Covid resilience could soon be followed by another Ireland bust.
This time it will be a busted health service, in terms of its ability to provide day-to-day care for non-Covid health problems. From best boys and girls in class, we could yet again quickly become the school underachievers.
Underlying our wild swings is that, as a society, we have yet to have a debate in relation to the contending rights of those who feel they have the right to infect others through unvaccinated socialising, arguing along with some venue owners for right of entry to pubs and nightclubs for the unvaccinated, and the rights of those who wish to stay Covid-free and to be able to access health services when they need them.
Understandably, many hoped that 92 per cent vaccination coverage in adults would make us safe. However, Covid-19 vaccines only promised protection against serious disease, and not for everyone; and now that protection is waning.
We have also known from early on that you do not relax critical control measures during an upswing in case numbers. Yet we have allowed pressure on the Government to follow the date, not the data.
So how do we extricate ourselves from this impending mess? First, let’s dispense with the notion that there is a quick scientific fix, such as rapid antigen testing, which has been recommended as a screening tool before engaging in high-risk indoor events.
Such tests are only good at detecting cases in those with symptoms, and those with Covid symptoms should get a PCR test. In those without symptoms, rapid antigen tests fail to detect half the cases detected by PCR.
But the bigger problem is that quick fixes, and the complacency that comes from a negative test result, give false confidence and distract from the measures that are proven to work.
Negative tests will encourage the belief that, despite a recent high-risk exposure or Covid symptoms, I can safely go for a night out without a mask and without social distancing.
So if we know that full vaccination, masks and social distancing – taken as a package – reduce the risk, what can we do to ensure everyone in high-risk settings complies? We must legislate for these measures to be mandatory. We must enable staff and other customers to put pressure on customers who do not comply.
Covid-19 continues to be unfair to the young. But it is our yet-again delayed response to the latest wave that is more unfair to the health staff who are again in the front line
We must enforce sanctions on venues that do not demand to see a Covid certificate and do not enforce compliance with preventive measures, enforcement that if necessary could involve ejecting customers. Yes, that will require consultation with gardaí and could require more fundamental legislative changes.
Those who sell alcohol and their advocates must take responsibility for preventing the excessive intake of alcohol on their premises, which is the single biggest factor leading to the breakdown of mask-wearing and social distancing.
There have been 30 or more revisions of the Government’s reopening guidelines for pubs in 16 months, and still no inclusion of guidance for pubs to prevent excessive alcohol consumption or eject those who are drunk. New guidelines for nightclubs also ignore the elephant in the room – drunken customers who refuse to comply with staff requests to use preventive measures.
Schools’ guidelines are another weak point. Primary school pupils who for the most part cannot be vaccinated are not required to wear masks, unlike secondary school students who for the most part can be vaccinated.
Masks are effective at protecting children from the full range of respiratory infections that will hit them in the coming months. Hiqa has reported the evidence that masks cause little difficulty, even for quite young children.
Last winter, 18-35-year-olds contracted Covid-19 in pubs, and at work and home parties, and transmitted the infection to older relatives, many of whom died. We can count deaths, but have we measured the psychological impact on those left behind?
As we enter another winter, some of those who grab the opportunity to stand in crowded queues in pubs and nightclubs will bring the virus home to younger siblings, many of whom are unvaccinated, who will seed schools with infections.
Between now and Christmas, and beyond, class and school closures will become more common, with huge impacts on parents. Too many of us have been there before. Do we really have to go there again?
Covid-19 continues to be unfair to the young. But it is our yet-again delayed response to the latest wave that is more unfair to the health staff who are again in the front line.
The slow suffocation of our health services – patients facing further months on a waiting list for care; the haemorrhaging of nurses and trainee doctors as they reach the culmination of 10-15 years’ postgraduate training, knowing that other countries will genuinely value them – is not getting the Government or societal response that it deserves.
Young doctors arriving home, often after continuous days and nights on duty, and nurses finishing a week of night-duty will usually be too tired to avail of the new social opportunities opened up by the Government. They, and the people who need our health services, deserve better.
Ruairí Brugha is emeritus professor at RCSI, University of Medicine and Health Sciences.