Let us pursue the coronavirus - not just watch its R number wax and wane

We fail to focus on 90% of Covid-19 threat – infections not related to travel

Dr Ronan Glynn, acting chief medical officer, said even though the number of cases was lower than on some days over the past fortnight, it was too early to tell if this was the beginning of a sustained trend downwards. Video: RTE

 

We are now going into our seventh month under threat of Covid-19. Ireland started planning in January 2020, as we saw Covid-19 spread in China, and in February as we saw cases throughout the EU spread by returning travellers from China. We chose not to “close down the country”, screen at the airports for returning travellers or close down the nursing homes to visitors who could carry Covid-19. We did not recommend the use of face masks as we did not believe in asymptomatic spread of Covid.

We locked down the country sooner than the UK, and we prepared our acute care hospitals for the surge. We were more decisive than the UK. There were calls to restrict travel of those Italians who came to visit Ireland despite cancellation of the Ireland/Italy Rugby match, and there were calls to not allow the Irish to travel to Cheltenham to the horse racing, but such guidance was not given.

Dr Jack Lambert is professor of medicine and infectious diseases at the Mater and UCD school of medicine

These decisions resulted in many cases being imported into Ireland without our knowledge. A few weeks later, the virus had spread throughout much of Ireland and has remained that way ever since. At the peak, there may have been 10,000 or many more cases of Covid-19 circulating in Ireland – we will never know as we did not test many during this time. We are now well over the “surge” and indeed the hospitals have seen very few new cases since the last week in May. We have successfully suppressed but not eliminated the virus. We are now in a situation where the “first wave” of Covid-19 is over, and we are attempting to open up the country safely.

Irish-transmitted

Over the last few weeks, as we have been debating “travel-related Covid-19” coming into Ireland, which represented less than 10 per cent of the total recent cases in Ireland, we have failed to focus on the other 90 per cent of the problem, namely Irish Covid infections not related to travel. These are the clusters that are Irish-transmitted, not brought into the country from outside. An important message from the World Health Organisation’s Dr Michael Ryan, who directed their Ebola effort, was about chasing the virus and not letting the virus chase us. We monitor the R number and have seen Covid-19 increase and decrease over the last two months since the end of the surge. We have been unable to get community spread down to zero.

What did we learn from these clusters two months ago? How did we deal with them?

Months ago we saw upsurges in meat packing and direct provision facilities. We closed down the “offending” facilities at that time, but here we are again. They have flared up again, the same clusters, and the same conditions prevail that have led to these clusters. What did we learn from these clusters two months ago? How did we deal with them? What processes did we put into these facilities in the last months to prevent further outbreaks? It is clear we did not do enough.

The same conditions that put these facilities at “risk” will result in further outbreaks, unless we provide more support and training and resources to these venues. Besides meat packing factories, are the current facilities that have already opened in Ireland (creches, restaurants, building sites) fully prepared for Covid-19 in terms of their preparedness plan? And is there strict adherence to their preparedness plans? Clusters will likely occur again in these locales.

The State’s incidence of Covid-19 appears set to surpass that of the UK for the first time since the pandemic started, new figures show. File photograph: Valerie Macon/AFP via Getty Images
"So, are all of the current sites in Ireland that are open to business Covid-19 ready? I think not." File photograph: Valerie Macon/AFP/Getty

We need to learn lessons from our nursing home experience. Many of these nursing homes were not prepared for Covid-19, did not have the necessary equipment, did not have adequate training, and indeed the current inquest regarding the nursing homes is showing that up to 50 per cent of these nursing homes were not implementing Covid-prevention methods correctly. They asked for help and it was not provided in many cases. They were often just sent a check list and instructions and left largely on their own to do their best without detailed education, support, resources and inspections to assess their preparedness.

Guidance and support

So, are all of the current sites in Ireland that are open to business Covid-19 ready? I think not. Watching the virus and reporting daily numbers, without any interventions, will only result in repeated upswings in numbers. This is what Michael Ryan says we should not do; instead we should be chasing the virus. We need to provide more guidance and hands-on support.

It is time for a new call for Ireland. A call for Covid-19 prevention. We all have a role in finding solutions

So what will the future bring? We have had lots of scaremongering about dangers of travel and a new surge which will result in schools not being opened in September. In actuality it is our lack of preparedness within Ireland that is jeopardising moving forward to Phase 4 and opening our schools.

As Ryan states, “You need to go after this virus. You need to engage with communities. You need to be co-ordinated. You need to be coherent. Be fast. You must be the first mover. You need to be prepared. The problem in society is everyone is afraid of making a mistake. The greatest error is not to move. The greatest error is to be paralysed by the fear of failure.”

So it is time for a new call for Ireland. A call for Covid-19 prevention. We all have a role in finding solutions. We need 100 per cent commitment from all our citizens and all of our organisations, public and private alike. We need 100 per cent use of face masks, 100 per cent commitment of all our governmental officials to work hand in hand with public and private constituencies to find solutions, and to support organisations who need assistance with Covid-19 preparedness. We need solutions that are well thought-through and can be implemented quickly. We need our Ministers to return to work and direct a multisectorial attack on Covid-19. We need solutions that allow us to work with our EU and UK neighbours.

The alternative – new flare-ups resulting in lockdown or delays in restarting our “new normal” existence – is unacceptable. The toll on Ireland’s citizens medically, psychologically and economically is great, with no end in sight.

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