Aggressive suppression and zero tolerance of Covid are crucial

Sir, – Senator Michael McDowell wrote a piece in The Irish Times headlined: "Covid controls should err on side of keeping society open" (Opinion & Analysis, January 12th).

The article stated: “It is well to remember that apparently serious people attempted up to a year ago to convince politicians and the public that Ireland’s response to Covid should be a total ban on travel and extinguishment of the epidemic by a complete internal lockdown. Their zeal was genuine but, we now know, utterly misguided.”

The Senator seems to misunderstand what was proposed at the time, and what actually happened.What was proposed was aggressive suppression with zero tolerance of Covid, using the time-tested methods of rapid diagnosis, isolation and contact tracing, with the objective of running every outbreak to ground.

This is a pandemic policy which has protected populations from before the modern medical era to now, and for example leading to the prompt elimination of Sars.


Had the Government actually chosen such a policy, we might never have reached zeroCovid, but having that objective would have reduced the time spent in restrictions and reduced our many preventable deaths.

That policy works, and Ireland showed it could work here when we applied it in March to June 2020.

New Covid cases fell to as low as 10 to 20 per day. The Government relaxed travel restrictions in the summer of 2020, and then variants imported from Mediterranean countries set off a second wave.

We held up New Zealand and other countries as leaders. They were, and still are, better off than we are in the choices they made across every possible metric of success. The deaths per million in each country is evidence of this:China, four; New Zealand, 11; Taiwan, 36; Australia, 97; Iceland, 106; South Korea, 120; Norway, 251; Finland, 301; and Ireland, 1,205.

To put it bluntly, the total Covid deaths in Ireland (population five million) has been 5,952, in China (population 1.4 billion) there have been 4,636, and in New Zealand (population five million) there have only been 52.

To the credit of the Government and the health system, Ireland has a wonderful vaccination programme – as do the countries listed above, some of which have higher vaccination rates than us (South Korea). Our vaccination programme mitigated the loss we might otherwise have sustained and it will hopefully continue to help in the future.

But it alone could not and did not prevent the deaths of more than 5,952 of our people in the Republic, or those not represented in this figure but who died as a result of reduced care capacity, nor could the vaccination programme alone protect those now with long Covid syndrome.

Prior to vaccination, countries with aggressive suppression policies have had more freedom, not only from sickness and death, but they have spent less time in lockdowns or severe restrictions and their economies have, on the whole, fared better.

Ireland spent a total of 227 days in three lockdown. Most of New Zealand spent a total of 73 days. Many regions of Australia spent only a matter of weeks in strong restrictions, including Brisbane, Darwin, and Adelaide, which managed to stay with close to zero cases, with all the benefits of full domestic freedom, until the decision to open Australian borders (Covid is still suppressed in Perth and Western Australia even today). Sydney and Auckland were less fortunate with 159 and 185 days in lockdown, respectively, and Melbourne had a particularly hard time with 262 total days.

Thousands of deaths were prevented in all of the above regions; we could have and still can learn from their implementation.

Ireland has never had a serious plan to combat a pandemic. Our underfunded and insufficiently respected public health system’s capacity to diagnose, isolate, test and trace was nowhere near what was required for the height to which the Government allowed the case numbers to rise.

We had no stocks of personal protective equipment. We prevaricated for longer than was necessary on the use of masks, (and now on which masks to use) and on the introduction of antigen tests.

We gave insufficient advice on air filtration systems. Our Government advisers did not include sufficient scientific expertise, even when that was available.

It is no solace that these weaknesses are not unique to Ireland – many EU countries noted for their science and medicine have suffered terribly for similar reasons.

The Irish Government decided that it would not pursue aggressive suppression or elimination, but that we would “live with Covid”.

This decision has left the Irish people with no choice but to hope that this fast-track route to endemic transmission will minimise overall harm and result in an end state we can actually live with. That, however, is far from guaranteed and the long-term success of this approach will take years to establish.

This pandemic, still raging in many countries, is not over and we need to be prepared to deal with a succession of new variants that may be more transmissible, more resistant to the current vaccines and perhaps significantly more virulent. We must be prepared, before it happens, for a variant as transmissible as Omicron, but much more severe.

In order to keep both domestic society and international borders open, a “vaccines-plus” framework is clearly necessary. This should include better standards of air hygiene especially in our schools, the widespread availability of high-grade face masks, significant investment in our regional public health medicine departments, with enhanced testing, tracing and supported isolation systems, as well as the option of rigorous controls on domestic and international travel, including Covid passports.

Especially now, as many argue that the end of this pandemic is in sight, we must stay vigilant and our fellow citizens should be warned that there may be scenarios where we have to introduce more aggressive suppression.

We must be prepared to do what New Zealand did and is still doing, if and when needed.

Vaccines and drugs, even new ones, may not be always able to match the speed of change in Covid-19, or other novel pathogenic viruses.

We need plans for this, and the capability, and resources to deliver them.

This is not misplaced zeal, it is scientific common sense.

When faced with a catastrophic pandemic we need to accept that the Darwinian evolution we have all witnessed these past two years does not know about, much less care about, our optimism and we need to be ready and willing to err on the side of keeping society safe, and by doing so, keeping it open. – Yours, etc,


Professor of Health Systems,

Dublin City University;


Smurfit Institute

of Genetics,

School of Genetics

and Microbiology,

Trinity College Dublin;


Associate Professor,

School of Psychology

and Trinity College Institute

of Neuroscience,

Trinity College Dublin;


Director of the Moore

Institute for the Humanities

and Social Sciences,

National University

of Ireland, Galway;


Fellow Emeritus in Genetics,

Trinity College Dublin;


AXA Research Chair

in Applied Pathogen

Ecology, School

of Biological, Earth

and Environmental


University College Cork;


Dean of the School

of Public Health,

University College Cork;


Associate Professor,

School of Geography,

University College Dublin;


Professor of European

Public Health,

London School

of Hygiene and

Tropical Medicine;


Human rights lawyer;


Associate Professor,

School of Biochemistry

and Immunology and

Trinity College Institute

of Neuroscience,

Trinity College Dublin,

Dublin 2.