The Republic of Ireland had its first case of the new coronavirus, Covid-19, at the weekend, after almost two months of warning that this moment was inevitable. Our hyper-connected world might have been designed for the spread of a virus like this. It was only a matter of time. So what now?
Containing a virus involves a careful combination of public health measures, political determination and psychological awareness. While medical interventions are key, they rarely achieve their goals without firm political support and an awareness that unhelpful psychological reactions can lead to hysteria, disengagement and nihilism.
But if we set about this correctly, all of these problems can be avoided or managed. Coronavirus can be contained.
A wise teacher once told me that humans have two basic responses to threat: panic and complacency. Neither response is helpful and both are in evidence today, albeit about two different kinds of threat: panic about coronavirus and complacency about other, apparently less dramatic problems, including, most notably, climate change.
My teacher overstated her point so that I would remember it. And, to her credit, I do, some 33 years later.
In fact, there are plenty of people who are responding calmly and efficiently to coronavirus, and plenty who are appropriately exercised about climate change. But my teacher had a point. If even 10 per cent of the panic about coronavirus was shifted to climate change, the world would be a substantially better place and our fight against coronavirus would be none the weaker.
Take the issue of face masks. The World Health Organisation is clear that people with no respiratory symptoms, such as cough, do not need to wear face masks. Masks are recommended for people who have symptoms of coronavirus and people caring for those who have symptoms, such as cough and fever. This includes healthcare workers and people who are minding someone either at home or in a healthcare facility. There is no reason why people outside of these categories should wear masks. There is no benefit.
But is there any harm? What about wearing a face mask “just in case”?
There are two problems with unnecessary masks. The first is that the world has a limited supply. If face masks are worn by millions of people who do not need them, there will be fewer for those who do: people who are ill and the healthcare workers caring for them. This will increase risk for everyone and make the situation worse.
Ireland's health officials are acquitting themselves very well so far. Our politicians need to do likewise
The second problem with unnecessary masks is that they fuel panic. Face masks give physical form to the psychological barrier between “us” (the well) and “them” (the ill). If the general wearing of masks served a medical purpose, this would be a reasonable price to pay. But unnecessary masks in public areas – on city streets, for example – simply deepen this division with no benefit. They cast the entire world into the category of the “ill” even though most people do not have coronavirus. By wearing unnecessary masks in public, we are not isolating the ill: we are isolating ourselves. No good will come of this.
Of course, there is reason to worry about coronavirus. The infection is spreading and needs to be contained. But there is much that can be done and is already being done.
Hygiene and isolation are effective measures to reduce transmission. And, compared to other viruses, the mortality rate is relatively low. Between 1 per cent and 2 per cent of people with coronavirus will die from it. The mortality rate with SARS was 10 per cent.
Of course, high-level statistics are no consolation if you or a family member are in the 2 per cent of those with the virus who might die. As a result, public health measures are vital. To date, Ireland’s Department of Health, Health Service Executive and public health bodies have responded admirably. They have been open, assured and measured. Long may this continue.
But healthcare is not delivered in a vacuum. Containing coronavirus has as much to do with psychology and politics as it has to do with medicine. Most importantly, Ireland needs a strong government at a time like this. The inchoate process of government-formation that might or might not be happening at present needs to be co-ordinated and accelerated.
Viruses spread in countries that are poor and countries that lack strong, democratic governments with the support and confidence required to take unpopular decisions if needed. This is especially true in relation to issues such as quarantine, isolation and cancelling public events. Ireland is a rich country and our health officials are acquitting themselves very well so far. Our politicians need to do likewise.
In the words of the 19th-century German pathologist, anthropologist and politician Rudolf Virchow: “Medicine is a social science, and politics is nothing but medicine on a large scale.” Politicians, please take note.
Brendan Kelly is professor of psychiatry at Trinity College Dublin