Zero Covid must be the aim of Ireland's health authorities
NPHET, HSE and Dept of Health must change policy from partial suppression to targeted elimination
I fear it will be very hard to avoid another national lockdown, which it will be hoped will bring cases to 10 per day. Photograph: Francesca Volpi/Bloomberg
In the absence of vaccines and drugs two, broad strategies are being used internationally to combat the coronavirus pandemic: lockdown and test and trace. We know that lockdown does reduce the number of cases, but it causes enormous social, cultural and economic damage, and on its own it will not eliminate the virus.
Every relaxation of lockdown, however welcome in the short term, is guaranteed to lead to a resurgence in cases – we were down to 10 cases per day in June and July. Then we began to relax the restrictions, and we are now at 100-150 cases per day. We are opening schools and entering the winter and it is plain as plain can be that cases will continue to rise. It is hard to imagine that we will not be forced into another total lockdown.
I wonder how many people now realise that the Government is being advised to accept that we are going to have to live with the virus for the foreseeable future
Government policy has now become explicit, made clear by the head of the Health Service Executive, Paul Reid. The HSE takes the view that eliminating the virus is not realistic and the plans are no longer around a second surge, but more about managing peaks and troughs, he told the Oireachtas Special Committee on Covid-19 Response.
I wonder how many people now realise that the Government is being advised to accept that we are going to have to live with the virus for the foreseeable future.
It is particularly disappointing that we have not been given any detailed evidence for Reid’s assertion that “eliminating Covid-19 is not realistic”.
Why is it that we cannot devise a policy to eliminate the virus? Is it because the best is getting in the way of the good? Of course it is not realistic to eliminate the virus, but a policy of elimination is an entirely different matter and one that is so realistic that it has been adopted in other countries.
Testing and tracing is seen worldwide as complementary to lockdown, and as increasingly important as lockdown fails. The best example is New Zealand – various commentators say we should not compare ourselves to New Zealand but I suspect that very few people have bothered to do so.
It is easy and salutary to find out about how New Zealand has dealt with the disease. The New Zealand coronavirus website is a revelation. First and foremost, it states that New Zealand aims to eliminate the virus by testing and tracing. Second, it provides a massive amount of detailed information.
The website records the details of every single case by date, sex, age group, location [by district health board], and whether the person had arrived from overseas. There is great focus on vulnerable groups, especially the Maori and the Pacific Islanders. The number of tests per day features prominently.
A high number of tests across the country helps identify cases of the virus early, manage clusters of cases when we find them and track how well our efforts are working.
The website shows there were no community based cases for June and July, with about two cases per day detected in travellers from abroad, who were detected at the ports and quarantined in secure “hotels”. In this period they carried out 1,000-5,000 tests per day on incoming travellers and on people with suspicious symptoms.
On August 11th, a community outbreak was identified in Auckland and new cases quickly rose to about 10 per day – testing and tracing combined with genome sequencing showed that all of these formed a single cluster; each was anonymously recorded on the national website by district health board so everyone could see where the outbreak was located. Within two days, testing moved to about 20,000 tests per day, contacts were traced with great precision and 141 positives had been identified to August 31st. It is by far the largest cluster seen in New Zealand – the speed of the spread of the virus has been awesome.
I am concerned that we are paralysed by a kind of group think, stuck with one policy, lockdown, perhaps put off by the challenge of setting up a new test and trace system on the scale necessary.
The hunt for the virus in the Auckland August cluster is still ongoing with tighter and tighter testing, using pop-up testing stations for example. You can get a sense of the reach of the system by looking at the website, which shows places of interest where infected people were known to have been. Eight places of interest included a church, a junior rugby club, a primary school, a shopping mall and a guinea pig show, and people who were at these locations on certain dates at specified times are asked to be on the alert. If they feel ill they should self-isolate and contact a health line. Everyone in New Zealand can observe this hunt for the virus, which has huge community support.
Note the intensity of testing for the Auckland cluster – 20,000 tests per day for one cluster. And there are concerns that this might not be enough if this cluster continues to expand or if new ones emerge. We have many more clusters and we are carrying out 10 - 15,000 tests per day.
The National Public Health Emergency Team, HSE and Department of Health must change their policy from partial suppression to targeted elimination, that is to aim for zero Covid, through a combination of lockdown and deep testing and tracing. I am concerned that we are paralysed by a kind of group think, stuck with one policy, lockdown, perhaps put off by the challenge of setting up a new test and trace system on the scale necessary.
Most of us have responded heroically to the pandemic – a serious problem lies with the Government authorities. The chance in June [with 10 cases per day] to hunt the virus to virtual elimination was missed. Now it has been confirmed that our policy of variations on lockdown entails the prospect of recurrent irruptions of the virus into the winter, into 2021 and beyond. The Minister for Health Stephen Donnelly has warned that a new wholescale lockdown may be necessary.
Indeed I agree. I fear it will be very hard to avoid another national lockdown, which it will be hoped will bring cases to 10 per day. If we can achieve this again we must be ready to use test and trace to bring it even lower, and we cannot do better than look very carefully at what is being done in New Zealand.
David McConnell is fellow emeritus in genetics at Trinity College Dublin