'I'm seeing many people who've had Covid for the second or even third time'

At the pandemic's peak, 60% of  GP Phil Kieran's patients had Covid. Now it's down to 10%. But with cases still high in the community, he asks if was right to remove all restrictions

Dr Phil Kieran says he expects to wear a mask at work for the rest of his career. Picture: Dan Linehan

Covid is finished. No need to worry about it or to focus on respiratory hygiene anymore. None of this irritating mask-wearing and we can all move on with our lives... This is what I hoped we would be saying in March of this year and for a while it looked like that might happen. However, it has not fully turned out that way, has it?

The HSE stats show declining numbers of positive cases, and the numbers in hospitals and ICUs seem reassuringly stable. But most of us have noticed an increase in people with coughs and colds and runny noses and, yes, with positive Covid results over the past month. 

Looking back over my work diary,  I had about four covid consultations out of 36 consultations last Thursday and three out of 35 the week before. So, on those two days, Covid took up around 10% of my consultations. This is nowhere near the peak where it probably was closer to 60% but still it is evidence of significant disease burden in the community.

I'm also seeing many people who've had Covid for the second or even third time. There are two differences this time around. It is hitting them quite hard but most are not running into too much difficulty with breathing or needing hospitalisation. This is now starting to look a lot more like flu (genuine flu makes you feel like you were hit by a bus, and it's definitely not a cough and runny nose). 

Most of my patients who have been vaccinated recover over a few days and get back to normal quickly. Many patients, and indeed friends and colleagues, are going on to develop secondary bacterial chest infections/pneumonia or have significant deteriorations in their asthma. These patients feel they are just getting back on their feet and, all of sudden, they are in their beds and wondering what went wrong. Thankfully, if indicated, a change of medications or a course of antibiotics gets most of them back to normal quickly.

Questions to be answered

This leads us to ask did we open up too early? Should the government have kept mask rules for longer? And, the one I'm most interested in, where does all this end?

I don't think we were premature in reopening. A lot more goes into this decision than just the raw numbers. The most important way to think of this is to look at what lockdown or restrictions were meant to do. They were intended to save lives and, looking at the situation back at the start of Covid in countries like Italy, America, and the UK, the restrictions did just this. Our health service (which is overloaded at baseline due to under or mis-investment by every government in the past 20 years) did manage to pull through - we never ran out of ICU capacity completely. And we never had to implement procedures I remember learning back in March 2020, such as how to deliver end-of-life care in people's homes without access to usual medication. (This was one of the scariest probabilities I planned for, and it became a reality in other countries.)

 Our lockdowns worked, so why did we abandon everything and go back to zero restrictions? 

We had a phenomenal uptake of vaccination. This reduced the risk of hospitalisation and death hugely and so this took away a lot of the fear of further overwhelming hospitals. It also meant that most of our population had some degree of Covid immunity. New variants have shown that these vaccines are not perfect, but still the rates of deaths and ICU admissions have not climbed even though case numbers are rising. This tells me there probably wasn't merit in continuing lockdown. We needed to open up society and our economy. People needed to see their friends and family, and those who have business in the hospitality industry needed to try and get their lives back on track.

Continuing to wear a mask

Should mask rules have been kept? That's a tough question to answer. In some Asian countries which experienced the 2003 SARS pandemic, we saw that mask-wearing in public persisted long after the clinical need was gone. I still wear a mask when I go into shops or on public transport but I am grateful that it is not compulsory. People should have the freedom to decide when or where they wear a mask now. It reduces the spread of all respiratory infections, not just Covid, and I think we will see mask-wearing to some extent for a long time to come. I will probably be wearing them at work for the rest of my career, and I'm OK with that.

So the last and most important question: where will it end? I hope that the summer will see a massive decrease in transmission as we move outdoors more, and hopefully,  we will be able to stop talking about Covid for a while. I reckon we will have ongoing vaccination boosters for the most vulnerable. So if you were advised to get the flu vaccine every year before the pandemic, you will probably need a yearly booster for Covid (let's hope this will be a single combined vaccine). The rest of us will move on and not need further vaccination.

 I would like to see the pandemic lead to a permanent shift to more hybrid/flexible working for everyone and that this will stop people feeling they need to go to work when they are sick. My advice to all my patients/friends and anyone who stands still long enough for me to talk to them at the moment is this: cover your mouth and nose when you sneeze, don't go in to work if you're sick and try to move on from Covid in whatever way you feel safe to do so. 

We all need to make our own risk assessment, and so long as no one is forcing their risks on us, we shouldn't judge others for the risk decisions they make about Covid.