Our Covid-19 approach to date is untenable: We need to take back control

It has never been more urgent to reconsider the wisdom of our policy of 'living with the virus', which basically amounts to playing for a draw against an adversary that doesn’t tire, doesn’t give up, and continues to surprise us
Our Covid-19 approach to date is untenable: We need to take back control

2020 has been an exceptionally tough year for everyone in Ireland, especially those who came into it disadvantaged in any way. 

The Covid-19 pandemic has exposed almost every inequality and fracture that existed in our society, including several that we had underappreciated and will need to work on long after the virus has gone. 

Infectious diseases love nothing more than to exploit the vulnerable, the marginalised and, of course, also the irresponsible. Never before has the concept of the social contract that binds families, friends, neighbours, and citizens into a society ever been so obviously important.

As we’ve seen repeatedly proven all over the world, Covid-19 runs riot through divided societies and spirals wildly out of control if even a modest minority of a population cannot or will not comply with ambitious programmes to suppress and eliminate it. 

Here in Ireland, most of us have united to successfully contain the first two waves but are now struggling to contain the third and largest so far. 

It has never been more urgent for us to reconsider the wisdom of our irrationally-named policy of “living with the virus”, which basically amounts to playing for a draw against an adversary that doesn’t tire, doesn’t give up, and continues to surprise us.

The virus is living thing, not a fixed entity and the rules of how we deal with it are always changing.
The virus is living thing, not a fixed entity and the rules of how we deal with it are always changing.

Crucially, Covid is not a fixed entity but rather a living thing, so the rules of the game can always change at short notice. 

Covid is always shuffling its genomic deck in search of new combinations to trump the various winning hands we humans have relied on to keep it at bay. Unfortunately, nothing evolves faster than an emerging pathogen, especially one that has been allowed to grow to very large population sizes across much of the planet. 

The emergence of a more infectious new variant of Covid on our doorstep, in a country with a regrettable track record of failures to tackle the virus, is therefore more alarming than it is surprising. 

This latest play by the virus changes the rules of the game decisively, demanding an immediate and equally decisive response from us as a unified society.

Looking ahead, we should expect four major changes to Covid epidemic trajectories that will directly affect the numbers Nphet report every day, the daily financial struggles of employers and employees across the country, and the harsh realities faced by patients, nurses and doctors in our besieged health services.

First, merely repeating our most successful response efforts thus far will deliver far less bang for the buck. In the forms we are familiar with, even the old phase 1 or newish level 5 will probably only shrink case incidence rates at half the rate they did before. 

New tricks

We will have to improve their stringency and add some new tricks to see the kinds of steep downward trends we all took solace from during previous lockdowns.

The good news is that there certainly are plenty of options for stepping up our fight against this more transmissible new variant and retaking control of our own destinies, perhaps in time to enjoy a St Patrick’s day worthy of celebration under the appealingly lenient conditions of level 1.

New approaches that could supplement and strengthen our existing response measures include routine serial testing of essential workers with cheap and cheerful rapid antigen tests. 

We could even deploy targeted mass testing of entire populations wherever outbreaks occur once we get down to sufficiently small numbers of residual transmission foci. 

Further new tricks we can learn from others are all standard procedures in Covid-free countries like Australia. 

Such established approaches include more accessible testing, more inclusive testing criteria, compulsory airport quarantine, identity-based border bubbles to facilitate limited essential travel between adjacent counties (including those in the North), trailer exchange facilities at our ports so that goods can enter without drivers, and comprehensive outbreak investigation led by expert public health physicians.

Frustrated health experts 

On the latter point, it would help if our public health doctors weren’t frustrated to the point of an imminent strike to secure the autonomy, authority and resourcing they need to rescue us from this crisis. 

They’re a small, elite group of devoted public servants whom we desperately need to lead us out of this pandemic, so we should collectively insist that our elected leaders give them what they need to wrestle this virus into submission. Let's allow the real public health experts in Ireland get on with their jobs and lead us out of this mess without any further constraints.

I’m sure the first change they’ll make will be extending the retrospective reach of contact tracing at least a week into the past, so that the sources of Covid-19 transmission can be identified and entire transmission chains smothered comprehensively. 

Until we can achieve that level of outbreak containment, Covid-19 may go down but it will never really be out. Current protocols in Ireland limit tracing to a mere 48 hours prior to the index case becoming ill, so whoever infected him or her will never be identified. 

We need to give our doctors and health experts the tools to lead us out of this pandemic.
We need to give our doctors and health experts the tools to lead us out of this pandemic.

That, in turn, means that most of the other people exposed to the same source infection will never be traced, contacted, or quarantined, so the show goes on for that viral transmission chain. 

Given that most people infected with Covid experience only mild symptoms, which they usually shrug off without being tested, and this is how mystery cases known as community transmission arise. 

This is what sets Covid apart from ebola and SARS and makes tracing at least a week back into the past, to find the source infection and all their contacts is essential to contain entire transmission chains. 

To do otherwise, as we are presently, is like trying to bail out a sinking boat with a colander.

If we allowed our public health physicians to correct this fundamental error in our outbreak investigation system, they should be able to sustainably lock in the hard-earned gains achieved through difficult lockdowns. 

Of course detailed and intricate detective work is a big job for large teams led by expert public health consultants, so it simply can’t be done for hundreds of new cases a day. 

If our public health teams are to have a fighting chance of chasing Covid out of Ireland and keeping it out, we need to get back below 10 cases per day as we did over the summer.

And there’s also lots we can do to get us to that point faster, simply by improving what we’re already doing. 

Rigorous implementation

For example, more rigorous implementation could be achieved, while also addressing ongoing mass unemployment, by mobilising small armies of community-based workers armed with clipboards, identity badges, and the authority to issue on-the-spot fines for non-compliance with basic regulations like mask-wearing, social distancing, and close contact quarantine requirements.

This would also allow our gardaí and HSA staff to focus on issues that really need their attention, such as enforcement of local travel restrictions and high-risk workplace inspections.

The second major implication of enhanced transmissibility is that the consequences of any failures to control this new Covid variant will be much more extreme going forward. 

Proper tracing is vital to find the source of infection and their contacts.
Proper tracing is vital to find the source of infection and their contacts.

Indeed the epidemic expansion rates we have seen during our failed efforts to contain the virus with phase 3 and level 3 could easily quadruple. That means even very low incidence rates like those we saw in mid-June could rapidly spiral back above 1,000 cases a day within a month if allowed to do so by prematurely relaxing the restrictions required to get us there. 

Any relaxation of restrictions starting at higher incidence rates, like those we got down to at the end of our second lockdown, will result in even more spectacular and devastating rebounds. 

Any illusion that we can limp along from one lockdown to the next, to allow ourselves meaningful reminders of semi-normal life in between, will be cruelly exposed by this new Covid variant because it may be reasonably expected to unravel our hard-won gains four times faster than its predecessors.


Third, and most worrying of all, if we fail to contain this new faster-moving variant, the resulting epidemic surge would overwhelm our health system much faster than anything we have seen so far. 

With global scientific consensus now settling on an infection fatality rate of about 1%, we can all do the basic arithmetic required to understand what a full-blown epidemic wave with this new variant could look like if we allowed it to overwhelm us before we achieved sufficient vaccine coverage in the second half of 2021. 

The vaccines are coming and hold welcome promise of a conclusive and sustainable escape from this pandemic. Unfortunately, however, they won’t come soon enough to avert a faster fourth wave, a harsher fourth lockdown and a much wilder ride than anything we’ve experienced so far on the Covid roller-coaster. 

Rather than relax as we enter the final lap in the new year, we need to outpace the sudden sprint finish our viral opponent.

Fourth, we should all be aware that our fourth wave, driven by this new variant, is already brewing and needs to be nipped in the bud before it breaks through to become starkly obvious in the daily Nphet briefings. 

While we can’t see this wave within a wave in the crude numbers of daily cases yet, molecular analysis has confirmed it’s well established here in Ireland. So even if ongoing restrictions cause our current third wave to peak sometime in early January, a fourth peak driven by this new variant may well rears its ugly head well before the end of the month. 

Unless of course we act now to get it under control immediately and snuff it out while it is still manageable in scale.

If there’s anything we’ve all learned over the last year, it’s that hesitation can have fatal and economically devastating consequences in the face of a pandemic. Every day counts and what better day to collectively find a new gear than today?

This new variant of Covid-19 can be stopped, but will require a level of decisiveness, determination and ambition we haven’t yet seen from our government and authorities.

As we start the new year faced with even starker choices than those we were confronted with in March, we need to urgently rally as a society and take on this new challenge with renewed resolve. 

We can get our country back this spring, even without the bulk supplies of effective vaccines that will come later in the year, but only if we unreservedly realign our national strategy with the singular goal of putting Covid down and out for good. 

The alternative doesn’t bear thinking about and we’re running out of time to make those choices. 

This new variant renders our current strategy to merely mitigate and “live with” it even more untenable. 

It’s therefore time to finally take the fight to the virus with an ambitious plan for aggressive suppression and elimination, so we can hold the fort securely until vaccine scale up is completed. 

However, we need to make those strategic decisions and commitments right now, meaning within days rather than weeks or months.

  • Prof Gerry Killeen is chair of Applied Pathogen Ecology University College Cork and Founding Member, Independent Scientific Advocacy Group on Covid-19 for the island of Ireland

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