Gerry Killeen: How have we let ourselves sleepwalk into such a vulnerable position?

As difficult as things are for us here in Ireland, I remain optimistic that we can find our way out of this pandemic next summer with a proactive, pre-emptive, technically informed Covid-19 elimination strategy, similar to those that have worked for measles, rubella, polio, and several other viruses.

New Zealand, Victoria and, most encouragingly of all, New South Wales have started steadily reeling in their delta epidemics over recent weeks, while Queensland has maintained its elimination status throughout.

All of Australia recorded only 388 locally acquired cases yesterday, while New Zealand reported 127, every single one of which could be traced to a known source. Their suppression and containment programmes haven’t crumbled and they’re now regaining lost ground. 

Just like us, our friends in Australia and New Zealand are looking forward to seeing third vaccine doses and vaccine eligibility for young children swing the odds firmly in their favour. 

And they continue to develop new solutions that we should learn from, my favourite being the compulsory recording of traceable QR codes required to enter any business, organisation, club, or event. 

Looking beyond the English-speaking world, China remains Covid free in practical terms and incidence rates in Japan have steadily shrunk from a peak of over 20,000 new cases per day in August to only 81 yesterday.

Lots to get excited about over the medium to long term, but only if we urgently tackle the ongoing massive surge of infection into which we have allowed ourselves to drift. 

What worries me most right now is that we should have known better than to sleepwalk into the frustrating, constrained, uncertain and vulnerable position we find ourselves in today. 

Put plainly, we have allowed ourselves to be misled with palatable, often attractive, falsehoods. 

It’s now time for us to say it like it is. If we do that, we can give ourselves a fighting chance of regaining the old normal that we all miss so much.

I can’t think of any starker way to illustrate our societal failure to make objective, decisive choices than simply pointing out that nightclubs, pubs, and restaurants remain open while at the same time our schools are threatened with closure, one third of all ICU beds in the country are occupied with Covid-19 patients, regular routine care is badly compromised, and debilitating cases of long Covid continue to accumulate.

Our healthcare workers aren’t just exhausted, they’re also disillusioned by a society that has repeatedly forced them to make some terrible choices about whose care to prioritise. 

Also, spare a thought for our regional public health teams who have been slaving away in the pump room of our pandemic response ship from the outset — this is now the third time we’ve deliberately pointed the Titanic back towards the iceberg. 

When we allowed incidence to exceed 600 cases a day and then quietly allowed it to creep up into the thousands, that pump room flooded, leaving our public health teams drowning in an impossible workload.

Hospital staff are not only exhausted, they are also disillusioned about the choices they have been forced to make over whose care to prioritise.

Even if public health teams could recruit enough Hogwarts graduates to magically conduct full outbreak investigation on all the new cases reported every day, we’ve now exceeded our national PCR testing capacity. That means that all the dedicated lab scientists who have burned the midnight oil since early 2020 are no longer in a position to support outbreak containment with sufficient diagnostic services.

It also means our apparently plateauing incidence rates may merely reflect saturation of our testing system and our true incidence of infection may well exceed 10,000 a day. 

Given that there are now thousands of positive cases reported daily, and thousands more missed, how could we possibly identify an outbreak of the new Omicron variant fast enough to contain it?

Despite all the detailed debates on our national airwaves about all the small tweaks that could be made, the reality is that we’ve been led by the nose into a situation where there is no fast or easy way back to normality.

All the dedicated professionals working in the trenches of our war against Covid-19 urgently need our support as a society if we are to collectively avert a traumatic Christmas, establish robust hope for the spring, and regain the option of a sustainable exit from this pandemic over the summer.

Sound familiar?

Fourth wave

Yes, that third vaccine dose will do wonders once rolled out. Just as importantly, we can soon start vaccinating the young children who have entirely innocently constituted the real critical mass of unvaccinated individuals underpinning our fourth wave. 

That, however, will all take time, and so will buying HEPA filters for every classroom if our national authorities ever get around to admitting that may have been a good idea all along.

Technically rational targeted applications for rapid antigen testing exist, one of my favourites being daily testing of close contacts in schools. 

Unfortunately, what we’re currently rolling is out is largely necessitated by an overwhelmed PCR testing platform and motivated by political expediency. 

Rapid antigen tests seem to bring out the epidemiological Harry Potter in politicians of all stripes and the latest proposals to use them for screening travellers potentially carrying the Omicron variant into Ireland is nothing short of full-on magical thinking.

Too little, too late

Nphet has finally accepted that mask-wearing by our unvaccinated primary school children is a good idea, but that comes too late for the dozens of citizens struggling in ICU, especially the quarter of them who will never go home.

The slow, steady surge of our fourth wave has eroded school attendance by students and staff so much that keeping them open is a day-to-day battle for many principals.

Incredibly, we have yet to restore contact tracing in primary schools, seemingly because defending past mistakes appears more important to our government and authorities than correcting them.

The fiasco of pantomimes that are open for business but discouraged for children says it all. 

Too much corporate and political spin in a vitally important technical arena that demands solutions, vision, transparency, and honesty. We should demand better from the people who seem to be leading us through, rather than out of, this pandemic.

But we should also expect more from ourselves.

Duped by palatable falsehoods

How did we allow ourselves to be duped into the idea that the world’s best journals were all wrong about the substantive role that schools play in sustaining transmission? 

How did we all buy into the “Schools are safe” mantra without question? Perhaps because the responsible few who did present us with the facts were ignored or worse.

My colleagues and I at the Independent Scientific Advocacy Group have been persistently ridiculed over our efforts to share the best science we are aware of. As a society, we’ve got to learn to embrace uncomfortable truths.

Now would be a good time to do so. While none of us really know how Omicron may impact our lives, it is reasonable to expect a substantive upward step change in transmissibility, virulence and/or immune evasion. 

So probably bad news, and perhaps even shocking, but surely not surprising after seeing alpha, beta, gamma and delta all arise from similar circumstances over such a short period of time? 

Everyone on the planet deserves the same access to vaccines. Picture; Dan Linehan

And who do we have to blame but ourselves, having failed to front up the hard cash required to pay for Covid vaccines for everyone on the planet? 

Ultimately, this is small beans in the global economy and perhaps we should learn from the fact that there’s nothing new about the Covax scheme being grossly underfunded — the same has been true for decades of the Global Alliance for Vaccines and Immunisation and the Global Fund to Fight Aids, Tuberculosis, and Malaria.

It is time to rethink our value system and priorities.

We will find our way out of our current short-term crisis, or at least we certainly can if we choose to.

However, the big questions are how, when and what do we then do next? 

Based on my experience of what “living with” various high virulence endemic pathogens really means in practice, and my biological understanding of the various curve balls Covid-19 has thrown at us thus far, my best guess is that where we are right now is probably a reasonably representative snapshot of what our “new normal” could look like on at least an intermittent basis if we continue to accept that oxymoron as our overall goal. 

The only positive thing I can say about our current situation is that it offers an invaluable opportunity to learn what “living with the virus” may well look like over the long term.

Perhaps time to start asking ourselves if we’re sure that’s really what we want?

• Gerry Killeen is a founding member of the Independent Scientific Advocacy Group (ISAG) and the AXA Research chair in applied pathogen ecology at the School of Biological, Earth, and Environmental Sciences at University College Cork

This article was originally published on December 2, 2021.