Ireland is in a precarious position and our neighbours are not making it easy.
Vaccines are weakening the link between infection and hospitalisation, but only 40pc of the population is fully vaccinated and about 40pc of people (including children) are not vaccinated at all.
As a community we are still vulnerable to surges through the unvaccinated population, which could cause significant sickness and deaths in the vaccinated and unvaccinated.
The UK government is embarking on a radical and reckless accelerated reopening of society, even though only half of its population is fully vaccinated. More than two million British cases are anticipated in the coming months, and many will spill over into Ireland – partly as result of our decreasing travel restrictions for Britain.
Boris Johnson has openly admitted this policy will result in increased deaths, hospitalisations, and interference with non-Covid healthcare.
Our Government has never promoted such maniacal policies. We tend to opt for vague and indecisive “centre” positions, executed with a special kind of ineptness that relegates us to grey and miserable outcomes.
As a result, Ireland is an outlier in Europe. We have among the highest Covid case numbers, surpassed only by Spain, Portugal, and the UK. We are experiencing exponential growth, and the highly transmissible Delta variant is about to become dominant.
We’re an outlier, but we’re not the right kind of outlier. Norway (population 5.3 million) has suffered only 796 Covid deaths in the entire pandemic. Finland (population 5.5 million) had 976 deaths, while Denmark (population 5.8 million) lost 2,537 people. Last week Ireland (population 4.9 million) reached 5,000 deaths in the pandemic. Based on recently modelled scenarios, we risk 250 to 1,200 further deaths or worse in the coming months. Is this the best we can do?
Instead of learning from the best-performing countries, in Ireland we tend to compare ourselves to the worst. Johnson has presided over 128,037 deaths, a higher Covid death rate than the US and nearly twice that of Ireland. The UK’s omnipresence in our public life distracts us from more optimistic comparisons.
Why don’t we learn from our better performing European neighbours? Finland and Norway made sensible decisions regarding international travel. They established effective track and trace systems and made decisions swiftly. Their governments communicated clearly to the public and, perhaps more importantly, the public trusted their leaders. They did everything to achieve the best outcome for both health and the economy – keeping cases low.
It’s never perfect, but every effort and every brave decision makes a difference. We don’t need to be New Zealand to be relatively successful, we just need to decide to be successful.
Crucially, we need to move from “Vaccines only” to “Vaccines Plus”. Covid is not just about sickness, it’s about surges. The vaccines are weakening the link between infections and hospitalisations and deaths, but, while many are now more protected, the population remains vulnerable.
Sickness is what can happen to infected individuals. Surges are what can happen to the population when base numbers rise. Unlike the flu or most endemic diseases, Covid can spread like wildfire in the population if left unchecked.
What can protect the population from surges? Low case numbers and “herd immunity” through vaccination. For herd immunity, we would need 80pc to 90pc of the total population (including children) vaccinated. This has yet to be achieved in any country, but Ireland is in a strong position to come close as we have the highest vaccine uptake in Europe.
On the other hand, suppressing cases to avoid surges has been most successfully demonstrated without vaccines in countries like South Korea. Starting from here, an Israel-inspired hybrid strategy may be most beneficial to us, where we use vaccines as a tool not just to protect individuals from sickness, but to protect the population from surges by enabling the vaccines to reduce transmission, and keep cases low.
Children are susceptible to Covid and contribute to its spread. We cannot abide a scenario where children are forced to develop immunity through infection by allowing Delta to flood our schools in September. We do not know enough about the natural history of this virus, and Long Covid is still a science of unknowns.
What we do know is that 10pc to 20pc of young people with Covid experience Long Covid, lasting many months. The UK’s Office for National Statistics reported that at least 13,000 children aged two to 11 and 20,000 aged 12 to 16 have suffered Long Covid. Planning to vaccinate young people in order to approach widespread population immunity will be necessary before full reopening.
We can do better than Nphet’s “optimistic” scenarios, and things can get worse than their “pessimistic” scenarios, but we can’t continue to tread water for a middle-ground outcome.
One thing we have learned about pandemic management is that the centre will not hold. We can swim toward a better outcome like Finland or Israel, or allow the current to drag us to the UK’s nihilistic scenario. It’s not about the next two or three weeks, it’s about the next six to nine months.
Tomás Ryan is associate professor in the School of Biochemistry and Immunology and Trinity College Institute of Neuroscience at Trinity College Dublin and a member of the Independent Scientific Advocacy Group