Cynics thought Covid would be “just like the flu” but were wrong. Yet can we turn this illness into a seasonal one?
A common narrative during spring and summer of last year, with European governments struggling to respond to the new epidemic, was the downplaying of Covid as “just like the flu”, a seasonal nuisance long familiar in the northern hemisphere.
Initially deployed as justification for resistance to public health measures, the narrative re-emerged among the vaccine-hesitant earlier this year as governments mobilised their programmes to inoculate the population.
The vaccine-hesitant contended that the risk from vaccination exceeds the risk of catching the disease, a proposition for which no evidence has been found after billions of people have been vaccinated around the world. The only exception appears to be those with specific medical conditions, and their GPs will advise accordingly.
Governments have prioritised vaccination, including booster jabs to counter declines in immunity, and vaccination coverage in most European countries has now reached levels initially seen as adequate to stem the spread of infection.
Epidemiologists had been hoping that coverage at 75pc or 80pc would bring suppression of the disease into view through diminishing sufficiently the risk to our vulnerable population.
Those hopes have been frustrated by the emergence of variants with higher transmission and the recent surges in Europe partly reflect the mutation pattern of the virus.
There are reasons to believe in a pure seasonal element, too, with a consensus among virologists that the disease is mainly airborne, more likely to transmit in confined indoor spaces to which the public will resort in winter.
Protestations that these indoor venues are safe have come from those most affected by public health restrictions, including bar owners and parents anxious to keep the schools open. The protestations are dismissed by many experts as unsupported by available evidence.
Without a reliable method of tracing the venue of transmission for each chain of infection, most cases must be ascribed to ‘community transmission’. Only when case numbers are very low has it been possible to avoid this agnostic designation.
The virologists are unable, for now, to offer assurances that vaccination will be sufficient and have been urging the re-adoption of restrictive measures, including partial lockdowns.
If newer virus strains are less lethal while more transmissible, next year will not see the back of Covid and it becomes an ongoing, if less daunting, concern to public health. ‘Just like the flu’ in this scenario, with a continued reliance on booster vaccinations.
But many experts are arguing that measures should also be taken to improve permanently the standards of ventilation of indoor venues and that mask-wearing is here to stay. An ancillary benefit is other winter ailments would also be mitigated.
The pre-Christmas relaxations of public health measures in many European countries, in 2020 and 2021, were a gamble in this view, since the rate of new infection was already high.
Starting with a high incidence of new cases, any relaxation of measures risks a surge of infection which could overload health service capacity. Even if the Omicron variant makes people less ill, the sharp increase in transmission offsets the benefit according to researchers at Imperial College in London.
The team reported Omicron cases were around 40pc less likely to need a hospital stay of one night or more but warned the stress on hospital capacity was likely to grow regardless.
“Given the high transmission of the Omicron virus, there remains the potential for health services to face increasing demand if Omicron cases continue to grow at the rate that has been seen in recent weeks,” Professor Neil Ferguson concluded.
It is noticeable how the re-imposition of restrictions has been more severe in some continental countries where recent case incidence has been lower than in Ireland or the UK. Bars have been closed altogether and attendances banned at big outdoor events.
At recent rates of infection, possibly under-measured because of limits to testing capacity, the unvaccinated will acquire immunity the hard way and the administration of boosters to the vaccinated will take many weeks while Omicron spreads.
Christina Pagel, a modeller at University College London, complains of “the massive gamble we’re taking as a country with Christmas”. Last Thursday Paul Reid, chief executive of the HSE, warned that daily cases in Ireland could reach 20,000, about four times the recent level, as Omicron becomes dominant.
The Government has set its course for the short term, hoping the more pessimistic projections do not materialise and will tighten policy for the new year only if hospitalisations increase substantially.
But suppose that vaccination, with boosters, eventually gets ahead of the virus and future mutations are relatively benign.
Covid really would become ‘just like the flu’, a transmissible disease capable of further spread but with widespread immunity through prior infection as well as effective vaccines and improved antiviral treatments for those infected.
The containment policy would then need a longer-term component to accompany vaccination, including mask-wearing and upgrading of indoor ventilation. If a policy for winter 2022 is to be put in place, what might it look like?
According to an expert group chaired by Professor John Wenger of University College Cork, which reported to Nphet nine months ago, there should be a focus on improved ventilation in buildings, a view which Nphet appears finally to have endorsed.
It is fair to ask why the advice from the Wenger group was not implemented last summer. Public discussion of the issue has focused mainly on schools, but the report applies equally to bars, restaurants, offices, other workplaces, and retail premises.
School principals have been scrambling to acquire air filtration equipment in time for the return of pupils two weeks hence but could have been spared the burden had the task been embraced earlier by the Department of Education.
Legislation about workplace air quality has also been progressing, at the initiative of Paul Murphy TD, and funds have finally been allocated for schools.
Some sectors adversely affected by the public health measures may need support for improvements to ventilation.
The amounts required should be compared to the €9bn already made available for the pandemic unemployment payment alone.