Experts fear festive season will spark return to pre-coronavirus habits, writes Catherine Fegan
‘Picture the scene,” says Dr Douglas Hamilton, a public health specialist based in the midlands.
“It’s Christmas and you are in a really good pub that you go to every year with your family.
"There is music, there is singing, there are pints being moved from hand to hand, people are sitting close together, shouting and laughing.”
In conjuring up memories of Christmas past, Dr Hamilton, part of Midlands Public Health team who have been investigating cases of Covid-19 since March, has a blunt message to deliver.
The nostalgic pub scene just depicted, he says, is a classic “super-spreader event”.
“It’s the type of event that caused the second wave,” he adds.
“It’s what we have been cleaning up to a certain extent and now that things are plateauing, we can’t run the risk of people gathering in those types of settings.
“My personal view is that pubs, particularly wet pubs, should not open for Christmas and that would be the view of the department. We are nervous about what might happen in January.”
For the team in the midlands, and indeed, public health departments across the country, the fallout from the last surge in case numbers, when staff were working around the clock, with limited resources, desperately trying to investigate outbreaks, pushed them to their limits.
“Things were very intense,” says Dr Gerard Meagher, a public health doctor who works with the midlands team.
“We aren’t even sure if we are out the far end of it.”
Towards the end of the summer, explains Dr Hamilton, there was “a lot of virus transmission” among communities.
“We were overwhelmed essentially,” he says.
“It occurred in a multitude of settings and across society. That has now been confined a lot but that doesn’t mean it stops.”
Several weeks into Level 5 lockdown, with people confined to home, households have become the new hotbeds for transmission.
“There isn’t that much transmission from household to household because of the lockdown,” says Dr Hamilton.
“Instead, transmission is within the household. From there it is going into different workplaces.
“Household members are working in nursing homes, essential services, meat factories, food plants, schools and hospitals. That’s how it is getting into those.”
During the first wave, the midlands team dealt mainly with complex outbreaks in nursing homes, meat plants and hospital settings. This time, the clusters are again in nursing homes, a setting that bore the brunt of mortality during the first wave.
“They are all nursing homes that were lucky enough not to have been affected during the first wave,” says Dr Hamilton.
“We would have up to 40 residents and staff affected in some of them and its hard work handling it.
“The mortality this time is slightly lower than the first wave, but there are deaths and it’s not to be ignored. These people are very vulnerable.”
While household transmission is the main source of spread for the team in the midwest, in Donegal, where case numbers have been high for a number of months, public health teams are dealing with outbreaks connected to funerals and wakes.
Dr Aidan Ryan, specialist in Public Health Medicine, HSE North West, says the entire county is still struggling to suppress the virus, which is still circulating at worrying levels.
“The numbers have been high in Donegal for quite a while,” he says.
“There is a lot of virus in the community. People are visiting each other in their homes, and we have had large gatherings at funerals and at some wakes and that shouldn’t have happened.
“That is a problem. It’s a difficult time when there is a bereavement.
“People can revert to pre-Covid behaviour and the importance of showing respect, especially in local areas, can influence their behaviour.”
It’s not just the large numbers attending wakes, says Ryan, it’s their behaviour, offering comfort by embracing and shaking hands, that has also been cited as a problem.
“First of all, these shouldn’t happen (gatherings at wakes),” says Ryan.
“I think people are letting their guard down, especially with people that they know. If people do insist on doing it, they shouldn’t, but if they do, the basic principles, wearing masks, physical distancing and handwashing, need to be followed.”
Proximity to the border and trips back and forth either for work, or more recently to avail of the retail shops that are still open in the North, is also hampering efforts to stem the spread. “There is the draw that retail in the North is still open,” says Ryan.
“Having said that, they don’t seem to be having the same problems with case numbers in other border counties, like Cavan, Monaghan and Louth. They seem to be suppressing the virus.”
He hints that once the current Level 5 lockdown restrictions end on December 1, a more local level approach to what is happening in Donegal might need to be applied.
“Look, it’s up to government to decide,” he says.
“But he national framework for loving with Covid was conceived at the start as something that can be applied at county by county level.”
In the midlands, Dr Hamilton is confident the team there are on course to drive the virus down further.
“I think we can get to where we need to be by December 1,” he says.
“You would have had two to three times the level of transition in the community about two weeks ago and that has gone down to a plateau level.”
While stressing the public health advice about gatherings, Dr Hamilton is pragmatic about what will happen at Christmas. Families will come together, he acknowledges, but if they do, tight controls need to be placed on the setting they are in.
“Look there are things you can do to reduce the risk of transmission,” he says.
“If you are having people over for Christmas dinner, especially elderly relatives, ventilate the room.
“Someone has to be the old-fashioned servant, no passing the gravy boat around. Where possible, and obviously when not eating, wear masks.”
Meagher, his colleague, is equally conscious of public perceptions about what will be required in the coming weeks.
“Before this there was a Covid fatigue,” he says.
“With Christmas coming, people have been without contact for so long that there’s more desperation than fatigue setting in. It’s so completely against human nature to do what we are doing and human nature is fighting back to be in contact with one another.
“We have to keep that in mind to try and best to bring people along with us because we need their help.”