Dr Domhnall Heron
Ten months into this coronavirus pandemic Ireland is in its third wave. Though the finish line is in sight, how far into the future it is remains to be seen, asks Drumshanbo native, Dr Domhnall Heron.
Effective vaccines have ushered in the new year with a sense of valid optimism. Unprecedented collaboration, streamlined authorisation and pre-paid vaccine orders expedited their development.
The Pfizer BioNTech and Moderna vaccines are now being administered in Ireland. Very soon all healthcare workers and nursing home residents will have received their first dose.
The Oxford AstraZeneca vaccine may be accepted by the European Medicines Agency as soon as January 29th. This vaccine may be stored in a regular fridge making it suitable for distribution to and administration by all general practitioners and pharmacists. This will no doubt vastly speed up the process.
Indeed GPs and pharmacists could conceivably administer the entire population with one dose in less than a month. However, the issue is supply. Ireland may not receive enough vaccines to cover the entire population until late 2021.
The government’s strategy appears to be ‘delay and vaccinate’. There is no plan to eliminate the virus but rather enforce the minimum of restrictions to keep our hospitals and intensive care units being overrun. In practice, this could mean two more lockdowns or perhaps even one very long lockdown if the new strains transpire to be 50-70% more transmissible.
The UK B1117 variant is fast becoming the dominant strain in Ireland. It has been shown to be more transmissible though estimates of the increase vary from 50% to 70%.
A preprint study from researchers at Imperial College London found the B1117 variant increased the virus's reproduction or R number, the average number of people an infected person infects, by between 0.4 and 0.7.
In other words, say the old variant was spreading at an R of 1.5, meaning 10 Covid-positive people transmitted infection to 15 new people, the new variant would have a R of 1.9 to 2.3, so 10 people with Covid-19 would transmit infection to 19 to 23 new people.
Two newer variants have been named the South African and Brazilian variants. Both are more transmissible than the original but also may even be less susceptible to the body’s neutralising antibodies.
The South African variant has been detected in Ireland. We don’t know if the Brazilian variant is here yet.
Last week Belgium closed its borders to all non-essential travel. Several recent online surveys suggest that 90% of Irish people now support mandatory two week hotel quarantine (MHQ) at airports and ports.
Support is growing among the opposition parties too with Social Democrats, Labour and People Before Profit all calling for its introduction. MHQ is an essential component of all successful strategies against Covid-19. No country has successfully controlled the virus without it. Afterall, we cannot weed a garden if someone continues to plant weeds behind our back.
In January 2020 there were probably no cases of Covid-19 in Ireland. From February imported cases seeded from countries like Italy. In October 60% of cases in Ireland were a Spanish variant. Today 60% or more of cases are the UK B1117 variant. If contact tracing were to go back far enough, every single case would be found to be related to an imported case.
Many have cited the border with Northern Ireland and the perceived intransigence of the DUP an obstacle. Certainly a joint strategy with Northern Ireland is desirable and the government could highlight its engagements with the North and barriers to date. In its absence, border policing is not unprecedented as happened during the foot-and-mouth crisis in 2001.
Some countries value their public health experts: doctors, nurses and scientists whose specialty is in outbreak management. Beyond the more simple contact tracing, public health professionals are experienced and skilled in managing the complex outbreaks.
In March 2020, Australian public health experts recommended that their country restrict travel at its borders and introduce mandatory hotel quarantine. This contradicted World Health Organisation advice at the time that border control was unnecessary.
Such was the respect for their expertise that the Australian government acted on the advice of their public health experts and closed its borders. The Australian people now live a normal life apart from foreign travel.
In Ireland, unfortunately, our public health experts are not bestowed the same gravitas. Public health is chronically underfunded with small teams and poor IT infrastructure. Public health doctors are denied consultant status and the associated decision-making authority. There is no public health representative on NPHET.
Countries that have successfully eliminated mystery or community cases of coronavirus now provide a normal life for their residents. All have three similarities: mandatory border quarantine, strict lockdown to get mystery cases to zero and an enabled public health specialty to keep it there.
If we rely on vaccination alone, the end of this pandemic may not be until the end of this year. It is not too late to learn from countries who now lead a normal life.