‘Living with Covid’ is an empty slogan that needs a plan

People in wealthy countries like Ireland have little experience of the long-term reality of serious infectious disease. Covid-19 has changed that for the foreseeable future. We have been in a new phase for a few months now, where protective measures against Covid-19 are largely removed but Covid-19 continues to circulate. We can do better in Ireland. What should we strive for?

The first thing to do is to establish what “living with the virus” really means.

Many people have died and we have reached the grim figure of 7,000 dead. Many families go through infections in tandem – one half of the house gets Covid-19 and some time later the other half follows. This significantly disrupts daily life. Many people are re-infected and long-term immunity is limited. This appears to be an unfortunate feature of the biology of Covid-19. Although vaccination significantly reduces the worst outcomes of this disease, neither vaccination nor previous infection, or both confer complete immunity to reinfection.

Uncertainty is inevitable. What we can say with confidence is that the Irish State’s protection against Covid-19 is very limited.

As a result, we may continue to have large numbers of people out of work at the same time, and then face post-Covid-19 fatigue that disrupts the economy and life in general. We do not yet know the full impact on people, or populations, of reinfection with Covid-19. However, the long Covid, which affects around 125,000 people here (an estimate based, to the shame of our health authorities, on UK figures), may lead to further substantial economic losses, as some people are forced to change job or leave the entire workforce.

Uncertainty is inevitable. What we can say with confidence is that the Irish State’s protection against Covid-19 is very limited. Monitoring the intensity of government measures at the University of Oxford places Ireland above Mongolia (last out of 185 countries) in terms of the intensity of protective measures put in place to prevent the spread of Covid -19 here.

WHO’s Dr David Nabarro called the Irish government’s removal of measures to protect its citizens against Covid-19 “brutal”. We know that Covid-19 singles out the poor, the elderly, and those with existing disease for the worst outcomes. We have no plans for these people as we are “living with Covid”. Antiviral drugs may be helpful, but their overall effect remains unclear.

Inevitable litigation

It is very clear that transmission cannot be stemmed by appeals to individual responsibility. The government’s strategy to remove all protective measures against Covid-19 at once (except for vaccines already administered) assured this. Litigation is the inevitable response to the failures of this policy approach. A meat factory worker is suing over injury sustained from Covid-19 infection on the job, and litigation over hopelessly lonely deaths in nursing homes is expected.

The WHO is rightly concerned about the risk of a new wave, possibly coming from the new variants of the Omicron group

Some of the consequences will fall on the government, others will affect small and large commercial enterprises. It is doubtful to what extent this spending will benefit the health of the Irish population.

We don’t know what will happen with Covid-19 next. The WHO is rightly concerned about the risk of a new wave, possibly from the new variants of the Omicron group (BA.4, BA.5), or perhaps from a new variant of the virus original (BA.2.12.1), which are now rapidly spreading to different parts of the world.

Very recent work suggests that all of these are quite resistant to current vaccines and that even recent infection with BA.1 or BA.2 (the “original” Omicron) offers little protection. Better vaccines may help in time, but they may not be possible. Given the uncertain risks of new strains, long Covid and repeat infections, our current approach offers limited protection, whether for people, jobs or the economy as a whole.

We need further investment in Ireland’s public health infrastructure – in the people, systems and research capacity needed to ensure we detect and can respond quickly and appropriately to new variants of Sars – CoV-2 and other pathogens, but we also need to act.

Proven measures

There is an alternative, which costs very little – certainly much less than what we paid each month during the lockdown, and surely less than the personal and economic costs described above. The alternative is simple and achievable: keep the proven protective measures that have served us very well – vaccines and masks – and invest the modest amount needed to maintain excellent air quality in indoor environments.

Mask use has fallen below where it should be, but masks are cheap and surprisingly effective

Covid-19 is an airborne virus and good air hygiene is a crucial tool to manage its transmission. Specifically, this means pushing the vaccination rate as high as possible; wearing FFP2/N95 masks in crowded indoor environments – retail, schools, workplaces, public transport; and ensure good ventilation where possible, including air filtration in schools, pubs, theatres, nightclubs and other indoor places where large numbers of people gather, as is currently the politics in Belgium. Mask use has fallen below where it should be, but masks are cheap and surprisingly effective, with recent Irish data suggesting they can reduce transmission by more than 40%.

This approach is compatible with a more or less normal life with minimal disruption, and an active economy – living best with Covid.

Anthony Staines is Professor of Health Systems at DCU and Daniel Carey is Director of the Moore Institute, NUI Galway

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