The Covid-19 era of perpetual uncertainty

At the time of writing, there is a lot of talk about the second Covid-19 wave. At the end of July, World Health Organisation (WHO) spokesperson Dr Margaret Harris dismissed this term. Rather, she said the pandemic was “one big wave”.

“The pandemic is a once-in-a-century health crisis, the effects of which will be felt for decades to come,” Dr Tedros Adhanom Ghebreyesus, WHO Director-General, told the Organisation’s emergency committee on 31 July.
“Many countries that believed they were past the worst are now grappling with new outbreaks. Some that were less affected in the earliest weeks are now seeing escalating numbers of cases and deaths. And some that had large outbreaks have brought them under control.”

Even New Zealand, which went over 100 days without community transmission of the disease, has had to implement restrictions following an outbreak in Auckland.

At home, worryingly, on 10 August, it was revealed that Covid-19 cases per 100,000 people over the previous 14 days was higher than in the UK, according to the European Centre for Disease Prevention and Control (ECDC). Ireland’s rate was 16.9 cases while the UK’s rate was 16.5. The rise in cases was largely in Kildare, Laois, and Offaly and resulted in restrictions in these counties.

The move generated understandable local anger given the spike was due to outbreaks in meat factories and direct provision centres. This was a reminder, if one was necessary, that the pandemic does not affect all of society equally. Those working or living in sub-standard conditions are particularly vulnerable. As many have said, Covid-19 is ruthlessly exposing the existing faults in our socioeconomic system.

So what now? In this issue of the Medical Independent, public health consultants Dr Niall Conroy and Dr Nick Eichler argue Ireland should follow the policy of Covid-19 elimination pursued in Australia and New Zealand. The article states that sustained elimination of community transmission of the virus is Ireland’s best chance at economic and societal recovery. To those that say this path would jeopardise the economy, the authors reply: “The biggest threat to the economy is likely to come from the unpredictability that comes with recurring outbreaks of Covid-19 and the inevitable oscillations of societal restrictions that they bring.”

Dr Conroy and Dr Eichler are positive about Ireland’s early response to the pandemic, but say more decisive action is now needed.

The recent developments in New Zealand show that elimination is not easy to achieve. Although there is no guarantee it will work, what is the alternative?

The ECDC recently recommended that Ireland, as well as a number of other countries experiencing the resurgence in Covid-19 cases, should consider reinstating restrictions to limit the spread of the virus.

The Government has already delayed moving to the next reopening stage and has now adopted a ‘colour-coded’ response instead of the phased approach. This new plan is designed to be more flexible than the phased reopening process in recognition that SARS-CoV-2 is indifferent to official timetables. It is also intended to offer a more localised and regional measure of how Covid-19 is spreading.

However, in the absence of a vaccine, the key to combatting the pandemic remains preventive action. Without a clear path in which the spread of the virus can be limited as much as possible, particularly heading into the winter period, we will continue to live in perpetual uncertainty.