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Why is Ireland choosing a 'seesaw' approach to tackling Covid-19?

The Taoiseach said certain approaches, such as ‘Zero Covid’ or herd immunity, are not realistic for Ireland.

Taoiseach Micheál Martin at Government Buildings in Dublin where he addressed the nation on Monday night.
Taoiseach Micheál Martin at Government Buildings in Dublin where he addressed the nation on Monday night.
Image: Julian Behal Photography via RollingNews.ie

TAOISEACH MICHEÁL MARTIN on Monday night confirmed the entire country will move to Level 5 of Covid-19 restrictions for six weeks from Thursday onwards in a bid to tackle a spike in cases.

Martin said it is “the core responsibility” of the government “to protect lives and to protect public health, while also protecting livelihoods and supporting the wider economy and society”.

He then stated that Ireland strategy’s will involve working to “suppress the virus when it is growing” and reopening “as much of our society and economy as possible when it is safe to do so”.

“Until we have a safe vaccine, we must continue in that pattern. This is the reality in the rest of the world and it is unfortunately the reality here,” Martin said.

Although not named as such by government, some people have been critical of this so-called ‘seesaw’ approach that has been signposted as Ireland’s path through the pandemic.

Speaking about coming out of lockdowns back in May, the World Health Organization (WHO) said easing restrictions and reopening an economy too quickly could lead to a “vicious cycle” of economic and health disasters.

Dr Mike Ryan, Executive Director of the WHO’s emergencies programme, said countries that reopen their economies and societies need to have an adequate testing and tracing system in place first.

“If you reopen in the presence of a high degree of virus transmission, then that transmission may accelerate,” Ryan said in May.

He added that “the worst thing that could happen” to an economy is if a country reopens and then has to shut down again to respond to a resurgence of Covid-19.

The HSE has increased its weekly testing capacity from 100,000 to 120,000, the Department of Health said this week.

The WHO has consistently said that lockdowns may be needed – but not as the primary means of controlling Covid-19, and only when the spread of the disease is out of control.

Up until that point other methods of controlling the disease – such as hygiene and social distancing – are more effective and beneficial from both an epidemiological and economic standpoint.

‘This won’t end in 2021′

Dr Kim Roberts, a virologist in Trinity College Dublin, said Ireland needs to “make the most of this lockdown”.

She has called on the government to carry out a feasibility study into what is needed so Ireland can develop an evidence-based, sustainable plan for the next 12 to 18 months.

Roberts said we “can’t wait blindly for a vaccine”, adding that while the first licensed vaccines may arrive by the end of the year, global distribution will likely be “problematic”.

Speaking to TheJournal.ie, Roberts said the pandemic “is not going to end at Christmas, it’s not going to end in the next six weeks, it’s not going to end when the vaccine is licensed, because it’s going to take such a long time for a vaccine to be distributed”.

“Who’s going to get the vaccine first and how many doses are going to be distributed to different countries? Is it going to be the richest countries that get the vaccine first or is it going to be evenly distributed around the world?,” she asked.

“What more can we do [in Ireland]? What work can we put in over the next few months so that we can keep community transmission levels as low as possible for as long as possible?”

Roberts said we can learn from our own experience, and that of other countries, over the last seven months, but that a feasibility study would highlight “certain pieces of the puzzle that we’re not putting in place”.

Unless we can see the data, unless somebody critically analyses the situation, we’re kind of just bumbling around blind.

Some of these “missing pieces”, she added, could involve giving public health doctors consultant status rather than specialist status as this would give “the people who can keep track of where the virus is, where transmission is, up to date with what the risks are” a “louder voice at the table” when decisions are being made.

She said the introduction of mandatory quarantining for people who arrive in Ireland, similar to the measures implemented in Australia and New Zealand, should also be considered.

“We can’t just keep ticking along week by week hoping that it’s going to go away, and waiting for 2020 to end. When 2020 ends, 2021 is going to start and it’s just going to be as bad.”

Roberts said she does not want to be overly pessimistic but people must be realistic about how long Covid-19 will affect the world. 

She added that she’s “not convinced cycles of lockdown are sustainable”, but also hasn’t read “a solid Zero Covid strategy”. She said if Ireland was to consider this type of approach, an all-island strategy would be needed.

‘Zero Covid’

At the start of his address to the nation, the Taoiseach said he wanted “to be straight with people, lay out all the facts as I have them, and explain the rationale for the decisions that your government is making”.

Martin discussed the country’s strategy and why he believed certain approaches would, or wouldn’t, work for Ireland.

He told the public: “You will have heard many potential approaches mentioned and it’s important to be clear on what is, and what is not possible.

“There are some who argue that the country should be taking a ‘Zero Covid’ approach.

“That we should lock down the country and seal the borders until the virus has been eliminated and then maintain the infection rate at zero.

“The people who take this position are well motivated and serious people.

“However, given our geographic location and proximity to Britain and mainland Europe, and with two jurisdictions on our island, the advice of NPHET is, and our view as a Government is that this is simply not a realistic option.”

A Zero Covid approach – where a country aims to eliminate domestic transmission of the virus – has perhaps most famously been adopted by New Zealand.

The notion that the model was unrealistic was repeated by Chief Medical Officer Tony Holohan last night. A government source yesterday was also impatient with talk of the southern hemisphere country. They said the New Zealand approach needs to be “knocked on the head once and for all”.

They said that the Taoiseach made it clear that the zero Covid approach will not be pursued here, and neither will herd immunity. They said the continuous discussion about such strategies by some experts serves no one, as due to the border issue, it was never going to be runner.

Although they admit Zero-Covid is almost impossible to achieve, experts believe it still should be the goal for many countries.

An international report, published in The Lancet journal in September, analysed the strategies for easing Covid-19 restrictions that were implemented in nine high-income countries after the first wave of infections, including New Zealand.

The report’s authors state there is “a strong argument for adopting a so-called zero-Covid strategy, like in New Zealand, which aims to eliminate domestic transmission, particularly considering emerging evidence on the effects of long Covid (which occurs in people who have survived Covid-19 but continue to have symptoms for longer than expected)”.

Co-author Martin McKee, professor of European public health at the London School of Hygiene and Tropical Medicine, said governments should be ambitious and consider adopting a Zero Covid strategy, in the knowledge that this likely cannot be achieved.

In an interview with TheJournal.ie last month, McKee said: “You have to recognise that with the best will in the world, you’ll never eliminate it completely, but [New Zealand has] done incredibly well, they’ve had very few deaths, they were able to open up most of the economy.”

McKee noted that while there had since been been another lockdown in and around Auckland, the numbers are “nothing like what you’re seeing in other parts of the world”.

He said governments should “not be judged for failing to get to zero Covid”, but should still make that their aim.

McKee said countries need to get the number of cases as low as possible before they start opening up their economies.

“You need to get it down, and then you need to ease the restrictions with great care, with really good data, really good surveyance, really good testing and tracing.”

In New Zealand there is a four-level alert system; a so-called ‘social bubble’ approach allows a gradual expansion of small social groups; testing and tracing capacity has been increased; efforts were made to increase number of ICU beds; the border is closed to most visitors, and all arrivals are tested and quarantined for 14 days.

People are advised to maintain a physical distance of two metres in public spaces and one metre is recommended in schools and workplaces at high alert levels, but there are no distancing requirements at alert level one.

A government source told us the New Zealand approach needs to be “knocked on the head once and for all”.

They said the continuous discussion about strategies such as the New Zealand approach by some experts serves no one as, due to the border issue, it was never going to be runner here.

Herd immunity

The Taoiseach also discussed the herd immunity approach in his speech on Monday night.

Martin noted some people have suggested the government “should let the virus run its course and that the economy is too important for any more restrictions”.

“This implies that we should accept higher levels of illness and death, and it ignores the deadly long term effects of the virus on many people. The government will not be taking this approach,” he stated.

US President Donald Trump is among those to call for a herd immunity approach. However experts are pushing back on this, saying this strategy is not supported by scientific evidence.

Eighty doctors and public health experts called the herd immunity approach a “dangerous fallacy unsupported by scientific evidence” in a letter published in The Lancet last week.

Since the letter was published last Wednesday, more than 2,000 others have signed.

The letter states: “In the initial phase of the pandemic, many countries instituted lockdowns (general population restrictions, including orders to stay at home and work from home) to slow the rapid spread of the virus. This was essential to reduce mortality, prevent health-care services from being overwhelmed, and buy time to set up pandemic response systems to suppress transmission following lockdown.”

The letter notes that although lockdowns have been disruptive, substantially affecting mental and physical health, and harming the economy, “these effects have often been worse in countries that were not able to use the time during and after lockdown to establish effective pandemic control systems”.

“In the absence of adequate provisions to manage the pandemic and its societal impacts, these countries have faced continuing restrictions.”

The letter states that this fact has “understandably led to widespread demoralisation and diminishing trust”.

It adds that the arrival of a second wave and “the realisation of the challenges ahead has led to renewed interest in a so-called herd immunity approach, which suggests allowing a large uncontrolled outbreak in the low-risk population while protecting the vulnerable”.

“Proponents suggest this would lead to the development of infection-acquired population immunity in the low-risk population, which will eventually protect the vulnerable

This is a dangerous fallacy unsupported by scientific evidence.

“Any pandemic management strategy relying upon immunity from natural infections for COVID-19 is flawed. Uncontrolled transmission in younger people risks significant morbidity and mortality across the whole population.

“In addition to the human cost, this would impact the workforce as a whole and overwhelm the ability of health-care systems to provide acute and routine care.

“Furthermore, there is no evidence for lasting protective immunity to SARS-CoV-2 [Covid-19] following natural infection, and the endemic transmission that would be the consequence of waning immunity would present a risk to vulnerable populations for the indefinite future.

“Such a strategy would not end the COVID-19 pandemic but result in recurrent epidemics, as was the case with numerous infectious diseases before the advent of vaccination.”

‘Why are we having this debate?’

Announcing the move to Level 5 on Monday night, the Taoiseach said, in the effort to suppress the virus, Ireland has “already introduced what is probably Europe’s strictest regime”.

“As a result of this, we can see some evidence that these restrictions have been effective in slowing the growth and spread of the virus.

“However, as the daily figures show, these restrictions, on their own, have not been enough to significantly reduce the levels of infection.

“So, while we have slowed the spread of the virus, this has not been enough and further action is now required. NPHET has been clear on what it believes is needed.”

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A ‘seesaw approach’ of lockdowns is not something the government wanted to do, Finance Minister Paschal Donohoe told TheJournal.ie yesterday.

“We’re trying to get the R number below a certain level so that it stabilises at a far lower level,” he said. 

“This isn’t something that we want to. This is something that we have to do in order to have a better chance of beating this disease in the next number of weeks. The objective of the government is to try to get the so-called R number, the transmission of this disease below a certain level, so that it stabilises at a far lower level.

“And we are only embracing this approach – which we know is having such an effect in our economy – because in the absence of doing something like this, it is our fear that the impact that this disease will have on the lives of our citizens will even be greater, and even more tragic, and none of us want that to happen, which is why we’re taking these measures,” Donohoe said.

While the minister acknowledged the impact of the seesaw approach on society and the economy, the Taoiseach said he was “being candid” about the situation.

There will be “periods of higher level restrictions, followed by lower level restrictions and, if necessary, followed by higher level restrictions again”.

When asked about possible further lockdowns in 2021, Public Expenditure Minister Michael McGrath said the assumption for next year is “we will have to live with Covid-19 through next year, but it is not based on the worst case scenario of a severe lockdown right through the year”.

“That’s not the baseline assumption, the baseline assumption is that the virus will be there, that there will be some restrictions, that it is about containment, and it is about living with this in the best way that we can throughout the next year. That’s the underlying assumption within the Budget,” he said.

A sensitivity analysis in the Budget day documents does look at the scenario of a severe lockdown situation, and its implications, McGrath said.

“We’re very conscious of what the impact of that would be. We can see it here over a six-week period. So the numbers are there for all to see as to what the impact is over a short period, and clearly we are not countenancing a situation where that level of deep restriction, and the associated economic impact, has to be carried right from next year. That’s not the baseline assumption.”

What happens if Level 5 does not have the desired effect on the numbers? Donohoe would not entertain questions from TheJournal.ie about a Plan B. Neither would Chief Medical Officer Tony Holohan at last night’s Department of Health briefing. 

“All of our focus is on making this work,” Donohoe said.

“We’re already seeing what is the effect of Level 5 on the social and economic fabric of our country. It is so great. All of our focus is going to be on making this work. And I’m confident that with the cooperation of the Irish people and the different measures that we’re putting in place that all that can be done can be done to make it work will be done.”

However, government sources have stated that if the seesaw effect of this lockdown does not work to get the numbers down by Christmas, a mitigation strategy would have to be pursued, with a focus on protecting the most vulnerable and treating the sick.

A further 1,031 cases of Covid-19 were confirmed in Ireland by the Department of Health yesterday evening.

A total of 50,993 cases of the virus have been confirmed here since the first case at the end of February. The death toll from Covid-19 in Ireland is 1,852.

The 14-day incidence rate in Ireland has risen to 261.7 per 100,000 people, with the highest incidence rate in Cavan – 824.4 per 100,000 people.

Roberts said one of the “frustrating things” about Martin’s speech on Monday night is that there “seems to be a disconnect between what the government is planning on what people want”.

“So there’s a lot of anger about the idea that we’re going into a lockdown, but that is what the Living with Covid Strategy is.

“The government were reluctant for us to go to ‘Level 5 minus’ or whatever it is. But that’s the strategy and if that’s the strategy then why are we having this debate?

“And if we need to have this debate because it’s going to be so economically disruptive, then it’s not a good strategy, and we need to look for other options instead,” Roberts told us.

With reporting by Christina Finn

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