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Here's why NPHET believes Zero Covid wouldn't work in Ireland

Health officials have said there are many similarities between their approach and the proposed strategy, but the differences are important.

Image: Sasko Lazarov

A GROUP OF scientists and academics yesterday launched a campaign calling on the government to adopt a Zero Covid plan.

We Can Be Zero has said a change in strategy is required if Ireland is to avoid a fourth lockdown.

The Zero Covid plan would mean having “zero mystery cases”, the group has said, with strong control measures to prevent new cases coming into the country and a robust system to track any cases identified.

We Can Be Zero says this should be implemented using ‘The 3 Cs’; crush, control, chase.

Crush means aiming to suppress Covid infections during the current lockdown to fewer than 10 cases per day, ideally to single digits or lower.

“The government also doing its part with support and logistics and knowledge sharing,” the group said.

“Why this number of – fewer than 10 cases per day? This low number of cases means that the contact tracing system can function; it can hunt those few cases down and contain them, aiming to eliminate them as well.”

Control means preventing new cases coming into the Irish community with mandatory 14-day quarantine for international travellers.

Chase means a variety of actions required of citizens and of the government and health service:

  • Reduce the spread by wearing masks at all times when outside of bubbles, wash hands and ensure good ventilation indoors;
  • Track and trace all cases aggressively – a measure contingent on keeping daily case numbers below 10;
  • Better resource public health physicians and enhance coordination of the test and trace infrastructures;
  • Introduce regional ‘green zones’ to protect Zero Covid areas;
  • Financially and socially support people affected by self-isolation and businesses interrupted by restrictions put in place to manage clusters of infection;
  • Continue the vaccine roll-out.

At yesterday’s briefing by the National Public Health Emergency Team (NPHET), Chief Medical Officer Dr Tony Holohan said there are many “eminent colleagues” who are advocating this policy and officials have given consideration to this approach.

“There is an awful lot more in common with what we do, but there are some important differences,” he said. “And I think we would highlight those difference rather than be dismissive”.

The first issue with implementing this strategy, he said, is that Ireland is part of the European Union, “economically, socially, legally, culturally”, and this union is designed to provide for the free and easy movement of people, goods and services.

“It is very different to the kind of experience in the countries that are at a distance from other parts of the world, and have been able to achieve [this], countries like New Zealand and Australia and there are plenty of other examples too,” he said.

“The epicentre of this infection has been in the northern hemisphere in Europe and in North America and we’ve had a very significant challenge right across Europe since the very beginning of this pandemic wit very large levels of infection.

Dr Holohan said it is “just not realistic” to expect that Ireland could have a “completely sealed border” not least because of the movement of people to and from Northern Ireland for work. 

He said he recognised that the Zero Covid approach does not presume that there would be no importation of disease, but it does require a more robust public health system than Ireland currently has.

“There is a presumption that we have a public health system that is lightening quick in terms of its ability to really pick up, at a local level, those importations when they occur, stop them becoming established as localised transmission and the progressing on,” he said.

“We don’t have features in our public health system that are sufficiently robust enough to enable us to have that level of confidence, such that we could say to the population honestly ‘you can go back to your normal activities’.”

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Professor Philip Nolan, chair of the epidemiological modelling advisory group, and Deputy Chief Medical Officer Dr Ronan Glynn also pointed out some similarities between NPHET’s approach and the Zero Covid strategy.

Nolan said there is a “common objective” to bring case numbers to a very low levels, to minimise the risk of importation of new cases or new variants, to empower and resource local and regional public health departments, alongside an “impressive central contact management system” and to roll out a vaccination programme.

However he said given that we cannot reduce the risk of importation to zero, “we individually are always going to be the first line of defence for this and until such time as we have appropriate levels of immunity in the population we will be required to make sacrifices”.

Dr Glynn said there is a need, for the current strategy to work, for “a strong, intelligence-led public health response”, integrating various data points with more minute detail on transmission and outbreak settings at a local level.

One of the main aims of NPHET’s approach, he said, is protecting the most vulnerable and “ensuring that we level up and give additional resources” so that they are shielded from Covid-19.

“A key part of that over the coming months as we roll out the Covid vaccines will be to ensure that that vaccine is provided to those who are most vulnerable across society and that they have access to it and access to the necessary information to make informed decisions about receiving that vaccine when it’s offered,” he said.

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