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Professor Ruairí Brugha: We must engage all of society in the battle against Covid

The professor of Public Health and Epidemiology says the engagement of communities and families could be the key to getting a handle on Covid.

Ruairí Brugha

THERE WAS A simplicity in the light that shone at the end of the tunnel in mid-November. As Ireland emerged relatively unscathed from a fairly well-managed second wave, we learned of the successful outcomes of two vaccine trials.

Offered the choice of some controlled socialisation in restaurants and pubs, or some inter-family mixing over Christmas, too many chose both. For the majority, there has been frustration, resentment and weariness, seeing how such hard-won gains were so easily thrown away.

On foot of the all-too-slow control of the third wave, we now learn that the light from the new vaccines, which were to carry us out of the Covid-19 tunnel, is fading. The predictable and predicted ability of the virus to mutate has resulted not only in greater transmissibility. Reduced effectiveness of a vaccine against a new strain is always a concern, as witnessed recently with the South African variant.

Lessons to learn

But let’s step back and see the positives, even if the picture is more complex and messier than in November. New vaccine technologies have the capacity to keep pace with the virus, and new trials are testing the effectiveness of different combinations of vaccines.

The analogy is with the incremental advances achieved in the treatments of cancers – there was never going to be one ‘cure for cancer’. And, unlike the case of smallpox and possibly polio, humankind is unlikely to ever eliminate Covid-19.

But new vaccines and treatments can go a long way towards reducing the ability of this virus to cause long-term damage and death, by protecting the vulnerable.

However, until we have identified and rolled out the right combinations of vaccines, nationally and globally, we cannot let our guard down or dispense with the measures that continue to protect us. It is not a one-size-fits-all.

Each country has its vulnerabilities and strengths in the battle against this disease. In Ireland, that means, for example, not resuming our love affair with alcohol, taken to excess in close company with each other.

If some choose to do so or engage in other risky behaviours, leading to the deaths of older people and the vulnerable, then we as a society need to start taking responsibility for each other’s behaviour, and not sit back and leave it to the Government to importune and issue fines.

A clear approach

There is only ‘one show in town’ when it comes to Covid-19 control and that is to have an effective public health strategy, the individual components of which we all know. Public health means the public needs to be engaged in developing and implementing the strategy, which we will continue to need – hopefully with a lighter touch – once we have achieved sufficient vaccination coverage to protect vulnerable individuals.

We still don’t know if the vaccine part of the strategy will reduce virus transmission, or merely reduce the severity of the disease. It was looking like the latter, but recent evidence from Israel points towards reduced transmission and scientific understanding is evolving rapidly.

The problem, as others have pointed out, is that Ireland doesn’t have a Covid-19 public health strategy; or at least not one that can prevent and control large waves of infection, without causing severe social and economic harm.

There have been real positives along the way, notably the social solidarity that got us through the first and second waves. However, that has been dented and people have little or no patience for further missteps by the Government. Lesson-learning is useful, but only if we use it to chart the way ahead.

We can now surely all agree on the need to control this virus. We cannot co-exist with it. Either we keep our foot on the snake’s head, or it quickly winds itself around and squeezes the life out of us.

If we are to chart a feasible and effective public health strategy, let’s not argue about the meaning of ‘to the point of elimination’ – there will be trade-offs between the tightness and duration of control measures, their impacts and case numbers.

Acknowledging trade-offs means listening better to (and measuring and addressing) the impacts of restrictions on the mental health and social wellbeing of people, especially the young. It also means listening less to others such as business lobby groups, whose influence on the Government has been as harmful to the long-term interests of their own members, as it has been to the public’s health.

Community prevents spread

One year into the pandemic – naively predicted in December (by me) as half-way through – there has been no engagement of the Irish people in a discussion around a public health strategy for our island, beyond newspaper opinion pages, social media and talk-shows. And we have failed to build on some of the big positives of Irish society, such as the social cohesion – battered and bruised, but resilient – which continues to be reflected in Amárach surveys.

A top-down approach worked between March and June because we were dealing with two large semi-independent outbreaks – in residential care institutions and hospitals – in both cases with bridges into the community. Between June and September, when we had the spare testing and contact tracing capacity to track down, investigate and eliminate the relatively few outbreaks in the community, we threw away this opportunity.

Now, the virus is deeply embedded in Irish communities and households; and we need a community-supported, community-driven public health strategy. 

We can demand that the state adopts the draconian measures that are acceptable to people in Asian countries that have successfully controlled the virus. Or we can find a way to take responsibility, not only for our own but for our families, friends’ and neighbours’ behaviour. But that requires supporting them in dealing with the impacts of restrictions, particularly the poor and the young, whose lives are disproportionately affected by those measures.

Engaging the public, giving them (us) the responsibility for protecting the health of the population, as far as possible across the island of Ireland, may feel threatening to Government.

Solutions that emerge from such a process may infringe on civil liberties – be it around compulsory mask wearing, physical distancing, limitations on holidays abroad, enforced and monitored quarantines, and prioritising schools over restaurants. It also means shining a light into people’s homes.

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Neither the Government nor the Gardaí have or wish to have, the legitimacy to do this. Getting Covid-19 to the point of elimination will require actions within families and households.

It is time for the Government to institute a process – be it a virtual citizens’ assembly or some other form of dialogue involving non-government partners – that engages the commitment and mobilises the resources of Irish society; and creates a shared responsibility for determining, legitimising and implementing the necessary measures to get the country out of this tunnel.

Ruairí Brugha is Emeritus Professor, RCSI University of Medicine and Health Sciences.

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