The World Health Organisation (WHO) has officially declared COVID-19 a pandemic. We are now all faced with an unprecedented problem – a “once-in-a-century event”, as Bill Gates put it.
The evidence from Wuhan, the cruise ship Diamond Princess and Italy shows clearly that a large proportion of the population can be infected with COVID-19, the novel coronavirus.
The good news is that the spread of COVID-19 has been severely curtailed in 30 provinces in China
The rate of transmission depends on social contacts, touching and the spread of the droplets in coughs and sneezes, with estimates ranging from 20-80%. While we don’t know the exact figure, the range is good enough to indicate that dramatic social, economic and health-sector interventions are needed urgently.
COVID-19 has an estimated mortality rate of 2-4%. The numbers sound superficially low until you calculate the absolute numbers involved and compare that to a usual year’s deaths; seasonal flu, which we still have to contend with, has a mortality rate of about 0.1%.
The good news is that the spread of COVID-19 has been severely curtailed in 30 provinces in China. By carrying out a ‘four-step plan’, Chinese government action has kept the virus under control, a fact independently verified by an international team of experts from the WHO led by Dr Bruce Aylward.
The Chinese first secured basic essential services though meticulous business continuity and contingency planning. This included the basics such as water, food, electricity, internet, phones, GPS, mobile network, media, governance, healthcare and pharmaceutical supply chains, as well as protective equipment for health workers.
Secondly, they created social distance. They cancelled non-essential travel, closed non-essential factories and businesses, enforced mandatory work and education from home, stopped social gatherings and cordoned off entire parts of the country, much of which has since been replicated in Italy.
In a dictatorship such as China, the ruling party can unilaterally enforce this kind of large-scale action. In Ireland, we have to all agree to temporarily suspend our expectation of the human right to freely walk our streets and to freely associate together in groups. We must find a way to do this through consent and agreement with very widespread voluntary adherence and compliance.
Four health ministries
Thirdly, we need to scale up government healthcare, as the Chinese have done. We need four health ministries: one to lead the public health activity to stop COVID-19; one to lead, develop and scale up the new services to support and care for people with COVID-19; one to lead the old pre-COVID-19 services, which must continue; and one to lead the securing and maintaining of the supply chain of drugs, medicines and personal protective equipment.
Fourthly, in China, the government organised rapid contact tracing, testing and self-isolation of suspected cases, and all of their first-degree contacts, using artificial intelligence and computer-based solutions. The Chinese did this very quickly and with adherence of about 98%. Modelling suggests that the speed and effectiveness of contact tracing is one of the strongest tools to control the outbreak. In Wuhan alone, there were 900 teams, each comprising five epidemiologists, doing this quickly and effectively for a population of 11 million people.
Now is the time for our leaders to unite and for all of Ireland to row together behind them
We should move experienced staff, who can deal well with the general public, from other public-sector jobs to the Department of Health to be trained rapidly to help public health staff perform contact tracing. We are half the size of Wuhan, so we need about 5,000 people moved, retrained and organised into teams to be ready and effective in a few days.
I am supportive of the Government’s action on Thursday to close all schools, colleges and public facilities while we try to contain this outbreak. However, there is more to do.
Four-point plan
Ireland must implement China’s four-point plan, transparently through our liberal parliamentary system, as soon as we have a broad-based effective government that can rely on the co-operation of at least 98% of the Irish population. This must happen very quickly.
The plethora of splintered political parties – including Independent deputies – must come together with one voice and lead the nation. We need wise and cool-headed leaders who, through respectful dialogue, can build cross-party agreement and consensus; lead teams of diverse people; make difficult decisions that temporarily change our basic human rights, such as mass quarantining; consider health benefits against economic and social costs; and inspire the people of Ireland to row together.
The O’Donovan brothers from Skibbereen, who have won many medals for Ireland, do just that. The two men pull their oars at the same time to take their boat across the finishing line to victory; one has to follow the stroke of the other. Now is the time for our leaders to unite and for all of Ireland to row together behind them.
Prof. Samuel McConkey is Head of the Department of International Health and Tropical Medicine at RCSI and President of the Infectious Disease Society of Ireland.