With a few exceptions, we have done well in managing the pandemic which is now clearly the most significant infectious disease in a century, resulting in the fastest and deepest recession since the Great Frost of 1709, to quote the Financial Times quoting the Bank of England, both sober organisations.
Today coronavirus, also known as COVID-19, is under temporary control. The number of people in hospital is currently few, only a small number needed intensive care for the disease in the last week but the numbers of newly diagnosed cases have edged back upwards.
Yet, according to Dr Tedros Gebrejesus, head of the World Health Organisation, “the worst is yet to come”.
At a worldwide level, I am sure that he is right. But in Ireland, we can control our fate, because our actions and behaviours, our public policies and our social cohesion will determine what happens next.
So how can we prevent a second wave or a second tsunami of the disease in Ireland?
We should wear face coverings when social distancing is not possible, because asymptomatic and pre-symptomatic transmission of the virus may cause about half of all transmissions to other people. To reduce the environmental impact, re-usable coverings are preferable to single-use ones. After use, we should take them off carefully from behind, put them into a plastic bag and then wash them at 60 degrees with some detergent, in order to kill any virus that might be present.
If we feel unwell with fever, cough, raised temperature, chills, shivers, or just new body aches, or fatigue or loss of smell, we should call our GP – quickly. We should stay away from others, even those that we live with. The family doctor might arrange a test that same day. Ideally the result would be available quickly.
Keeping the network of people we come into close physical contact with small is also important and possible through a safe home community, or a small collection of households socialising and enjoying life regularly together. By keeping to our own exclusive social bubble for physical contacts, we can prevent the faster spread of the virus. We should also download and use the coronavirus tracker contact-tracing app.
We can carry a disposable tissue pack everywhere and use it for our coughs and sneezes. After one use, throw it in a bin and wash or alcohol gel our hands. As a second best, we can cough or sneeze into our left elbow.
Regular swabs for those quarantining
Incoming travellers are obliged by law to complete a form when they arrive, stating where they will reside for this time. The publicly funded contact-tracing staff and community testing staff, in my view, should visit the stated residences of these inward travellers, offering them tests on the third, fifth, seventh and 10th day following their arrival. This would allow us to measure how well an early swab can predict if a person will develop COVID-19. If the early swab proves accurate, it might allow us to shorten the duration of isolation.
It would also allow us to measure the effectiveness of self-isolation and to develop proportionate and effective ways to encourage and enforce it. This might require the Garda Síochána to be called if it is clear that incoming travellers are not following the laws of this country.
If the appearance and encouragement of the gardaí are not successful, then prosecution to implement our present laws should be considered.
Changes to the delivery of healthcare is also necessary as we navigate the next phase in our response to COVID-19.
We need immediately accessible GP services all day, every day, with doctors who can immediately assess and manage risk and organise testing where appropriate. We need national availability of same day swabbing, laboratory testing, and communicating the results to the patient, the GP and to public health staff.
We need sensitive same-day contact tracing of first-degree, and perhaps also second-degree contacts, and the capacity to advise them.
Where an outbreak of two or more cases is detected, we need specialists in public health to intervene quickly to prevent spread of coronavirus. This could involve self-isolation, quarantine, recommending closing a business, contact tracing, recording of results, testing, cleaning, advice, or recommending a cordon sanitaire.
We need a national database to collect, collate and analyse comprehensive data about the pandemic in Ireland and our public leaders will need to use that data to evaluate the effectiveness of our current restrictions and to change or augment them as required.
At the levels of all organisations, Government departments, and local and regional government, the next phase of the pandemic requires a response. Each organisation and unit of Government needs a strategic COVID-19 planning and implementation group, to prepare a business continuity plan. Ultimately, we have to change our normative way of life to make the transmission of the virus from person to person slower.
Home-working, where possible, is essential. Cleaning hard surfaces, cough etiquette, physical distancing, a stay home if sick rule, records of attendees at meetings, face-coverings for all policy, separate pods of workers who do not meet each other, are all important measures that need to be part of our planning for the months ahead.
These interventions will all slow down the spread of viral transmission in our society as and wherever it occurs. Thus we can detect it and control it before it goes rampant again. More of our society and of our economic and social, musical, educational, religious, cultural and sporting activity will be able to open if we take these actions now.
This article was originally published in The Irish Times on 18 July 2020.
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.