Language helps us make sense of epidemics and it is no accident that we describe them as coming in waves. Our COVID-19 journey has taken us down a river, with successive waves of infection due to new virus variants accelerating the current, leaving many in difficulty.
Language helps us make sense of epidemics and it is no accident that we describe them as coming in waves. Our COVID-19 journey has taken us down a river, with successive waves of infection due to new virus variants accelerating the current, leaving many in difficulty.
From the start, public health advice and control measures acted as life jackets; the health services were there to treat those tossed against the rocks; and one year ago we started to roll-out the vaccines that science provided. Vaccines are the boats that have enabled most of us, in Ireland at least, to negotiate the rapids and stay afloat.
In our daily lives we have become more adept at using these aids to keep us safe. But now, as our river-journey is bringing us closer to a calmer estuary, a tsunami that is higher and faster than anything we have experienced until now has picked us up and increased our speed of travel. This is frightening, but most of us will ride this wave to safety. The reasons for such hope come later. But first, what are the dangers immediately facing us?
The limits of political feasibility, that is the limits set by people’s willingness to accept further increases in restrictions (a willingness that has served Ireland well until now), mean that any further damage limitation is in our hands. Those who decide to visit pubs, restaurants and other indoor venues should first think hard about the vulnerabilities of those they live with, and those they will encounter two to five days later.
The incubation period of the new Omicron variant, the time from close contact to showing symptoms, is around three days; and people may become infectious before showing symptoms. This means that transmission will occur considerably more quickly, as well as more efficiently, than with earlier variants. Those of us who mixed with a few close family or friends over Christmas should now forego further household mixing. Very few of us can imagine the implications of one further week of rapid exponential spread of the virus but that realisation will soon follow.
In the days and weeks ahead, most of us will hunker down, thankful for the essential workers who keep the electricity and phone networks functioning; those who stock and sell us food and medicines; and the doctors, nurses and laboratory staff (also neglected heroes) who are there to treat and save those of us who are tossed overboard into the raging waters. Battening down the hatches is a fit metaphor for what we now need to do.
When our boats reach calmer waters we will need to take stock, as families, a nation and a global community,and ask: where is the collateral damage that needs to be assessed and fixed, such as neglected and pandemic-induced health problems? What cannot be delayed is preparation for the next pandemic. This requires practical steps such as putting in place surveillance systems to detect future variants of concern and new viruses entering human populations. It also means ensuring that we have the professional and political capacity to take rapid and effective action.
Hopeful rather than fearful
So why should we feel hopeful rather than fearful of another false dawn? One of the two features of Omicron about which scientists are confident is its much greater transmissibility. The speed with which Omicron has outcompeted the more dangerous Delta variant has been phenomenal. What has severely disrupted our Christmas and New Year celebrations, in the short term, is likely to play to our advantage over the medium, if or when Delta disappears.
What is not yet clear are the relative, overlapping contributions of the Delta and Omicron variants to the numbers experiencing complications and hospitalisation. Different types of evidence point to Omicron being less likely to cause severe respiratory complications, which have been the main cause of COVID-19 deaths. It will be months before we know the other and long-term consequences of Omicron.
The second feature of Omicron and COVID-19 variants generally is that successive variants of concern have had varying abilities to evade the body’s initial antibody response, enabling the virus to enter and multiply. However, the second line of defence, the body’s killer T cells, have generally retained the capacity to eliminate virus-infected cells before the virus can do major damage. COVID-19 vaccines are doing what they promised: greatly reducing the risk of such complications.
The medium-term risks from COVID-19 suggest a mixed picture. The virus appears to have become less lethal, for the time being. This will allow us get on with our lives – that longed-for state of ‘living with the virus’. In this respect, it may resemble influenza, against which older and vulnerable persons require an annual early winter vaccination. However, we must remain vigilant.
Soon we will be looking back to learn lessons. We may conclude that the Government generally did the right things, but usually, at each stage, a bit late; and that Irish society demonstrated remarkable cohesion, support and willingness to implement the public health measures that brought most of us to safety.
The damage assessment will estimate the mental health and social costs that were endured by all, though most older people recognise the particularly damaging impact on the young. Given that so much got put on hold during the pandemic, personally and politically, it will be tempting to conclude that we have given enough attention to health. But we cannot afford to allow this happen.
This is the year to prioritise investing in a fit for purpose health service. This means getting Sláintecare back on track, putting the essential components of a public health service in place, and effective hospital and workforce reconfiguration to retain our doctors and nurses. This is not to downplay other immediate priorities such as housing, and potentially greater ones such as slowing down climate change.
Preparing for the next pandemic needs to be part of a broader debate on our ability and willingness as a nation to raise and invest the funds needed to restructure society, nationally and globally. This time we were lucky. The Spanish flu caused the deaths of 50 million mainly young people. Whereas COVID-19 has killed about 5.4 million mainly older people.
We need a national reflection in 2022, supported by a Citizens’ Assembly, so as to consider and understand what measures, including more draconian ones, might be needed in the future in the face of a more deadly epidemic; and to build political momentum for the investments needed to protect the health of the nation.
This article was originally published in The Irish Times on 4 January 2021.
Prof. Ruairí Brugha is a medical doctor, public health specialist, Professor Emeritus and recently retired Head of the Department of Public Health and Epidemiology at RCSI.
RCSI is committed to achieving a better and more sustainable future through the UN Sustainable Development Goals.
