EXPERT COLUMNISTS ON THE BIGGEST HEALTH CRISIS OF OUR LIVES
Ireland is getting many things right in the Covid-19 crisis — but there is still vital work to be done, writes Dr Ciara Kelly
Dr Ciara Kelly We have to fight together on all fronts
FIGHTING a pandemic is a bit like fighting a war. There are different fronts where battles need to be waged. For ordinary people, the battle plan is clear (I hope) and composed of three key things.
Firstly, self-isolation for 14 days for anyone who gets respiratory symptoms — cough, sore throat, fever, shortness of breath. They need to stay home with or without access to testing in order to prevent them spreading Covid-19.
Rigorous social distancing for those occasional times we need to leave the house for essential reasons such as to get groceries, medicines, access healthcare or take a small amount of local exercise. Remain more than six feet from other people at all times. Wash your hands before you go out and after you come home. Use handsanitiser where possible.
And if you inadvertently cough or sneeze, do it into your elbow and don’t touch your face.
And lastly, cocooning for those most at risk of becoming very unwell with Covid-19 — the over-70s and those with underlying health issues that compromise their immune or respiratory systems. Those people shouldn’t leave their homes until this storm passes.
Food and other necessities should be dropped to their doors and they should communicate with friends and family via digital means.
These three things are all that people can do and to be honest they will make an enormous difference to the rate of the spread here which is vital in order for our health service to be able to cope as the case numbers climb.
What the Government needs to do is different. It must instigate the best public health strategies to tackle Covid-19. The
World Health Organisation recommends testing as many people as rapidly as possible and tracking down contacts of positive or presumed positive cases as the main ways to stop the virus. And we’re doing that to the best of our abilities, shortages of reagent and resources notwithstanding.
But there are other things we need to do as well and in my opinion these are the areas we are getting wrong. It is public health medicine that is informing much of Government strategy and, to keep the war analogy going by paraphrasing a speech, “Never has so much been asked of those few on behalf of so many.” In many instances, they’ve moved far too slowly. Returnees from Northern Italy — a clear epicentre — should have been told to self-isolate. Ditto for those coming home from Cheltenham. Contact tracing at the beginning of this was done from day one of symptoms — it only changed to 48 hours before onset of symptoms earlier this week, when even a humble GP like me could see that was stupid. If we can’t link one case to another, test and trace will not stop this virus.
And they’re now moving too slowly on masks as well. Places in Asia with flatter case curves than ours all wear them. The CDC in the US has advised wearing them. And even the World Health Organisation appears to be shifting on this too. You wear a mask to stop your own droplet spread — not to avoid other people’s. So my mask protects you and your mask protects me.
It’s the same idea as coughing into a tissue. That we have a global shortage of personal protective equipment is not a reason to not give that clear advice. Because ordinary people don’t need to wear hospital style masks — they can wear cotton ones. What we should have now is clear advice on masks for all, and people should start making and selling cotton ones that are washable and reusable. Pandemics move too quickly for us to wait on evidence in the normal way — we need incisiveness, speed and common sense now in the absence of that.
But there is another important conversation that needs to be had. The Government needs to do its utmost to ensure the cure is not worse than the disease. When GDP falls below a certain level, the poverty that ensues will result in death and suffering for huge numbers as well.
We need to resuscitate the economy as fast as we can — in tandem with protecting people from the virus.
I, like thousands of others here, have had Covid-19. I’m now immune. I can’t give it or get it. My daughter is the same. As is my mother-in-law — who shook it off quite easily in her 80s — something I think many people will take great heart from hearing. We’re all still in lockdown, though. And God knows how many other people here are immune as well who had an asymptomatic course with Covid-19. Confirmed case numbers are likely only the tip of the iceberg.
One study in Iceland where they tested 10,000 citizens for Covid-19 antibodies showed 5,000 had had the virus already — many had no idea they’d had it. It’s not impossible we already have herd immunity of 30, 40 or even 50pc.
Antibody testing needs to be rolled out as quickly as coronavirus testing so we can see who is immune and let them back out to restart our economy.
They did this in China — those recovered from the virus had a special green pass that allowed them to move freely. And in Germany they’re starting a mass study now to see how many people are already immune, so they can be issued with ‘‘immunity passports’’.
I’m being told we’re months away from this here but it is urgent. Hundreds of thousands of us have just lost our jobs. Many more of us have taken swingeing pay cuts.
The measures that have been — rightly — rolled out by the Government will impoverish us a people for a decade. We’ve only just come out of a recession: going back into one will see longer hospital waiting lists, an absence of social housing and all the things we have been railing against get worse. The world is facing a global depression that will mirror that of the 1920s if we’re not careful.
The UK may have guntered the point and the process of trying to establish herd immunity, but if we can allow the immune and very possibly the under-30s back out while continuing to cocoon the vulnerable, we will continue to save lives while maintaining a world for people to come back to when coronavirus is finally treatable or preventable.
That all of us are in lockdown — even those who have no reason to be — will make this situation worse than it has to be. I’ve signed up, like 70,000 other people, to be ‘‘On call for Ireland’’ as I believe that an immune doctor in the time of a pandemic is a very useful thing and I want to help if I can.
But so is an immune bus driver. An immune nurse. An immune secretary or an immune shop assistant.
We don’t know yet what the true cost of the pandemic will be in terms of lives yet. But if there is a second wave coming, those of us who can keep the lights on, the wheels turning and the hospitals open need to be allowed back out to do so. This isn’t a secondary issue. It’s vital.
We are getting lots right but there is more to do and we need to move very rapidly in this direction.
‘Government needs to do its utmost to ensure the cure isn’t worse than the disease’