Luke O’Neill on how to hit ‘zero-Covid’

Careful easing of restrictions, enhanced testing and tracing, and strict rules on travel and compliance can help control Covid, says Prof Luke O’Neill

EXPERTS in several countries, including Ireland, are pressing for a “zero-Covid strategy”. But what does that mean? It means taking strict measures in our society to relentlessly drive down the level of Covid-19 infections. The agreed number is one new infection per million of population per day. We are clearly a long way off that. Our current level is around 10 times too high. How do we achieve it?

With a lot of pain for everyone. Psychological, social and economic. Pubs not reopening. Home working. Strict controls on travel. Laws in place to ensure people comply with the guidelines such as mask wearing in public places. Strict monitoring of our schools. Not easy. People objecting. Radio and TV full of debate about rights and wrongs.

And yet the prize is worth it. Achieving zero-Covid means we become like New Zealand and Taiwan, where everything is almost back to normal.

Apart from the pain, it’s not clear whether countries that achieve it can survive economically in a world where Covid-19 still rages.

What is clear is the alternative is hardly working. We’ve learnt from Spain, Israel and England that easing restrictions leads to outbreaks that then lead to a reimposition of restrictions. Singapore has had five separate outbreaks in succession which happened because of reopening and inward travel, in spite of doing their best to control spread.

And look at what’s happened in the midlands. An outbreak in Kildare, Laois and Offaly — with over 280 cases in the past 14 days — has led to a partial lockdown for two weeks.

Sporadic reimposing of restrictions has to be seen as disastrous given the psychological and economic impact. It can only give rise to a losing of trust in authority followed by less compliance, fuelling the fire and maybe even giving rise to social disorder. People also lose confidence and then don’t participate in the economy resulting in further distress. Our Government therefore has to ask: ‘How do we reach zero-Covid?’

The way forward is crystal clear so it comes down to having the will to do it and a robust plan. A combination of measures is needed.

Firstly, very careful easing of restrictions, one step at a time, with monitoring of the impact of the change. A detailed protocol is needed to allow places to reopen. In the current phase this particularly applies to pubs and schools.

Perhaps only in Ireland would these two places be in such juxtaposition. It probably reflects the importance we Irish give to pubs and our children’s education. Strange indeed that these two occur in the same sentence.

There is a case for rural pubs reopening if they can guarantee close monitoring, given their specific role in their communities and their location in regions that are possibly zero-Covid already, but we’d need to be careful.

The ideal would be for all of Ireland, including Northern Ireland, to be zeroCovid and then all the pubs can reopen. The schools are working very hard at making sure they will be as safe as possible for our children and teachers.

Experience in other countries such as Japan says this is feasible. Currently, Ireland has decided not to move to phase four, reflecting this careful approach.

The second thing is testing of people coming into Ireland with subsequent isolation for two weeks for those testing positive.

Thirdly, a fully functional testing, tracing and isolating strategy, including localised quarantine, that can be deployed quickly to contain any outbreaks.

And finally, careful consideration of particular people and places. This includes our nursing homes, but experience also tells us that there are inequalities when it comes to Covid-19.

Those in lower socioeconomic communities, especially those living or working in crowded places, are also particularly vulnerable. They need our special attention. Why there wasn’t a focus on meat factories and crowded accommodation in the recent outbreak in the midlands, which could have forestalled it, is not clear.

All of these measures can be implemented. We need a zealous commitment to them from our Government. That won’t suffice, however. What’s also needed is to bring the public with you. Clearly in certain parts of the US, the feeling was the public wouldn’t go along with strict measures and so opening up happened too soon and look where they are now. This also happened in Spain, where the opening to allow for tourism gave rise to backward steps.

In Ireland, we’ve done better, but it’s fragile.

There has to be a fully transparent dialogue with the public, with strong leadership, constant communication, a message that says we know there will be short-term pain — more for some than for others — but this strategy will work, freeing us from the constraints of this virus. We can give examples of how this worked in the past with even worse infectious diseases, such as Ebola in several African countries.

The two challenges are implementation of these measures which takes a lot of organisation and commitment, and the harm these measures will inflict on people, which are both economic and psychological. They will give rise to inequality, as can be currently seen for our pub owners.

But the truth of the matter is becoming clearer with each passing day.

We will have to live with this virus for months, if not years. We have an opportunity to control it now. Surely that is worth a shot?

Those advocating for a herd immunity approach need to explain exactly how it will work, including how we can reopen our schools and workplaces, how our hospitals will cope and what they think an acceptable level of death will be.

A zero-Covid strategy means short-term pain leading to long-term gain. It has the added bonus of protecting the vulnerable, surely a primary goal for any society. With strong leadership and a spirit of the whole country pulling together, it can be done. We need our Taoiseach to give a ‘blood, sweat and tears’ speech. We can then look back with pride on what we will have achieved when it comes to Covid-19, inspiring our children and moving forward with confidence.

‘The solution is crystal clear, it comes down to having the will to do it and a robust plan’