While the easing of restrictions following the peak of the Omicron wave should allow people to live a more normal life, a leading virologist has said that the Government should focus on improving the national capacity to deal with possible further waves.
Dr Gerald Barry, assistant professor of virology at University College Dublin (UCD), told BreakingNews.ie: "From a general public point of view I’d say let's start to live our lives, let’s be optimistic, but the Government should do the opposite, let’s allow the population to live but let’s bolster our defences."
Dr Barry feels the impending loosening of restrictions is the right move, but he thinks Government should prepare for the possibility of further waves, so that restrictions will not be the first port of call if the Covid situation worsens again.
While there has been a lot of talk about Covid moving from pandemic to endemic, Dr Barry feels it is not yet at this point as there is still uncertainty surrounding the virus and how it will evolve.
"Endemic kind of means to an extent the virus becomes predictable, we know what’s going to happen and enter an equilibrium between what the virus is doing and what we’re doing and that equilibrium or dynamic where we can live together, and it doesn’t cause massive unexpected disruptions to our lives. I think we’re probably moving in that direction, it has become more predictable to an extent, but I’m not sure if we’ve reached an equilibrium in terms of the virus being with us.
"Most of the viruses we live with that we would term endemic are very predictable, flu is probably the most similar example where we know every winter flu will come, people will get it, with fairly decent predictability we know what’s coming down the track, we know based on tracking it around the world roughly what kind of strains will be circulating in the country come next winter, and we can make vaccines based on that.
"Then we also live in a world where we accept that a certain amount of people are going to get infected by the flu, a certain amount of people are going to get sick, and a certain amount of people are going to die. As a society, we unknowingly or knowingly accept that. That is kind of an endemic situation."
Dr Barry pointed out that it is still uncertain whether Omicron, which causes less severe disease, will remain as the more prevalent variant of the virus or another more severe strain will emerge.
Health system
This is why he feels the Government should look to bolster the health system, while people are allowed to live more freely as restrictions are eased.
"Maybe it's a case of letting the population get on with their lives but in the background the Government needs to be aware that these are potentials that could come along and rather than downing tools and relaxing, thinking what a great job they’ve done getting us through this pandemic, in my opinion they should be looking and saying 'we’re through that wave, we don’t know what’s coming next, so we need to bolster our defences so if another wave comes we’ll be better prepared than we were for any wave previously'.
"Then we might be able to get through the next wave without massive restrictions and impinging on the population in general. We might be able to get through in the background by bolstering our tracking and tracing, bolstering our hospital system so that we can deal with surges of cases that might not be as severe, so the system is not overwhelmed.
"I would almost compare this to a war, after the second World War finished countries sat down and figured out ways to maintain peace. One of the ways was peace talks and another was by bolstering arms, so if peace wasn’t maintained, they could quickly respond.
"I would look at it that way and say we’re going to track this really carefully, keep an eye on it and not forget about it and presume we’re in peace time forever, we’re going to bolster our defences, so we’re better prepared for the next wave that might come. Even if it doesn’t come, and it stays as Omicron and becomes an endemic respiratory virus, where it disappears to an extent in the summer and comes back in the winter, if we get into a cycle like that you might think that’s fine.
"Even in that scenario it would be like going back to 2019 whereby we had huge numbers of people on trolleys, huge surges in cases of respiratory illness in general, spikes in hospitalisations in January when flu came along, go back to that scenario with 1,000 cases of Omicron on top of that because we’ve loosened all restrictions and there's loads of virus circulating, could our hospital system deal with that you’d have to ask?"
He added: "These are alarm bells that should be ringing in the Government currently, I hope those are the type of conversations already happening on top of the conversations around loosening restrictions. I hope that’s not a signal to down tools like it has been in the past. Look back at summer 2019 when cases were very low, we shut down contact tracing centres, reduced testing capacity, because the presumption was the problem was going away and that was proven incorrect, I hope we’ve learnt from that lesson and do the opposite by taking the opportunity to actually improve things in terms of infrastructure so if it comes back again we can deal with it better the next time."
As testing is wound down, Dr Barry said a strategy whereby it can be easily ramped up when needed would be the best route.
He suggested medical students doing rotations at diagnostic centres, and partnerships with universities and private companies as one possibility.
Testing
"They need to make a decision on what testing is done in the population, mass testing or like with other diseases where people are only tested if they get very sick, or a dynamic where everyone relies on antigen testing and PCR testing is only used for hospital patients, that’s a happy medium I would think. You can’t maintain a lab running 300,000 tests a week when there’s 2,000 cases or so a week in the population, but what you can do is build a system that can be rapidly converted, maintain the equipment, build proper links with universities, so they can help if necessary, that was done in the UK but not here, the same with private companies, so you have this rapid response system.
"What we need is a strategy where that can be easily ramped up, by maintaining stocks of antigen tests that can be rapidly supplied to the country for example, that’s much easier than re-establishing a lab.
"You could set up a system whereby every science student does a three-month rotation in a diagnostic lab, so if another pandemic came along you would have people that have been through a diagnostic lab. In previous waves we had to train people from scratch, bring people in that had never worked in a diagnostic lab before, all these things.
"You could imagine a scenario where you build that into science courses in university, so recruitment would be a straightforward thing if necessary. The lab facilities build them and maintain them."
He also said research into the level of immunity in the population, and focused policies for protecting the most vulnerable could help in the response to possible future waves.
"Beyond that there has to be a push to research things like what the immunity of the population actually is and try to in a more focused way identify what you might call vulnerable populations of people. Then we could focus our efforts on making sure they’re aware of their health status and supply them with antigen tests and anti-viral drugs or have a stream within hospitals to rapidly treat them.
"That type of research will be important, particularly with things like anti-viral drugs coming on the market that are very expensive, and you don’t want to be giving them out universally as not everyone will need them, but it could be crucial for vulnerable people. These things that can very quickly be ramped up could be built into the system."
"Hopefully the general population can get back to living their lives, but I think it’s incumbent on the Government side of things, HSE, Nphet and whatever equivalent becomes of Nphet, to maintain readiness, in case another wave does come along," he added.
I don’t think we can honestly say as a country that restrictions have ever been the last resort.
Dr Barry said now is the time to undertake this planning and preparation so restrictions and lockdowns will not be the first port of call if new variants do emerge in the future.
"Really we need to allow people to start living a normal life but at the same time look inward and say 'OK if we open up it’s probably going to lead to an increase in cases, are we going to then close down again or put restrictions on people or are we going to put in place better policies in the country that might help us control that increase in cases while still allowing people to live a normal life?'
"I would much prefer us to go in that kind of direction whereby we set up systems in the country that allow us to open up. The case fatality rate has decreased massively, the conversion into hospitalisations has decreased massively, so we need to strike this equilibrium with the virus where a certain amount of circulation is happening, a certain amount of people continue to get sick, as has been the case with every other virus infection we’ve lived with, but we have to be able to keep a lid on it to an extent, and it’s a question of how we do that, is it though reintroduction of restrictions every now and then or setting up the country in a better way that might be able to keep a lid on it without having to introduce restrictions on people.
"Going back to my original point about certainty I don’t think anyone knows in what direction it will go in. As a country everything possible needs to be done to try and keep a lid on the virus without reintroducing restrictions, they should be a last resort, and I don’t think we can honestly say as a country that restrictions have ever been the last resort. They’ve been one of the first solutions in every wave."
