Over the next six weeks we have an opportunity to once again suppress Sars-CoV-2, the coronavirus that causes Covid-19, and allow our health service, society and economy to begin once again to live alongside this virus. However, it is critical that we use this time wisely to progress our strategy of living with the virus while we await safe and effective treatments and vaccines.
As we adjust to the new restrictions, we need to understand that different generations and different cultures have different needs and concerns during a pandemic such as educating children, maintaining a business or a job, looking after a vulnerable relative, meeting friends and playing sports. At the moment we can’t have everything but it is important to listen to the concerns of different age groups, to engage and empower local communities to support people to live with the virus. It is also helpful to focus on what we can still do within the restrictions, form a social bubble, go for a walk, connect with friends and access the many supports that can help people to avoid loneliness and isolation.
There is an onus on us to respect those who are most vulnerable to developing severe Covid-19. They are our family, our neighbours, our relatives and friends. We can do this by simply adhering to the public-health guidelines so that they can live safely and without fear. By protecting them, we protect our health service. We need to understand the negative effects of the pandemic on those who are vulnerable, especially our older population.
Hospital Report
We also need to further strengthen our testing and tracing capacity and our public-health and hospital infrastructure in a sustainable way. This is essential. Policy decisions must be based on an in-depth analysis of Ireland’s existing data on the who, why, where and how people get infected. Also link this to real-time data that shows how this impacts on the regional hospitals in terms of admissions. Early assessment of those who require hospitalisation, using the interventions such as steroids for those who are severely or critically ill, save lives.
Forensically analysing this data can define Ireland’s vulnerable population, to access real-time data on Covid-19-related hospital and ICU admissions to inform our restriction levels, to provide data on where clusters happen so that chains of transmission can be broken.
This data-based approach is how we can manage outbreaks in a rapid, agile and focused way in the months ahead and ensure that we can continue to provide access to other vital health services. The public need to feel safe to be able to attend hospitals for treatment for strokes, cancers and other illnesses that are as much of a risk to many people as Covid-19. Remember, Covid-19 is a only part of what our health service is treating.
Buying time
The purpose of a lockdown – or restricting life as we know it – was never to stop everyone in the country from getting infected with coronavirus. This is highly unlikely without an effective vaccine or treatment in a democracy with a global presence. We can buy time until next year. Next year brings the hope of vaccines with many candidate vaccines currently being scientifically studied showing promise. To be ahead of the curve when the first vaccine is available, we need an implementation programme. How we roll out the vaccine, identifying the groups who will most benefit, how it is delivered and monitored are being worked on now. Vaccination programmes, and not just vaccines, are what is important.
No country or generation has the same experience living through a pandemic by virtue of differences in culture, geography, population density, life experience, health infrastructure and leadership. However, we can learn from each other and acknowledge that we all have different expectations and needs during this time. Living in a member state of the European Union gives us the opportunity to share our knowledge at governmental level to the benefit of our population. Encouraging international collaboration in scientific research and innovation in health with information exchange on the impact of the pandemic on health, society and the economy will help us safely live alongside the virus.
We are at a crossroads now but we are in a better place than we were earlier in the year. Our knowledge on how this coronavirus causes infection and disease and how we can prevent and treat it continues to expand. We need to use this knowledge wisely to, in the words of the World Health Organisation global strategy for Covid19, “suppress transmission, saves lives and livelihoods – the way forward . . . together”.
Experience
Ireland continues to build its public-health infrastructure, which is the cornerstone in controlling the virus through end-to-end testing, tracing and protection. We know what works – physical distancing, hand hygiene, face coverings, rapid identification of cases, contact tracing and cluster investigation to break chains of transmission. Using Ireland’s experience of the infection can help tailor our approach to living with it.
In a recently published book, The Language of Illness by Prof Fergus Shanahan, he outlines that pandemics are communications emergencies as well as health and economic threats. Communication needs to be honest, clear and concise with explanations of why things might change as our understanding of the virus evolves. Avoiding doomsday scenarios so that people can live with caution and not in fear is important for everyone’s well-being.
Communication of evidence-based, comprehensible messaging adapted to various audiences through social media, print and television is essential. It is also important that many perspectives inform decision-making around our response to this virus – gender balance, business interests and representation of vulnerable groups all enrich important decisions for our society and help to bring our communities together and to buy into new ways of living.
We can learn from previous pandemics – they affect the vulnerable and the marginalised, they highlight health inequities and can have devastating effects on our economy and society. How we live, learn, work and play is determined by how we behave now and how we adjust to a new way of living.
By looking after ourselves we look after each other.
Prof Mary Horgan is president of the Royal College of Physicians of Ireland and a consultant in infectious diseases at Cork University Hospital