Christmas 2021 and COVID-19

Independent Scientific Advocacy Group, 16th December, 2021

Last Christmas, we left it too late to do anything meaningful to save the country from what became 5 months of lockdown.

This year we know how to do better.

We must take action now to protect ourselves, our families, and our health service from Delta and the new Omicron variant of COVID-19.

Earlier this year, when the deep and lingering cost of a ‘meaningful Christmas’ eventually became undeniable, we heard contrite statements regarding mistakes that were made. Our politicians and leading decision makers expected us to forgive them for making mistakes, but should we forgive them for not learning from those mistakes?

As we write, Irish case numbers appear to be stable, although very high, at 4,000 to 5,000 a day. Hospitals are under severe pressure, and more than one bed in three in our ICUs is occupied by someone with Covid-19. The message from the CMO earlier this week was that perhaps one in 5 of current cases is due to the new Omicron variant.

Note that we cannot be confident in current case numbers – our case detection is limited by our testing capacity, and we expect that the actual infection numbers are in fact growing, for both Delta and Omicron, with Omicron growing at a faster rate.

The United Kingdom recorded its highest daily coronavirus cases since the start of the pandemic on Wednesday 15th - 78,610 COVID-19 infections were reported, about 10,000 more than the previous high reported in January. We see in Britain, and Denmark, how fast Omicron can spread even in populations with high vaccine coverage, and are starting to see early signs of the impacts it can have on people and health services. The current Government plan - boosters for all - cannot be delivered fast enough to halt the rapid spread of Omicron. Our testing and contact tracing systems, the primary Public Health tools for cutting chains of transmission, are already totally overwhelmed with Delta.

What does Omicron mean for us, and for the health service?

Right now, there are many things we don’t know about Omicron.

Despite all the ongoing speculation, we’re unsure how severe it really is - but hospitals in South Africa are already starting to fill up. Most troubling is the fact that it appears to spread much more rapidly, with one or even two doses of any vaccine doing little to reduce infection. A booster dose appears to offer significant protection, at least over the short term while we negotiate our way through the oncoming epidemic surge of Omicron. What this means is that even if the proportion of people who become severely ill and require hospitalisation is even close to what we have seen for Delta, Omicron stands to infect a much larger number of people - including the doubly-vaccinated - in a very short space of time. This is extremely troubling because, to repeat a well-worn refrain, a small percentage of a very big number is a big number.

What might this look like?

In the UK, cases are currently doubling every 2-3 days. If this happens in Ireland (and there’s no reason to believe it won’t), and if we have 500 new Omicron infections today, we may have 1,000 by Friday, 2,000 by Monday, 4,000 next Wednesday, and 8,000 by Christmas day. A proportion of today’s infections will hit hospitals sometime between Christmas Eve and New Year’s day; those that happen on Christmas Day will hit hospitals in the first week of January. If we wait until hospitals are overwhelmed to take action to stop transmission, hundreds of thousands more people will be infected as we wait, some of whom will need hospitalisation 2 weeks later. If that is allowed to happen, then there is nothing that we can do to prevent these hospitalisations, because the infections will have already occurred while we waited to take action. We really hope these predictions are wrong, but this is the most likely scenario without decisive action by the Government.

Who needs to act?

The government has largely left it to individuals to act to protect themselves and their families, instead delivering a series of lengthy lockdowns, and spending huge resources protecting the affected jobs and businesses.

What does the Government need to do now?

Their key task is to act now to reduce case numbers, by breaking the chains of infection.

Temporary closure of non-essential travel and indoor hospitality until we emerge from the forthcoming surge, unpopular though this will be. We suggest this with great reluctance but a short closure now may avoid a much longer closure later.
Increased capacity for testing, sequencing, case finding, contact tracing and supported isolation.
Decisive policies and action on ventilation, air filtration, and mask wearing.
Make antigen tests freely available in pharmacies and provide clear guidance on when to use them, how frequently to use them, under what circumstances, and how to interpret them.
Accelerated vaccination programs and universal use of COVID passports (also known as 'certificates') to facilitate automated contact tracing, much as Australia has by scanning QR codes for individuals entering any venue or event.
Demand a TRIPs waiver at European level and generous investment in established mechanisms for globally equitable procurement and distribution of vaccines through the COVAX scheme.
Support and regulation for the next year for safer environments for travel, social events, hospitality and entertainment.

What can we all do to protect ourselves and one another?

Wear better masks - N95, KN95 or FFP2 - everywhere outside your home. If you have children and they can wear a mask, ask them to wear one. Masks, worn correctly, are a simple and highly effective form of protection for the wearer and others.
Work from home if you can.
Use ventilation and supplement it with HEPA air filtration in schools, shops, pubs, restaurants and anywhere groups of people gather, including our own homes.
Avoid venues that don’t check COVID passports.
Reduce social interaction, and meet outdoors whenever possible.
Use antigen tests before you meet people, especially older people over Christmas.
If you have any symptoms, even if you believe it is a cold, or fatigue, do not see people, follow the HSE and NI Department of Health guidelines, and get a PCR test.
Get vaccinated if you haven’t already, and get a booster when eligible.
If you can afford it donate to the UNICEF Get a Vaccine, Give a Vaccine campaign
Push your politicians to ensure our government does the same, through COVAX and country-targeted contributions, and to ensure the EU finally gets behind a global TRIPS waiver, for sharing vaccine manufacturing know-how internationally.

Only by driving down case numbers and controlling them with an evidence-based strategy, will we protect both lives and livelihoods. ISAG's "Vaccines-plus" strategy is offered as reflecting the best international practice and evidence to avoid the collapse of our health service, unnecessary deaths (both from COVID19 and other causes), widespread disability from Long COVID and the continuing damage to many sectors of our economy.