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Letter to Minister Donnelly from ISAG, 20/7/2021

Dear Minister Donnelly,

We write to you as a group of concerned citizens, doctors, and scientists from diverse backgrounds but with a good understanding of infectious disease in human populations. As you know COVID19 cases are rising sharply, driven by the new Delta variant, and by changes in behaviour, changes which are likely to strengthen over the next few weeks.

Your own modellers have predicted the likely results of this, and we agree with them - a sharp rise in cases, and in the occurrence of Long COVID, a smaller rise in hospital admission and in deaths. Many of the admissions and deaths will occur in those already vaccinated, as has been the case in Israel and the UK. The very effective vaccination program here will reduce deaths and hospital admissions compared with January 2021, but it will not prevent them.

The likely impact of the Delta variant alone would not be trivial, but coupled with the decision to reopen foreign travel, and the expected decision to reopen indoor hospitality, we predict a severe impact. The difference between our current plan, and the reckless plan of the UK is less than you might think. We warn that the Irish health services are simply incapable of dealing with this, without further increasing waiting lists.

These likely outcomes are not set in stone, rather they are the results of past and current policy decisions. It is not too late to minimise a fourth wave, and prevent a fifth wave. The key need is to control case numbers. Right now this is done by extending lockdowns, with their enormous social, financial and economic costs. There are alternatives.

  1. You may have been told that there is adequate local public health provision. This is not the case. Control of infections requires enough bodies on the ground to identify cases, ascertain where, and how, they were infected, identify their contacts, interview the contacts, and arrange for testing, and support for the isolation of cases and contacts as required. To do this effectively you need local knowledge, so this is not a task for a call centre alone. We need to urgently augment test, trace and isolate capability in the short term. Many countries have recruited hundreds of temporary staff, often from customer service backgrounds, managed by local public health consultants, to augment public health capability for the duration of the pandemic. We can do the same.

  2. There are enough cases coming into the country through ports and airports to sustain an epidemic in Ireland into the indefinite future. Working and effective mandatory quarantine is necessary. The Northern Ireland border is a special case, and can be managed effectively, but is not the same as Dublin airport. There is no credible excuse for our failure to mitigate risks at the ports and airports we do control.

  3. It is too soon to open up indoor dining and travel. Serious pressure on councils to expedite access to outdoor space would be helpful for many businesses, but by no means all. Opening too much now puts at risk the return to school in late August.

Taken together with our vaccine program, measures to improve ventilation, outdoor activity, continued use of masks in shops, and other crowded spaces, and continued social distancing, these measures will drive down case numbers quite quickly, and give us the best chance of a normal return to school, in September.

Without such measures, the likely outcome is a sharp spike in cases, admissions and deaths followed by the reimposition of further lockdowns. You may be of the view that vaccination will prevent this. No reputable body of public health opinion thinks that this will happen. Best estimates are that until well over 85% of the *entire* population is vaccinated, the risk of major outbreaks is high. There are currently no plans to vaccinate children aged 12 to 16, although this may change soon, and there are also no plans to vaccinate primary school or preschool age children. In any event, this is unlikely to be accomplished before December 2021.

There is an opportunity to show leadership now, and to have a more effective response to this awful virus than continued lockdowns. We urge you to take it. If it is helpful we are available to meet with you or your colleagues at any time.

Yours sincerely,

Anthony Staines, Professor of Health Systems, DCU

Ivan J Perry, Professor of Public Health, UCC

Gerry Killeen, Professor of Applied Pathogen Ecology, UCC

Helen Dolk, Professor of Epidemiology & Health Services Research, Ulster University

Julien Mercille, Associate Professor, School of Geography, UCD

Philipp Hoevel, Lecturer, School of Mathematical Sciences, UCC

Tomás Ryan, Associate Professor, School of Biochemistry & Immunology, Trinity Biomedical Sciences Institutes

& Trinity College Institute of Neuroscience, Trinity College Dublin (TCD)

for the Independent Scientific Advocacy Group


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