Vaccines-plus - A Medium-Term Strategy for the Management of Covid-19 in Ireland
Independent Scientific Advocacy Group, 18th November 2021
Covid-19 is preventable.
It is possible to reduce infections and deaths from Covid, by employing the full range of tried and tested approaches to managing infectious diseases. It is the responsibility of the Government, not the public, to put in place the measures needed for this.
Covid-19 is airborne, so air hygiene is key to infection control.
Only the government can set scientifically-informed air hygiene standards for indoor settings, suitable for an airborne pandemic virus.
As a primary strategy, this includes requiring measured air hygiene, such as adequate ventilation and HEPA filters in congregated settings to reduce transmission in schools, colleges, workplaces, retail, public transport, hospitality, nightclubs, healthcare, etc.
This can only be done by the Government and by other community and sector level organisations; it cannot be done by individuals.
Without these interventions, Covid case numbers will continue to rise.
We already have many health and safety standards in place. For example, food standards are maintained by a network of food safety regulation and enforcement across the industry. This hard work is invisible to the customer, creates no obstacle to access, and requires no expert knowledge or judgement of risks by the customer.
In a café, no customer is required to verify the safe operation of fridges or the temperature of cooked meat. No customer is asked to take personal responsibility for what is outside of their control.
For respiratory viruses, air hygiene, with ventilation, filtration, and crowding standards should and must play a similar role.
While officials emphasise ‘personal responsibility’ for pandemic control, this can deflect attention from the duty of the Government to lead. This includes effective responses, such as air filtration guidance, mask standards, and adequate track and trace measures.
Current rates of Covid-19 in Ireland in November 2021 - twenty-one months into the pandemic, are amongst the highest in Europe
- despite our very high vaccine uptake.
This is why a Vaccines-plus strategy is required.
Even though vaccination has greatly reduced deaths and severe illness, the high Covid-19 case numbers impose high costs on all of us:
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Hospitals filling up, and waiting lists increasing for non-covid care;
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Children missing school for tests, isolation and sickness, as case numbers rise, and the unknown risk of Long Covid in children;
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Rising numbers affected by Long Covid in an over-stretched health care system;
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Disruption and extra costs to health care, education, and other sectors, as sickness absence rises;
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Enormous disruption to travel and hospitality sectors;
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Significant burden of acute Covid-19 itself, even at home.
Strategic Response: Vaccines-plus
To minimise the impact and costs of Covid, we propose a proven 3-point Vaccines-plus strategy, to replace the current vaccines and personal responsibility only approach.
1. Prevention
Ventilation
Urgent development, and active enforcement of minimum evidence-based standards for all public venues, including schools, with support from local environmental health officers.
HEPA filters, which are portable, cheap and practical, to respond where ventilation is inadequate.
Masks (preferably FFP2/N95/KN95)
These should continue to be required on public transport, in secondary schools, colleges and retail settings. The policy not to wear masks in primary schools needs urgent review in the context of international practice and guidelines.
2. Vaccination
Covid passports
These can be retained for any setting where large numbers of people are expected to spend significant time.
Completing existing vaccination program
Excellent work has been done by the HSE to date in achieving high vaccine coverage in teenagers and adults, including out-reach to those made homeless and other difficult to reach groups. This needs to be sustained and extended to 5–12-year-olds when possible.
Booster vaccines
These should be offered initially to those at high risk.
Ireland should actively support and campaign for global vaccine equity.
Antiviral drugs
When available, these will bring benefits, but we should all acknowledge that prevention is better than cure.
We need global equity in access to these drugs too.
3. Control
Resource regional Public Health Medicine Departments to respond appropriately with the required level of intensity to local outbreaks including (but not confined to) the work of “Find, Test, Trace, Isolate, Support”.
Antigen testing
Rapid antigen tests have a role to play in Covid-19 control, especially in reducing exposure. They are not adequate alone, but definitely have a role.
Conclusion
Failure to control case numbers places all of us at an unacceptable risk, and imposes unacceptable human and financial costs on our society and on our health services. There is an existing community of Long Covid sufferers who require recognition, assistance and support from government. The final scale of Long Covid is as yet unclear.
The "Living with Covid" policy, in choosing to allow high community transmission, comes at a very high economic and human price which has been, and will be, paid by the Irish people.
Tolerating unhindered spread in children is, at least, reckless. The costs include deaths and suffering from non-Covid illnesses, with outcomes worsened by delayed care or diagnosis, cancelled elective surgeries and unavailable ICU beds. To this can be added the effects of Long Covid, and dying from Covid-19 - avoidable deaths from a preventable disease.
We urge the government to adopt this Vaccines-plus strategy to bring Covid infections under far greater control, significantly improving the health and economy of Ireland.