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AN ADVISER TO the World Health Organization says Ireland should allow Covid-19 to spread in a “controlled” manner among people under the age of 60.
Addressing Dáil’s Special Committee on Covid-19, Dr. Johan Giesecke, a former chief epidemiologist in Sweden, said the government should protect the elderly with frequent testing of nursing home staff and residents.
He said Sweden never had a herd immunity goal, but rather the goal of protecting the elderly and vulnerable. This group should minimize their contact, adhere to social distancing, and stay home when ill, even more so than the general population.
He said intensive contact tracing and contact testing is key to controlling the virus.
He warned against building a Covid strategy in the face of the imminent arrival of a vaccine.
“We may have to wait and it may not be very effective for those who need it most,” he said.
Professor Kirsten Schaffer, a consulting microbiologist at St. Vincent’s University Hospital, clinical professor at University College Dublin and president of the Irish Society for Clinical Microbiology, told the committee that more granular details are needed on where the virus is spreading.
He said that epidemiological data are not clear and stated that while he agrees with the government’s roadmap, he believes that some of the measures imposed on some sectors are forceful instruments.
He also advised against “crude recommendations” stating that actions should be based on identified outbreaks.
No clear epidemiological evidence
Current epidemiological evidence does not clearly show what is needed or necessary, he said.
Currently, if someone tests positive, they are not asked if they were in a restaurant, they are not asked if they went to a house party recently, Schaffer said.
“It is vital that we collect this data,” he said, adding that it could point to where the virus is spreading, and therefore authorities could explain why measures are being imposed on society.
He said that data is being collected in Germany and indicates that the increase in cases is associated with congregated settings such as family gatherings, house parties and people who do not adhere to social distancing.
Explaining the rationale for the decision to ban indoor dining in restaurants and pubs, Professor Philip Nolan said last week that the resources and data are not available, stating that “public health would trace the source if they had the resources to do so, but they do not and must prioritize the management of the cases ”.
Keeping community transmission low to allow hospitals to function is what Schaffer advocates, stating that the economy should be allowed to open up.
She is not in favor of herd immunity, stating that the “price would be too high,” but said there should be a level to maintain community transmission and hospital cases as well.
Giesecke also told the committee that he is not close to schools and warned against “authoritarian and undemocratic decisions by the authorities.”
The committee was also told that the government should wait until at least a year before starting to make comparisons between countries and the different strategies used.
Schaffer agreed, stating:
Stop targeting a Covid-free Ireland or even levels as low as July at the end of the lockdown.
She said now is the time to change course. There is a divergence in society between the younger and older generations, and there is a risk of losing public acceptance, she said.
Nursing homes
Speaking about nursing homes, experts told the committee that it is difficult to keep the virus out of nursing homes, but that rigorous testing is very important.
The situation now is very different compared to March, Schaffer said.
In March and in the early days of the pandemic, no PPE was used, so “we had terrible outbreaks in nursing homes.”
He said that we now know that masks should be worn, that PPE should be worn and that we should test asymptomatic healthcare workers.
Giesecke said it was similar in Sweden, noting that the high number of cases in nursing homes was due to the unavailability of PPE.
“The situation is very different now,” he said.
Schaffer said the trial and trace period is very important, stating that it can take 48 to 72 hours to get a trial appointment and another 24 hours to get a result, with a variable rate of close contact tracing.
He expressed concern about contacting only 50% of close contacts on the 7th; this is too long, he said.
More transparency and detailed data are needed on where outbreaks are occurring. He said authorities must show the percentage of contact tracing that occurs both inside and outside of Dublin.
Speaking about the aftermath of Covid-19, Professor Sam McConkey, head of the Department of International Health and Tropical Medicine at the Royal College of Surgeons in Ireland (RCSI) said that the data is not yet available, stating that while it is being talked about a lot in the media, “nobody knows.”
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He called for an elimination strategy and then extremely limited travel between all countries.
Travel
On travel, Schaffer said he spoke to public health yesterday and they are not aware of any outbreaks associated with travel.
There is little risk on a flight, he explained, as wearing a mask is mandatory.
What people do on vacation could be the problem, he added.
Schaffer said that if someone travels to Italy or Greece “to sunbathe” and wears a mask on the flight, wears a mask indoors and adheres to social distancing while abroad, they will run a lower risk of transmission “than to be in Ireland and go to a party at home ”.
He advocated for a red list, rather than a green list for travel, and claimed that authorities could actively track people arriving from those countries and it would generate more acceptance from the public.
A review of NPHET’s terms of reference should also take place, said Schaffer, who also called for a governance and communication review of Ireland’s strategy.
When asked about wearing masks, Giesecke said that masks are not compulsory in Sweden and they are not compulsory in schools. In his opinion, the evidence for the use of masks is “scant”.
McConkey said that “if we fracture we will not succeed,” and said how divisive this pandemic has been has been underestimated.
People Before Profit TD Richard Boyd Barrett said that some people are afraid to have such a debate, noting that some believe it undermines the government’s message. He said that political control should not overshadow the opinions of some experts.
In closing, Schaffer welcomed today’s discussion in committee, stating:
“We haven’t debated enough about what facts exist and where we want to proceed.”
Giesecke concluded by warning against introducing emergency legislation when it is not necessary, stating that most adhere to advice when asked. He said this virus will be with us “for a long time”, and had doubts that a vaccine would be found before Easter.
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