Second and third waves are inevitable and there's no clear exit strategy without a vaccine. That's the view of Jeremy Farrar, director of the UK's Wellcome Trust and a member of the World Health Organisation's SAGE committee, which advises the UK and German governments on Covid-19.
The notion that we could have a finite period of shutdown before a resumption of normal activity is now a non-runner.
Renewed outbreaks in China and a worrying incidence of reinfection in South Korea illustrate the difference between containment, which can potentially unravel, and eradication.
Ireland is still at the mitigation phase, trying to slow the spread of an epidemic that's already taken hold. Containment is still the goal.
Elimination will require a vaccine, which may take anything from six to 18 months to procure, manufacture and distribute.
Until then, the best we can hope for is a partial lifting of the restrictions, but where the line between containment and restarting the economy is drawn is going to prove highly contentious.
Will it be based on populations, in other words letting people under a certain age back to work or school or university? A paper by researchers at the University of Warwick in the UK suggests releasing those aged 20-30 who do not live with their parents is one possible route out of the lockdown.
Or will it be based on sectors of the economy, with certain types of businesses reopening but with strict limits on hours and numbers?
Or will geography, in other words the areas with the lowest incidence of cases, be the governing factor?
Even the partial lifting of restrictions, which have been extended to May 5th, will be dependent on the disease being brought under control, the State's chief medical officer Dr Tony Holohan said at the weekend. What "under control" means has never been explicitly stated, but we can assume it means at very least getting to a point where hospital admissions are falling, and the R0 number – the number of secondary infections generated by a single case – is below one, the dividing line between a disease spreading and contracting.
But does anyone really believe we’ll be attending concerts and major sporting events this summer? There’s simply not a hope in hell that a fixture like an All-Ireland final attracting upwards of 80,000 people will get the go-ahead, not while a virus of this severity lingers in the ether. How could authorities justify the risk?
A more pertinent question might be when are you next going to find yourself in a pub or a restaurant with 50 or 100 other people?
Italy, which has the world's second-highest Covid-19 death toll, is maintaining tight restrictions despite seeing a fall-off in the rate of reported infections. It also indicated that restaurants – it has one of the highest number of restaurants per capita in the world – will not be among the first wave of businesses allowed to reopen, effectively putting many out of business permanently.
Trade-offs
In Lombardy, where the country's outbreak began, officials have decided to allow children's clothing shops to open, but not bookshops such is the fear of another upsurge in cases.
Spain, also one of the worst-hit nations, has allowed some factories to reopen as well as some construction work to restart, but schools, bars, restaurants and other services remain closed to the public and Spaniards are still being directed to stay at home.
The worst-hit sectors of the economy here – retail, hospitality, travel, tourism – are also the big employers and the ones that drive the consumption wheel at the heart of the economy.
Despite suffering most, they will almost certainly stay under lockdown the longest. These are the difficult trade-offs we’re making.
If the twin objectives of easing the lockdown and restarting the economy are to be achieved, it will have to take place in the context of mass testing and contact tracing.
Like the UK, the Republic’s testing regime has fallen short for a number of reasons and this will have to be reversed in the coming weeks.
Biometric testing
Mass testing allows authorities identify the people and the sectors most at risk; to quarantine them; and hopefully halt the chains of transmission.
The countries that have tested most appear to be having the best results. South Korea has been among the most aggressive and has a death toll of just 222 people, significantly less than our figure despite having a population of 51 million, nearly 10 times the Republic’s.
The Irish Government’s goal is to increase testing to 15,000 or more a day and to be able to turn around tests within 48 hours. Currently we’re conducting between 2,000 and 3,000 a day and have a significant backlog.
If the coronavirus is raging in other parts of the world as we relax the restrictions here, authorities may also have to consider some form of biometric testing at airports and ports, something we currently do not have the technical capacity for and something the airlines are likely to oppose on economic grounds.
Balances between containment and economics are going to have to be struck until a vaccine arrives.
