Covid-19 infections are surging again. But how worried should we be? And how likely is a reintroduction of mask mandates – or any other measures – to stop the spread?
How high are infections?
The metric we are all used to – daily case numbers – has been basically meaningless for some time now. “PCR and antigen are worse than useless [for monitoring spread],” says one senior source. Testing is restricted to people in “at-risk” categories and officials suspect the reporting of positive antigen tests is now haphazard at best. This is because the entire model of monitoring Covid built at the height of the pandemic is being dismantled. This means less testing and contact tracing – something that tracers themselves are raising red flags over, but the HSE says is the right call.
So what is being watched?
Hospital numbers, wastewater samples and a so-called sentinel network of GPs who carry out swabbing to measure flu (and now Covid rates) in the population. Hospital numbers are growing but are some way short of the March wave, which peaked at 1,600 but prompted no new restrictions to be introduced.
How long is this going to last?
Evidence from Portugal suggests the spike in infection driven by the currently-dominant subvariants of Omicron results in a wave of about six weeks. “This is going to be a shortish, four- to five-week wave and we’re into the second week of it already,” said a Department of Health source.
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Who is most worried?
Naturally, people who work in healthcare – and more specifically in the hospital system. HSE chief clinical officer Dr Colm Henry told RTÉ on Monday he was “very concerned”. INMO general secretary Phil Ní Sheaghdha has called for the reintroduction of mandatory mask-wearing in some areas of society, something HSE chief executive Paul Reid has indicated tentative support for. The situation in hospitals is a “nightmare”, admits one official, but it’s not the nightmare of collapsing hospitals and teeming morgues seen at the start of the pandemic, rather a logistical and management problem that pushes the system and those working in it extremely hard.
And is it going to happen?
As of now, it doesn’t look likely. The successor group to Nphet, chaired by Dr Tony Holohan on what will be one of his last days as chief medical officer, meets next Wednesday. But sources do not expect new restrictions to be on the agenda. One said that widespread mask mandates would probably slow the peak of the wave a little, spreading the cases out, making the pressure on hospitals less acute. But the current curve will not be crushed as long as widespread socialising continues. “You’re not going to wear masks in the pub and people aren’t going to stay home,” said one source. “Unless there’s huge fatalities, the system will be expected to cope,” a senior HSE official said.
Some medics believe mask mandates are not needed. Martin Cormican, professor of bacteriology at NUI Galway and a former Nphet member, said the evidence that masks could help to stop what is currently under way is “on balance, limited” – and that the bar for curtailing personal freedoms has not been met. “Is Covid doing so much harm to society that it requires these measures to stop its spread? In my view the answer is no,” he said.
So what will happen?
Expect a big emphasis on vaccination, especially among vulnerable groups. Take-up rates are lagging but vaccines keep people out of hospital and intensive care. More generally, senior HSE sources expect to substantially dismantle testing and tracing during the summer and are planning (depending on advice from the National Immunisation Advisory Council) for a campaign to vaccinate the whole population again from around October. This will be done through primary care settings and, to a lesser extent, a scaled-back network of vaccination centres.
The fear among policymakers and officials is not so much that this wave will overwhelm the system – but rather that Covid-19, or a new variant, could combine with flu and other diseases in winter to put real pressure on again.
What does all this tell us?
For now, Covid is less a challenge that involves all of society all at once but rather another chronic issue that compounds long-standing problems in the health service. “What we have here is a winter trolley crisis – it’s just happening three or four times a year,” said one source.
“That means they’re going to need to be better prepared, need more capacity and we need to improve the health system,” said another official.