All-Ireland exit strategy for Covid-19 restrictions is best, says expert

There is much unfinished business to be dealt with quickly before Ireland can begin to ease coronavirus restrictions, according to University of Limerick professor of general practice Liam Glynn.

While the critical question is how this can be done in a way that minimises the risk of a Covid-19 resurgence, in the meantime people should be required to use masks in public, border controls should be strengthened and contact tracing ramped up, he says.

In addition, a robust testing regime must be in place, backed by technology, including an app that will allow public health authorities to directly alert individuals if data taken from their smartphones suggest they have been in close contact with a confirmed case of Covid-19.

This app “has been in the pipeline for weeks” but has yet to be delivered, Glynn says.

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These measures should be in unison with Northern Ireland to maximise chances of restricting coronavirus. "Anything other than an all-Ireland approach is bananas. We are an island. [But] this is not possible without collaboration at the highest political level."

The eventual re-opening of the economy needs to be tempered by limiting non-essential travel into the country, especially from places that have higher level of infection, he said. Where travel is permitted, enforced quarantine for 14 days is necessary.

Reliable data

Ireland was ahead of the curve in responding to the pandemic with good measures and a high level of compliance, but now risks falling behind others, according to Glynn.

Data is key, he says. "If you don't have highly efficient testing and contact tracing, you don't have reliable data." In tandem, rapid testing is required. In Canada, this was down to a nine-hour turnaround. Even if Ireland got down to a turnaround between 24 to 48 hours, it would help a lot.

The thinking on masks has changed, he says. “It’s not about protecting yourself. It’s about protecting others . . . not transmitting an infection you may not know you have.”

Public health specialists stress reopening society is a long haul, marked by trial and error, and where there are different approaches side by side, it heightens the risk of the disease spreading.

Lessons from countries ahead of Ireland in easing restrictions will need to be carefully evaluated, including the latest on New Zealand’s “bubble approach”.

Prof Ruairí Brugha, head of the department of epidemiology and public health medicine at the Royal College of Surgeons Ireland (RCSI), says the date is not so important but what is in place by that point is.

Uncertainty around testing should be cleared up, he says. Current testing infrastructure needs to be complemented by good surveillance informed by validated antibody testing, which is vital to knowing what is happening in the community. This will enable better targeting of at-risk groups, says Brugha.

Rapid testing and quick contact tracing, informed by real-time information enables prompt warnings if the virus is erupting again, “so we can stamp it out”. This will also help determine levels of asymptomatic spread especially among younger people.

Brugha expects a plan will be announced on what is going to happen a week in advance, in a process that should be steered by Government with cross-society buy-in.

Workplace monitoring

In particular, “we need to look at the workplace as a setting for monitoring how well we’re doing; especially where you are going to have close physical proximity,” he adds.

While this will require agreement between employers and employees on how to monitor on a daily basis, it is “quite feasible”. People have become preoccupied with masks, but the effectiveness of temperature monitoring is shown to work, especially in picking up Covid-19 spikes.

This course at national and local level is critical as “we don’t know when a vaccine will come – it could be more than 12 to 18 months away” but evidence is emerging daily, informing the approach.

RCSI infectious disease specialist Prof Sam McConkey supports the New Zealand approach: eliminating coronavirus through 60 days of contact tracing; rapid self-isolation; using GPS location data; 14-day quarantine for travellers coming into the country; using cloth reusable masks for all; deployment of phone apps to show status; and phased re-openings.

Critically, this should involve creating “a bubble of seven million people on the island of Ireland”.

‘No border’

The joint approach with the North should range across face mask use, contact tracing, testing, duration of isolation and travel restrictions, while deploying the same way of processing data. It involves “no border” thinking, he says.

"In the island of Ireland the virus crosses our borders freely. The future of Donegal will be closely linked with its neighbours in Derry and Tyrone; Louth's future will mirror those of Armagh and Down."

He is hopeful the UK might decide to follow New Zealand and Australia, as they seem successful. The North would follow London, "and we can agree to go along with that so we could have our own little bubble on this island".

Yale University epidemiologist Prof Sten Vermund says geography must be factored because of differing disease levels, and consideration of what professions are allowed back to work when.

Construction workers are used to wearing masks and do not work in close proximity with one another, whereas routine dental work should be deferred because dentists work in close proximity to their patients’ respiratory systems.

A balancing of risks beyond public health is needed, he suggests, factoring in risk to economy, including human hardship. “We need a happy balance between extremes.”

Re-opening society requires a risk assessment. Hold off too long and economic damage is amplified. “If re-opening happens prematurely, you are inviting a second wave and really accomplish nothing.”