Here we go again, another set of bad Covid-19 figures prompting another round of restrictions

So here we go again. Another set of bad Covid-19 figures prompting another round of restrictions, almost inevitably.

The Republic may have the lowest case numbers in the European Union at present but we have also had restrictions, including lockdown, imposed for longer than almost anywhere else.

Not only have we not found a way out of yo-yo restrictions but we are further away than ever from finding a lasting solution to the challenge of controlling the virus while keeping society open.

A vaccine cannot come soon enough.

Swimmers urged not to take a dip at the Forty Foot this Christmas

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Nphet advises restaurants be limited to takeaway and deliveries only after Christmas

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‘We will have to struggle on’: Cork businesses brace for further restrictions

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Northern Ireland to impose 8pm curfew in week after Christmas

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The Government’s Covid-19 plan with multiple layers of restrictions has had so many tweaks now it is barely recognisable. It seems set to suffer further neglect next week when the Cabinet decides on the latest call by public health officials for stricter measures to stop transmission.

Events of recent days show the decision-making process around Covid-19 is broken, with officials making a recommendation to Government, the Taoiseach half-disclosing it on television, and businesses and others who could be affected left to swing in the wind until Cabinet makes it mind up next Tuesday.

Public health officials say case numbers did not fall enough at the end of the second surge, and were not kept at that level for long enough. Since then, we have been unable to stop them increasing again this month, once Level 5 restrictions were lifted.

The growth rate of the virus is about 2 per cent and indications from GPs and testing centres point in recent days to more people showing symptoms and testing positive.

As a result, the National Public Health Emergency Team (Nphet) fears numbers could hit 1,200 cases a day by early January, roughly the level which prompted our most recent lockdown in late October.

Case numbers are only one metric in this pandemic, though; one-quarter of those testing positive have no symptoms and most of those with symptoms will have only a mild illness.

The trends for serious infections are harder to interpret. The number of Covid-19 patients in ICU and the number of deaths now are the same as they were in October.

Then, case numbers were four times higher, with 33 in ICU and five deaths a day. These numbers would not be out of place in an average flu season and the health service has at no time been overwhelmed.

In Ireland, though not in other European countries this winter, trends in serious illness have not followed case numbers, for some reason. This is still broadly the case despite higher incidence among older people since October.

There hasn’t been any excess mortality in Ireland since spring, a phenomenon that needs greater analysis. And thanks to absence of flu, hospitals are quieter this winter than they have been for many years.

‘Substantial outbreaks’

Where are the 330 or so new cases each day occurring? Once again, information is scant. Nphet officials on Thursday talked of “substantial outbreaks” in workplaces, at Christmas parties and at funerals, but gave no details.

The figures in HSE reports paint a different picture, as usual. Last week, the number of outbreaks linked to cafes and restaurants, and to pubs, was zero. Just one was linked to a hotel, according to the Health Protection Surveillance Centre.

Of course, it is often difficult to determine precisely where a person contracted the disease. Yet the absence of greater surveillance details suggests a system that is not keeping up with the patterns of transmission.

As chief medical officer Dr Tony Holohan told Government this month, "further progress is required in the timeliness and robustness of the public health response".

Nphet members are not slow to point the finger at the hospitality sector, yet we hear much less about the role of healthcare settings in driving transmission of the virus.

Since July, there have been 100 outbreaks in hospitals, many substantial, and 93 in nursing homes. The two counties with the highest case numbers recently, Donegal and Kilkenny, saw large outbreaks in their local hospitals.

Undoubtedly many of these cases are brought in from the surrounding community. But, equally, it is likely that people are picking up the virus from someone infected in a hospital, or nursing home.

It is small wonder, therefore, that Nphet has in recent days proposed the setting up of an infection control team to tackle hospital outbreaks.

Infection over-spill

The other factor driving up cases in the Republic is the over-spill of infection from the North, where incidence is much higher. The two jurisdictions are almost comically out of synch these days in terms of restrictions, despite repeated nods towards an all-Ireland approach. The absence of any controls on cross-Border movement makes it harder to avoid the kind of blanket restrictions which are Nphet’s favourite way of controlling virus spread.

Taoiseach Micheál Martin has said the Cabinet will "seriously consider" Nphet's proposals to restrict travel and mixing and to close restaurants. Spooked perhaps by what has happened in the rest of Europe, the Government seems less willing to resist Nphet than it was in the autumn.

The arrival of a vaccine will tilt the odds against the virus, but not before we may have to endure a few more rounds of this merry-go-round.

So it seems likely the current easing of measures will be curtailed, and that further restrictions, perhaps even another lockdown, will be introduced in January.

And what then? How do we escape the cycle of repeated lockdowns? Do we try to drive cases down to the low levels seen at the end of the summer, which means a longer lockdown and more economic carnage?

Or do we settle for a more modest target, when this approach bought us just a month of easing of restrictions this time around?

It does not sound like much of a choice. But without faster testing, better control of outbreaks, stricter quarantine and other measures that have worked elsewhere, it’s all we have as a policy at the moment.