The dramatic resurgence of the Covid-19 virus across Ireland can surely not have come as a surprise. The lifting of restrictions in order to restore many aspects of normal life was always going to carry with it significant risk. Our only chance of avoiding a resurgence of the virus was to identify the key actions that would keep the numbers of new infections down to the absolute minimum and to make sure that those actions were carried out thoroughly and effectively.

As we head rapidly towards another universal and very strict period of restrictions, it is slightly surreal to look back only three months to when, for a period, the daily number of new infections was in the teens in the Republic of Ireland and in single figures in Northern Ireland. At that point there was a real opportunity to fully suppress the virus across the whole island and to take the necessary action to prevent its reintroduction. That would have enabled an almost complete lifting of social restrictions and enabled important parts of the economy to operate normally.

However, we are back in a dangerous place, with little option but to reapply restrictions that we all hoped would never be needed again. The sooner the necessary action is taken the better. The temptation for politicians faced with unpalatable choices is always to wait until things deteriorate so that it is obvious to the whole population that drastic action is needed. When you are dealing with a deadly infectious disease, delay and indecision only multiplies the size of the problem that will eventually have to be faced. It also means that measures you need to take will probably have to be more intensive and remain in place for a considerably longer time.

Hospital Report

The current critical problems being faced across the island present, once again, an opportunity to grasp some nettles. The nettles will undoubtedly sting and the necessary actions will not be universally popular. We are well past the time when there should be any doubt that an integrated effort to defeat coronavirus is needed across the whole island.

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Blythe assurances that there is co-operation and communication between the two administrations is simply not good enough. At the heart of that integrated effort must be the development of a find, test, trace, isolate and support system that effectively controls the virus at a local level. There is now enough knowledge and expertise across the island, and Europe, about what works and what doesn’t to enable an enhanced and effective system to be brought into being. What it needs is political commitment, resources and effective management.

The best protection against the virus is a stretch of water, and we are foolish not to use our island advantage

One of the features that distinguishes countries that have been able to control the virus is that they have taken steps to try and prevent new cases coming in from elsewhere. In some places this has meant strict quarantine measures, and these have proven extremely effective, notwithstanding the occasional and predictable breach.

For Ireland introducing effective public health measures for people arriving faces serious obstacles. Firstly, the political problem of getting agreement between North and South to take such measures in tandem. This week Leo Varadkar dismissed out of hand the very possibility of such a thing happening because of the Border with Northern Ireland.

In truth it is already happening on one island, albeit a small one. The Isle of Man has instituted extremely tough entry restrictions on non-residents and even residents are only permitted to return if they apply in advance and conform to strict quarantine. The best protection against the virus is a stretch of water, and we are foolish not to use our island advantage.

We have, within our grasp, a chance to suppress the virus across the whole of our island. Doing so will require political courage and statecraft of the highest level

Perhaps the biggest barrier to effective public health measures is the power and influence of the airline and international tourist industries. But if there is a choice to be made between, on the one hand, the continuing problems with resurgence of the virus and all the serious health and economic problems that follow and, on the other, having to take action to enable passenger airlines and the tourist industry to survive substantial restrictions, then I’m quite sure which is the better option. Standing up to the vested interests that want to keep ports and airports open for the virus is one of the key actions that we should be demanding of our politicians.

Standing in the wings and getting steadily more vocal are the siren voices that are whispering seductive and simplistic notions such as “living with the virus” and “herd immunity”. What is being promoting is basically survival of the fittest. They advocate a situation where the virus is allowed, or even encouraged, to spread while aggressive measures are put in place to protect the small proportion of the population that they deem vulnerable. This potentially disastrous approach, untried and unproven as it is, would result in enormous death and disability.

We have, within our grasp, a chance to suppress the virus across the whole of our island. Doing so will require political courage and statecraft of the highest level. We should be vocally demanding that our politicians, North and South, step up to the plate.

Dr Gabriel Scally is president of epidemiology and public health at the Royal Society of Medicine in London