The Sars-CoV-2 virus has inflicted an avoidable death toll on the island of Ireland greater than the War of Independence, the Civil War and the Troubles combined. It would be an almighty insult to those who have lost friends and relatives or have suffered severe illness if we didn’t do everything to try to make sure this could never happen again.

In dealing with significant health service and public health crises and scandals, I’ve learned that people want three things when things go badly wrong. Firstly, and most importantly, they want to know the facts of what happened and what decision-making took place. Secondly, if there were serious failings, they want someone responsible to admit them, say sorry and mean it. And, thirdly, they want to make sure that never happens again.

With such a huge avoidable loss of life from Covid-19, there must be an inquiry providing facts and answers, but, even now, it is good to admit that things could have been better and say sorry for errors. What can’t wait is making sure it doesn’t happen again.

Hospital Report

The reassuring notion of everything getting back to normal after Covid-19 is desperately attractive. But epidemics never allow that to happen. The nature of dangerous infectious diseases is that they demand change in how we live our lives by coming back at us until we learn to eliminate them. In past centuries, the response has included clean water, better housing, an emphasis on ventilation and light, fever hospitals and isolation facilities, and vaccination. If we want to be rid of the virus, the new normal must involve changes in our lives and the effective use of modern scientific tools such as vaccination and rapid testing.

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It is already clear that vaccination may have to be repeated, probably regularly, until we get the virus under control worldwide. The failure of many European countries to support the calls to boost vaccine production worldwide using a waiver on the intellectual property rights of the vaccine companies is disgraceful. It is short-sighted for population health even though it is terrific news for the pharmaceutical companies’ profits. International companies profiting at the expense of lesser developed countries worldwide is one aspect of life that is clearly “business as usual”.

Lessons of the past

In getting rid of the virus, Ireland’s most successful approach will be to relearn the painful lessons that earlier generations were taught by diseases such as cholera, tuberculosis and typhoid. General public health environmental measures such as clean water and fresh air, and approaches such as isolation and quarantine, had reduced the toll of deaths from infectious diseases long before antibiotics and most vaccines were available. The nature of the Sars-CoV-2 virus, with its ability to produce dangerous variants, along with the limited and waning immunity gained from the current vaccines, suggests that we would be foolish in the extreme to put all our eggs in the vaccine basket.

For Ireland, the only successful long-term strategy will be one of “prevention and vaccination”. In this case, prevention means reducing the ability of the virus to spread. We know that spread is predominantly airborne, so that is where concerted action is needed. Starting now we need an effective programme to improve the ventilation and air purification in all enclosed places of work, trade and education. There is nothing revolutionary about this.

In the past, we had many examples of buildings designed and constructed precisely to prevent airborne disease. I attended school in one of them, on the Falls Road in Belfast. The northeast of Ireland was the epicentre of tuberculosis in Ireland, so it wasn’t surprising that in Belfast, schools were designed and built, right into the 1950s, based on maximising fresh air and sunlight. Covid-19 has changed forever the definition of what constitutes “fresh air” in enclosed spaces.

While ventilation and air filtration and purification systems will solve a significant part of the problem, the arrival of the Delta variant means we need to encourage the appropriate wearing of effective face masks until the virus is under control. The masks we wear in the future need to be appropriately manufactured to the EU standards; the days of simple cloth face coverings should be gone.

Respect

One feature that is sure to outlast the pandemic is the respect and support accorded to public health doctors. Tony Holohan, Ronan Glynn, Lorraine Doherty, the local directors of public health, the local public health specialists and many others have been the backbone of the response.

Minister for Health Stephen Donnelly’s announcement that public health doctors are to get consultant status and that new posts are being created has been long awaited and was warmly welcomed. We are going to need the public health workforce in good shape to deal with the inevitable outbreaks and flare-ups of Covid-19.

There is one aspect of the pandemic where normality remained undisturbed. The almost complete absence of meaningful all-island harmonisation and co-operation is a profoundly disappointing feature of the past 18 months in Ireland and has undoubtedly cost lives.

After all that’s been achieved over the previous 25 years in bringing the Troubles to an end, why could our politicians not just lay aside their prejudices and protect their people rather than their political purity? At times the North-South bickering was nothing short of disgraceful and reminiscent of the attitude I grew up with in Belfast – “I blame nobody else only them uns.” It is one bit of normality that we should consign to the dustbin.

Dr Gabriel Scally is visiting professor of public health, University of Bristol