Zero Covid revisited…
As you could certainly be forgiven for not remembering them, the key provisions of Level 1 of the Government’s Plan for Living with COVID-19 included the following:
- 10 visitors to your home from up to 3 different households;
- Gatherings outside of up to 50 people;
- 100 people at weddings and other indoor events;
- Cafes, restaurants and pubs open;
- No restrictions on domestic travel.
Not “normality” as we knew it pre-Covid, but light years more relaxed than the gloom in which we are shrouded today and for the next month at least.
According to Professor Gerry Killeen, chair of Applied Pathogen Ecology at UCC and Founding Member, Independent Scientific Advocacy Group on COVID-19 for the island of Ireland (ISAG), Level 1 is within a couple of months’ grasp.
Writing in The Irish Examiner on 30 December, Professor Killeen first reviewed where we are now.
Having contained the first two waves, Ireland is struggling to contain the third and largest so far. Covid is continuously evolving “to trump the various winning hands we humans have relied on to keep it at bay”, as the recent emergence of a more infectious new variant of the virus demonstrates.
So, a simple strategy of lurching and limping between alternating lockdown and loosening will deliver diminishing bang for the buck with each new phase of restriction shrinking case incidence levels at lower rates than the previous one. Indeed, Professor Killeen suggests that a fourth wave is already brewing, driven by the new variant, even as we surf the third.
The good news:
…there certainly are plenty of options for stepping up our fight against this more transmissible new variant and retaking control of our own destinies, perhaps in time to enjoy a St. Patrick’s day worthy of celebration under the appealingly lenient conditions of level1.
Professor Killeen is not alone in his view. Making a parallel case in The Irish Times on 4 January, Roisin Shortall, joint leader of the Social Democrats, invited us to:
Imagine a situation where Irish residents could move unrestricted around the island from, say, mid-March; what a boon to the hospitality sector and think of how many people could get back to work. Such a situation may be only 12 or so difficult but do-able weeks away, if we show the ambition of other countries.
According to Professor Killeen, many of the tools for mastering the virus are standard procedures in Covid-free countries like Australia:
More accessible testing, more inclusive testing criteria, compulsory airport quarantine, identity-based border bubbles to facilitate limited essential travel between adjacent counties (including those in the North), trailer exchange facilities at our ports so that goods can enter without drivers, and comprehensive outbreak investigation led by expert public health physicians.
First step is to switch from the current strategy of living with the virus to one of fighting it, armed with an ambitious plan for aggressive suppression and elimination “so we can hold the fort securely until vaccine scale up is completed”. That won’t be until much later in the year — maybe another couple of lockdown/loosening cycles away.
A major milestone in the journey would be to get the country back below 10 cases per day, where we were last summer. From that base camp, public health teams would have “a fighting chance of chasing Covid out of Ireland and keeping it out”
And simply improving what we are already doing can get us to that milestone faster.
For example, more rigorous implementation could be achieved, while also addressing ongoing mass unemployment, by mobilising small armies of community-based workers armed with clipboards, identity badges and the authority to issue on-the-spot fines for non-compliance with basic regulations like mask-wearing, social distancing and close contact quarantine requirements.
This would allow our gardaí and HSA staff to focus on issues that really need their attention, such as enforcement of local travel restrictions and high-risk workplace inspections.
Professor Killeen’s article is in tune with the 7-point plan proposed by himself and his founding colleagues in the ISAG — all distinguished academics, mainly in health fields. The outline plan is accessible on their website (https://www.isagcovid19.org/) but here is a crude summary:
- Continue current severe restrictions until transmission is wrung out of the community;
- “Ring of steel” quarantine of incoming travellers, supervised rather than self-policed;
- Boundary management: protect areas, counties or regions where the virus has been eliminated by preventing incursions from other parts of the country where it hasn’t;
- Promote and enforce the “basics”: hand hygiene, social distancing, masks, ventilation, etc.
- Especially when case numbers get low enough, rigorous application of testing, tracing and isolation can nip new outbreaks in the bud;
- Regional control: restrictions should be able to be eased or enforced on a zonal, not just national, basis;
- Support those affected: make mandatory isolation painless, financially and logistically.
Unsurprisingly, there is no dispute on the desirability or worthiness of “Zero Covid” as a national policy goal. But, despite plenty of media profile, the kind of “intensive” approach proposed by Professor Killeen and his colleagues has won little public traction.
Lots of cold water has been poured on the practicality; whether this holy grail is attainable at all, whether individual aspects (e.g., managing the border) are achievable, whether the state would be capable of executing the strategy efficiently and whether the public would wear it. The arrival of the vaccine has also weakened the case for the “total war” approach, even if completion of the programme is at least 6 months away.
On the other hand, the sudden recent spike in case numbers — to over three times the level of the highest peak of the first wave, and the return of a severe indefinite lockdown haven’t exactly burnished the credentials of “muddling through” as a public policy success story. Case numbers have swamped mitigants like test and trace, leaving the government chasing rather than controlling the momentum of the virus, like a jockey trying to control a galloping horse without benefit of reins or stirrups.
Hence the revival of interest in the Zero option.
No battle plan survives its first encounter with the enemy entirely intact. Painting a picture is much easier than recreating its subject in three dimensions. Like “Get Brexit done”, “Zero Covid” exists more at the level of conceptual vision than plan, even if its proposed measures draw on successful international experience. The details are a perfect habitat for many unappealing devils. It sounds good in theory but would require an immense dedicated and co-ordinated national effort that might not work much better in practice than what we are doing currently.
An important but selfish reason for the Government to be cautious about espousing Zero Covid now is that it would be a repudiation of the “living with Covid” strategy of the past 10 months. The Government would as likely pay a higher political price for getting it wrong then than reap a reward for getting it right now.
A worthier alibi for caution is that no other country in Western Europe has gone “full throttle” for Zero Covid. Ireland being an island doesn’t position us a great deal more favourably than countries on mainland Europe to try it out. We still have a land border to protect just as they have.
Though rigorous policing and enforcement might seem superficially more certain than trust and voluntarism to assure rock solid results rather than just expenditure of effort, that outcome is not guaranteed. Compulsion inevitably engenders some level of resistance and its supervision itself would constitute a significant additional layer and kind of effort.
One thing that is clear is that Zero Covid would require throwing plenty of additional bodies at the problem in a systematic, process-driven way. For example, it is hard to see policing of the border between North and South (never mind county or regional borders within the South) being effective without 24/7 deployment of people at every crossing point — and that leaves aside the question of whether a way can be found only to police rather than seal that border; i.e., allow some traffic through but still keep the virus out.
Similarly, ensuring rather than simply hoping that incoming travellers will quarantine depends on people and processes for monitoring its observance. And ensuring compliance by people resident within the state with their hygiene and social distancing obligations would require, as Professor Killeen said, “mobilising small armies of community-based workers armed with clipboards, identity badges, and the authority to issue on-the-spot fines…”
If a Russian invasion force landed on the beaches of Wexford tomorrow, no government would feel obliged to adhere to EU procurement rules in sourcing more firepower to resist them. But even if peacetime norms are set aside, it would still take time and process to recruit, train and deploy civilian “armies” of any scale. Hastily assembled ones would be a magnet for the Captain Mainwarings and Warden Hodges of this world; people who love being in charge and giving orders, but whose egos exceed their abilities.
I suspect the Government’s read of the tea leaves of the public mood about Covid runs like this.
Of course, we would like to see it eliminated altogether and the sooner the better, just as many of us would like to be leaner, fitter and have a marathon to our name. But only some of us are “up for” the full measure of discipline and self-denial needed to get from here to there. Ambition is easy, achievement is less so.
Similarly, while the presence of Covid is probably the most intrusive and dangerous disruption to routine and normality in our lifetimes, it is still fundamentally transient and incidental, not an existential threat to our way of life or even, for most of us, an actual threat to our own individual lives. When we speak of being engaged in a “war” against Covid, the term is currently applied at least as much rhetorically as substantively.
There is only so much sacrifice we are willing to bear. Though that capacity is considerable, time alone will tell if it is enough or if it has been wisely directed.