All the talk now is of reopening. We all want it. The Government wants it and has given us the plan. Nobody can fully predict what might happen next, but the easing of restrictions is to be welcomed after the difficult few months we’ve been through together. Hopefully we’ve learnt how to make things as safe as we can, observing public health guidelines. We know that risks still prevail because the virus is still among us and has become more transmissible. We must continue to avoid the three Cs — Crowds, Closed spaces and Close contact — especially if all three of these are happening. The main variant in Ireland, the B117/UK variant, is at least 40pc more transmissible. This means we need to ensure more than ever that public health guidelines are followed because they will have an impact on the spread of any variant.
e also know how to mitigate against spread indoors: ensure there’s good ventilation and limited numbers, wearing a mask when we can. We need to keep things outdoors as much as possible as that is a highly effective mitigator. These measures work and we must try to keep observing them in these next few months.
Despite these concerns, we have a tremendous trump card. We didn’t have it last summer when we reopened, and ended up closing again later in the year. Science has given us several highly efficacious and safe vaccines and we will now begin to see the vaccine dividend. People who have received the AstraZeneca vaccine can meet freely with others who are vaccinated or who are not vulnerable, four weeks after the first shot. This should provide some relief for the over-60s who were given no choice but to take the AstraZeneca vaccine. It’s two weeks for Johnson & Johnson or Moderna, and one week for Pfizer/BioNTech.
Beyond that, surely widespread vaccination means we can reopen safely? The answer is yes, but we need to do it with a degree of caution. This is because we need to have as many of our people as possible vaccinated ahead of major relaxation. If only half of us are vaccinated, the virus might start spreading again like wildfire, giving rise to another huge surge. And we don’t want that.
We can look to two countries for guidance: Israel and Chile. These countries have raced ahead with their vaccination campaigns and Israel announced two weeks ago that it is exiting the pandemic. The numbers look great there: case numbers, hospitalisations and deaths have all fallen significantly. But Chile is a different story. Despite widespread vaccination, it has had to go back into another lockdown. Why the difference?
Let’s look first at Israel. More than half the population there are fully vaccinated, meaning they have received two shots of the Pfizer/BioNTech vaccine. Nearly everyone has had one shot, which confers over 80pc protection. Shops, hotels, concert venues and cinemas have all reopened. Masks are still needed outside the home though, and there are limits on numbers allowed indoors. Everything continues to look good and we watch Israel closely.
In Chile, more than 40pc have had at least one shot of either the Pfizer/BioNTech or China’s Sinovac Biotech vaccines. And yet case numbers have increased hugely and the healthcare system has been put under severe pressure. There are likely to be several reasons for this. One is that the speed of the vaccination programme may have given the country a false sense of security and it opened too fast. People were eager to socialise. There were no controls on people entering Chile. People could travel for holidays and the lack of an adequate contact tracing system led to travellers bringing the virus back into the country. Restaurants, shopping malls, casinos, gyms and churches all reopened. These things are likely to have led to the rise in cases. Another factor, however, might be the use of the Sinovac vaccine, although experts disagree on that. Although it is less efficacious at preventing infections, especially after one shot, it gives 100pc protection against severe disease and death.
Making comparisons between Israel and Chile is difficult, however, because of different demographics, cultural differences and possibly a different range of virus variants. But experts agree that the rise in cases in Chile is down to a government that wasn’t very strict at implementing restrictions and people getting too relaxed, through no real fault of their own, given the long lockdown.
One important point is, although there has been a steep rise in case numbers, this hasn’t been reflected in a rise in the death toll. This is important as it indicates that the vaccines are doing their job and preventing death. Most of the people who do end up in intensive care are in their 40s and 50s, which although obviously regrettable, are at a lower risk of death. Experts in Chile are now saying that for case numbers to go down, the vaccines need to reach people over 20 — the ones who are most likely to be spreading the virus.
There is widespread agreement that over 80pc need to be vaccinated to prevent further surges, although in truth we don’t know the exact percentage. This is likely to be in the right ballpark as it will mean all the older and vulnerable people will be protected to a large degree. If young people become infected, it is less worrying because they rarely progress to severe disease, although a small number might. And there will still be breakthrough infections among those who are vaccinated, most likely from the variants. This has recently been shown in a study in the US which found two cases of infection among a group of vaccinated healthcare workers, and both were with a variant different to the one from which the vaccine was made. Neither progressed into severe disease — which, along with other evidence, indicates that the current vaccines will still help against variants.
Professor Chris Whitty, England’s chief medical officer, has said there will be another surge in Covid-19 in the UK but it’s not clear how big that surge will be. We can anticipate something similar. If, however, we do what Chile did and open too quickly when there are still a lot of unvaccinated people, we risk that surge coming sooner and being a big one. As the summer rolls on though, and the level of vaccination goes up, we can start to think about reopening more and more. There will still be cases, and some may end up in hospital, especially if they are infected with variants. But hopefully this will be at a level we can manage and we can help those people with the newer treatments that are coming. That will mean no need for another lockdown.
As winter approaches we can consider booster shots for older and vulnerable people, ensuring that our hospitals are not put under pressure again. But the truth is we still can’t be sure. One thing we can be sure of from what has happened in Israel, mass vaccination is key, as is a measured response over the next few months. We’re definitely heading in the right direction.
The winter of 2021/22 might then look like any other winter. If we continue to observe public health guidelines, there might even be the bonus of low numbers of people on trolleys because of fewer respiratory diseases. This raises an important question. If people can’t ring up Joe Duffy to talk about Covid-19 and the many issues around it, or about trolleys in hospitals, what will they ring about? I’m sure they’ll find something.
Luke O’Neill is professor of biochemistry in the School of Biochemistry and Immunology at Trinity College Dublin