August 14, 2022

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Thanks to vaccination and the virus, the concern about Covid overwhelming our hospitals has dissipated...

Thanks to vaccination and the virus, the concern about Covid overwhelming our hospitals has dissipated for now. Vaccines give incredible protection and with help from Charles Darwin’s nugget of brilliance, good old evolution, the changes the virus has made have helped too. A virus doesn’t care whether it kills or causes disease, all it focuses on is survival and transmission.
here is no master plan; there is a constant fumbling in the dark until the right formula is found. It changes randomly by making mistakes as it copies itself. Sometimes those mistakes turn out to be beneficial and so the virus gains an advantage. If someone has Covid, they are not transmitting a single virus particle to others; it is a cloud of particles, like dust drifting in a shaft of light. Some particles are identical, but others differ slightly. The key is that when you inhale a nice big dose of this cloud, you are sprinkling your upper airways with a smattering of variation. The particles adapt to replicating in you, move to the next host, and the cloud of particles continues to evolve.

Omicron is the latest version, and it has a slightly different palate. It prefers to stay in your nose rather than hanging out in your lungs. It can still go there but does so with less frequency than versions such as Delta. That’s not to say it can’t cause disease — it can, and plenty of it — but when you combine its natural tendencies with the super protection of vaccination then we have a formula to protect our hospitals.
We got lucky with Omicron, in my opinion, not because it was a walk in the park (far from it) but because it could have been much worse. The process of change and evolution is still occurring though; we don’t know what will come next, it isn’t suffering from fatigue, and it isn’t necessarily going to get milder.

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Last week, a study of humans purposely infected with SARS-CoV-2 reported early findings. It showed that the people infected released infectious virus after just two days. It indicated that antigen tests were a reliable way of detecting infectious virus and, if used correctly and regularly, will have a major impact on breaking chains of transmission. It also showed that symptoms were not correlated with the amount of virus in a person — in other words, symptoms are not a reliable way of determining someone’s ability to transmit to others or not. This supports numerous other studies saying the same thing.
Despite that, in Ireland we place emphasis on symptoms. Are you symptomatic? Then stay at home, and at the end of your isolation you are clear to go “if you have no symptoms or your symptoms are mostly gone”, according to HSE guidelines. If you continue to test positive by antigen, ignore. In fact, don’t even do an antigen at the end of the isolation period, just be extra careful.
This policy limits some infected people from interacting with others during their most infectious period, but it is clearly not about stopping transmission in the population.
Based on this, we must conclude that we are in the slow-release phase of the pandemic, drip-feeding Covid over time. The policy suggests an approach centred on the idea that most people won’t get very sick, so we don’t need to stop it. This creates a conflict, however: it is safe to return to activities, but we need to isolate if we get it. If it’s safe, why do we isolate? How do we reconcile this conflict of messaging? Don’t bother, because very soon, these contradictions may well disappear if all restrictions are removed, and isolation periods go or at least reduce dramatically. In Denmark for example, if positive without symptoms or with mild symptoms, you isolate for only four days — and even that is likely to be removed soon.

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It seems that Covid will be treated like any other disease. Stay at home if unwell, go to hospital if very unwell. We are attempting to strike an equilibrium just as we do with other diseases. The reality though, is that this virus is not the flu, regardless of how much we want it to be. Does that mean we should continue with restrictions? No, I don’t think so. We have been restricted for so long, we cannot continue in the same vein, but to maintain an equilibrium with Covid, we need to fully appreciate what it will mean to “live with Covid” based on our current trajectory, and accept it.
First, accept that Covid is not gone. It still circles the world, prowling, skulking, pillaging, preying upon the weak and lashing its tongue against the doors of most houses.
Second, accept that Covid is not just about hospitalisations. It is about the rate it spreads, the level of infection in the country, the level of disruption it causes, the number of school days lost to sickness, the number of work days lost to sickness and the long-term effects in some, and this risk is not gone. Lots and lots of people continue to be infected, continue to get sick, even just for a few days, continue to miss school, work, etc. This is the reality we now live in, and we are being told to accept it.
What about next winter? Well, we know with other coronaviruses that peak infection levels happen in January. SARS-CoV-2 seems similar. Think about the number of infections we had this January. Think about all those “minor” illnesses for most people. Think about what that would have been like without restrictions — how many more cases would there have been? Think about the regular disruption that would cause to society if that was every January for the foreseeable. And remember, this winter most people got boosters. What if we don’t get those next winter so immunity is lower? Add in influenza, which also typically peaks in January, and can we honestly say that our lives won’t be disrupted? This is “living with Covid” as it currently exists and that is without even mentioning variants that are, I’m sorry to say, emerging constantly.

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I’m not making predictions; no one can tell the future. I’m merely playing out a scenario that we need to accept is a distinct possibility (but not an inevitability). This is a scenario that our policy makers should be living and breathing, trying to avoid. There should be no talk of inquiries to establish how we did as if it was over, but rather, experts should be huddling, building plans for how we are going to keep going.
Policy makers should explain to us exactly what is being done to prepare for the pessimistic scenario. If this is a period of ceasefire, please don’t lay down arms — prepare for the next onslaught! They should plan pessimistically so that the public can live optimistically.


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