- 08 May 20
Increasingly, there is evidence that coronavirus has been active across the world earlier than had been assumed – and Ireland is unlikely to be an exception. Anecdotally, there is evidence of a strange flu-like bug that was being passed around within the community in January and February. So what are the facts? Only large-scale testing – including antibody testing – will deliver the truth…
The news that the reproductive rate of Covid-19 is down to 0.5 and that virus-related admissions of Irish people – or every gender, ethnic background, and country of origin – to hospital and intensive care units have halved in the last week is very welcome. Looks like we’re getting on top of the thing, doesn’t it?
On the other hand, another 29 Irish people have died (May 7) and the Chief Medical Officer Dr Tony Holohan says that the overall numbers are still too high.
So… which is it? And if they’re still too high, why is that? Everyone is doing what they’re supposed to do, right? So how come the numbers?
Is it that the model is wrong or that some Irish people aren’t observing the protocols? If the latter, who are they and shouldn’t they be targeted in a meaningful way with the right kind of messages and persuasion? We really do need answers.
Alright, there is the obvious one: the authorities didn’t act quickly enough in relation to nursing homes or residential care centres. Around 60% of deaths have taken place in these. Honestly, it is very hard to understand how this was missed so badly, but it is best not to get too embroiled in that. It was an extraordinarily difficult, unprecedented situation. The authorities in Ireland did as well as, or better than, most others in Europe. We should be grateful for that not inconsiderable mercy.
That said, there is a recurrent problem in Ireland with public health and public safety. It boils down to this: policymakers in both health and justice know well that most Irish people don’t behave in ways that endanger others. Only a small minority is prone to excess, but there is a tendency to drag everyone under the one umbrella, with the effect that the policies decided on are often an affront to common sense.
We don’t invest nearly enough in consensus-building, nor in the kind of deliberative policy-making found in many other Northern European countries; nor do we focus effectively enough on precise, targeted initiatives. Yes, the latter would demand time and resources. We’ve had a historic issue with that in our dysfunctional health and hospital system. And our Gardai have long complained about the paperwork that keeps them off the street.
But the upshot on both counts is policies and implementations that are frequently so adrift from what rational citizens see happening that irritation, impatience and frustration are generated – which are followed, over time, by disagreement and disregard for the law.
A ‘Flu’ That Wasn’t The Flu
It’s happening now with Covid-19. The numbers come thick and fast – it is the cornerstone ritual on the evening news every day now – but they clearly only tell part of the story. Whether this is because the health experts don’t know more or are choosing to manage the information that is given to Irish people is something we’ll only discover later.
Granted, if there’s no tangible evidence supporting an inference, then an expert, quite rightly, won’t endorse it. But what if the evidence is hiding in plain sight? What if something is indeed happening, but nobody has been looking in the right place?
Almost everything we’ve done on Covid-19 derives from a particular epidemiological narrative and time-line. But now it’s getting complicated. For a start, the virus has been circulating for longer than was originally thought. Many more have been infected than the official figures show. We just don’t have a grasp yet on how many.
So far, what think we know has come from public health experts, epidemiologists in particular. But now other researchers – academic and citizens among them – have been probing the data to see what can be found. And things are getting very interesting indeed.
In Italy, France and the USA, they have re-examined autopsy results and swabs from patients that were infected with a mystery flu or pneumonia between December 2019 and February 2020.
They have discovered that, as we suggested here ten days ago, Covid-19 was in circulation, on three continents, up to six weeks before it was identified. It’s implausible that Ireland was an exception.
While Dr. Tony Holohan (pictured) seemed to dismiss the idea at the nightly press conference on Thursday, Leo Varadkar acknowledged as much in the Dáil on May 7, adding that more research is needed. "Time will tell," he said. Too damn right! But let’s not put finding out on the long finger.
The truth is that Irish people need somebody to chase this information down fast, because it would potentially change everything. Who’s doing it? At the moment, the suspicion is that it is not seen as a priority. That should be changed immediately. Because, there is widespread anecdotal evidence of a ‘flu’ that wasn’t the flu – and which affected a serious number of Irish people in the first couple of months of this year. Maybe it was the coronavirus. Maybe it wasn’t. We need to find out.
And, if – as looks increasingly likely – the disease was indeed here, how many were infected? The only way we can really know is through blood tests.
In Italy, they’re on it. Blood tests for antibodies are under way in several regions, including Lombardy – which has been hammered by the coronavirus – and the region around Rome. They’ll do 150,000 tests on health workers and police – people who were most exposed to the virus.
This exercise will dovetail with other studies from Germany, the Netherlands and a number of locations in the United States. Those undertaken to date have delivered varying results. Depending on the region, and the test used, anywhere from 2% to 30% of certain populations have already been infected with the virus. In New York city, on April 27, Governor Andrew Cuomo announced that 24.7% of people had tested positive.
The German study (carried out in the town of Gangekt, which was a Covid-19 hot spot) suggests that the infection rate could be at least ten times greater than we have so far been told, and therefore that COVID-19 cases are an even smaller fraction of the true number of people infected by the coronavirus.
We Need Reliable Antibody Tests
In fairness to the Irish medical advisors, this is a controversial process and many scientists are uneasy about results so far. There are potentially issues with the selection of participants, the assumptions underlying adjustments for variables and – most importantly – the reliability of at least some of the antibody tests themselves. Also, while the researchers in the Netherlands found that infection has been much higher than thought, they also say that the country is not yet near the “herd immunity” that some had hoped for.
Nonetheless, the consistency is remarkable and suggests that Covid-19 may not be as dangerous to the general population as was thought.
That said, overall population mortality from the virus, including patterns found by Gerard McCarthy of NUI Maynooth and Pádraig MacCarron of the University of Limerick and by the Financial Times in the UK, show us just how lethal Covid-19 is for some, whether age or a pre-existing condition is the deciding factor.
So, even if the exploratory research results are borne out and the death rate is well below 1%, control measures will still be necessary so that hospitals aren’t overwhelmed, at least until an effective vaccine, or treatment, is developed.
We have to acknowledge this much: the pandemic spread with great speed and high mortality and simply controlling its spread, and caring for the very ill, has consumed considerable resources. However, this means that we’ve only gathered a fraction of the data we need, to really understand what has happened, is happening and will happen to Irish people, as regards the infectivity of the virus and its actual and overall morbidity.
We need reliable antibody tests, and as soon as possible. And we need a large-scale randomised study of Irish people, to give us a clear picture of the actual general infection rate, that is, not just those who have presented for treatment. Only this can tell us how widely it has spread, how dangerous (or otherwise) it is to Irish people in general. It should also help sharpen the focus of necessary interventions, facilitating a faster return to work, to sport and to gigs for the majority of Irish people – the sensible ones among whom really want to get back to the grindstone!
Managing the pandemic shouldn’t just be about population control. Similarly, loosening the lockdown should be seen as just one part of a wider strategy. We need to know very much more than we do. Open, technically proficient and comprehensive research should now be up there, in or around the top of the priority list.
Time moves on. So should we.