Alternative Approaches - Part 3 Managing without a Vaccine

Updated: May 3

Let me tell you a story about a dystopian society; Where a ‘big bad virus’ appears out of nowhere, spreading across the known world. Sacred temples, (The Pub) restaurants, entertainment, retail, sporting, churches, you name it, all closed until further notice…

One must justify leaving home and indeed leaving the country and those who return are sent into ‘solitary confinement for almost two weeks.

It's a criminal offence to travel beyond 5KM from home unless under limited justifiable reasons. Waking up every day feels much like the previous 397, hoping freedom is just around the corner but inevitably gets delayed while we ‘double down’ just a little longer.

In rags we’re forced to use binary electronic signals (The internet) to socialise, work, buy the goods that the government deem not essential to have available in the few remaining brick and mortar stores allowed to open. Professionals once highly regarded, now demonised, discredited and forced to resign for having an opinion contra to their peers while a minority are elevated to demigods for their bravery and leadership in doing their salaried job.

The overpaid policymakers treat themselves to further pay rises, justified having provided state payments to the thousands left unemployed because of said policies. Funding for this big bad virus management comes from borrowed money inflating an already bloated national debt.

The media demonise protest and resistance while regurgitating the rhetoric from the regime who decreed one strategy of salvation, ignoring its consequences from mental health, lost livelihoods and shattered businesses. Free will suspended, personal choice a sin. Where freedom can only be obtained upon receipt of a flawed ‘half-baked’ elixir.

A society that lost its ability to take personal responsibility instead expect the government to do everything for them. Or at least that’s what the establishment wants them to believe. Systems in place that monitor movement and new draconian powers justifiably obtained when in normal times would never be allowed. The mediums for information to spread, now controllable by large corporations who decide to censor what they decide is blasphemous and false.

The parameters for the perfect dictatorship… all in the name of safety.

Farfetched and exaggerated? I’ll let you be the judge of that… but that is one perspective of our society right now. And even if things go back to normal, we’ve allowed the foundations for future totalitarian like control over our liberty and freedom of speech.

Some people look back on the last 13 months wondering “had we ever thought we’d be still here a year later…’ Forgetting that like-minded people like myself, (those “crazy conspiracy nutters,” as they called us) last year predicted exactly this.

We didn’t have a crystal ball, we’re not clairvoyant, not in touch with aliens, we’re just sceptical of any moves by the government that involve restriction of freedoms. It was clear to see from the beginning that our Government had no clear exit strategy when they started locking us down. And like any poorly built government plan, it can take a considerable amount of time to act and react.

Throughout 2020 the government engaged in knee-jerk reactions to issues as they cropped up, offering no alternatives and no proactive strategies. Token gestures toward investment in structures needed to prevent future lockdowns were made, but even today there isn’t a sufficient plan beyond forcing a primitive vaccinate to carry the weight of ending the crisis. It feels very much like our government are making it up as they go along, bending to the pressure of the opposition who offer no alternative solutions only to undermine the inconsistent, U-Turn prone policymakers.

This coalition government have squandered the public’s acquiescence in the last year. In the strictest of lockdowns, their only focus seems to have been on keeping numbers on a page down and gambling on a flawed unknown vaccine(s) to do the job for them instead of planing out a medium to long term solution for life without a cure.

The fallout from both AstraZeneca and J&J is only going to disrupt the supply of rollout further and we're not completing vaccinates any time soon. The Taoiseach reaffirms his objective of 80% receiving jab one by end of June. Confidence from an additional over 500K Pfizer vaccines coming by Q2. But after everything that has happened so far, I shan’t hold my breath.

A vaccine only strategy to end lockdown is naive and reckless. We need a plan for normality regardless of a vaccine.

COVID zero is not a realistic strategy. NPHET considered it an "utterly false promise" and I agree totally. At the very least we share a land border with Northern Ireland with tenuous relationships (to say the least) when it comes to an all-island approach to just about anything. That alone renders Zero COVID a pipe dream. But even the country credited with making it a success, in my humble opinion only demonstrates how impractical it is because if one person test positive in the entire country, everything and everyone comes to a grinding halt. In many ways, this is more uncertain than our current stop and start lockdown.

So in the absence of a vaccine how could we live as close to normal? In my view taking steps used abroad and increasing some of what we already do in the absence of a vaccine will work quite well. 12 countries (One been the USA where 6 states didn’t lockdown) managed COVID in the absence of ‘stay-at-home’ orders. But even those that did have such orders, avoided the draconian length we experienced.

Perhaps the money that was spent on policing lockdown and PUP etc would be better placed, funding temporary emergency hospitalisation wards in dedicated facilities to support existing hospital infrastructure while having mass screenings and testing while aiding in cocooning those who wish to cocoon but need added support to do so. To better learn how other counties achieve good management let's focus on what they did better.

Testing, Tracking & Screening.

Perhaps the best countries to demonstrate effective management of pandemics are East-Asian countries like South Korea who have the first-hand experience with a viral crisis in the past. The SARS virus in the early 2000’s been one of them. Lessons learned from these challenges allowed South Korea in particular to be ready to manage COVID in the absence of a vaccine. South Korea demonstrated effective use of testing, screening and tracking for COVID, but most notably is the unique utilisation of technology to monitor and track COVID and the movements of infected people. I’ve already discussed South Korea’s testing and screening roll out as part of the international travel perspective in Part 1 of this sub-series, so to avoid re-invention of wheels I recommend checking that out. But to sum up, their tested and screening of COIVD puts Ireland to shame.

One thing I didn’t go into detail on was their surveillance. Smart city data bank as it's also known might be a little spine-tingling for us westerns who are used to a level of privacy a system like this throughs out the window. However, if we had a choice between surveillance or house arrest, we might be inclined to “sacrifice privacy for surveillance and contact tracing” as one article puts it. If we had a trustworthy body to build, managing and execute this system only then could something like this be implemented here?

Authorised use of CCTV, credit card data, location data and travel information to build a profile of a subjects travel patterns and behaviours before testing positive. Artificial intelligence processes this data to determine whereabouts and time spend in a place. My understanding this is used when someone tests positive and the data is aided with Interviews with the patient upon who and where they were in contact with. This can help identify clusters and other outbreak zones. This process which takes only 10 minutes can produce a transparent picture of individual activity, thus a collective database can identify patterns within a city or region.

It has been emphasised that such data can only be accessed by a “small number of authorised users” and police approval must be obtained. So not exactly "Person of Interest" level… but comes pretty close.

But to conclude here. In Ireland, we need to radically ramp up our testing and contact tracing. Get ahead of the spread by having people identified as infected sooner rather than later. To do this, we need on-demand testing and screenings and one game-changer to this is Rapid Antigen Testing.

Rapid Antigen Testing is a non-lab test, involving a quick nose swab followed by the result, all within 15-20 minutes. Austria is a good showcase for Rapid Antigen Testing. They offer free antigen testing to residents of Vienna. They have clinics and drive-throughs. A test is valid for 24 hours. Negative testing gives you the peace of mind needed to go about your day, while a positive test will subsequently lead to a PCR test. Should it be positive, one must follow the standard positive tested guidelines and restrict movements.

Antigen testing is not a substitute for PCR testing, but it means that we could in theory undergo regular, on-demand testing for free (even at home) prior to attending large gatherings, events, work, restaurants etc.

I guess a centralised testing facility (rather than at home, unless it can be monitored) allowing for results to be updated to the COVID passport system might be more practical allowing business to confirm you're tested centrally, rather than having to perform one upon every premise, however, if a culture of testing oneself during the crisis was developed much like mask-wearing, we could have a scenario much like breathalyzing oneself before driving, test yourself prior to leaving home, negative result off you go, positive then you don’t instead book a PCR test and act as per health guidelines.

This also could mean the avoidance of strict lockdowns in itself and contain the virus quicker than before allowing us to open up and stay open. The EU has been looking into such approaches since late December, with a press release detailing their rules on such measures.

FaceMasks

Unlike Ireland, a lot of countries insisted on specific masks to be worn instead of just disposable masks and face coverings because the latter two offer less adequate protection according to some studies. Austria for example insisted on FFP2 Medical-Grade, but a lot of discussion and study references the N95 respirators, particular for medical settings.

I know from personal experience N95 and above does noticeably appear to keep out odours and smoke better than a regular disposable and the F8 respirator is a beast if not a little overkill for public places. I’ve attracted a lot of unwanted snaps from teenagers and odd looks from individuals on public transport anytime I wore it, I guess it's a 21st century equivalent to the plague mask. But generally, most people are amused not scared of me. I share this because it's my real-world first-hand experience noticing the difference various masks offer.

A WHO funded studies conclude that masks could have a “large reduction in the risk of infection” but highlighted N95 masks or similar respirators had a “stronger association” with risk reduction compared to the surgical masks.

Another study in the journal of Influenza and Other Respiratory Viruses concluded that there was “low certainty evidence” that medical masks offered the same protection as N95 and that N95 respirators should be preserved for “high risk” “aerosol-generating procedures” when in limited supply. This would conclude in my view that the higher graded masks are better than the disposable and that maybe in Ireland we should be a little fussier about the level of protection we put around our mouth and nose.

Now there is a lot of resistance to the mask with Anti-Mask movements quite vocal on their belief against mandatory masking. Definitely in western culture mask-wearing is very new, so it shouldn’t come as any surprise some will resist. But the issue is exasperated further by the politicisation of the subject. I guess part of what’s fuelling it is the masking mandates alongside other restrictions making the mask a symbol of suppression and one of the few ways to exercise a degree of control and protest over what many believe to be poor choices from their governments. That's just a personal observation I will admit.

But while some media and experts demonise anti-mask groups we may overlook that some countries to are moving away from universal mask-wearing. Bloomberg reports Denmark discouraging mask-wearing among healthy people saying they “can cause more harm than good” because people become complacent or masks become “a vector for the virus if mishandled.” They are among Finland and Norway in Europe alone.

These countries have demonstrated low mask-wearing and a well-contained virus. However, a WHO study reported by The Lancet found an 85% reduction in infection risk when a mask is worn. So it would appear that there is some merit to mask-wearing with focusing on the type of masks used.

Social Distancing

Finally on the topic of how far one should keep from another. Ireland uses a 2-meter rule, contra to other countries Like China, France and Denmark use 1 meter, or Italy, Australia and Germany that use 1.5 meters. But according to one study, either or is an “oversimplification based on outdated” and it depends on other factors like airflow and activity. A WHO funded study concluded transition is lower at 1 meter and that protection increases the further the distance. They also concluded masks and eye protection play a role and N95 respirators are mentioned yet again. The Conversation reports several factors that need to be considered when decided a distance including;

Respiratory droplet sizes and number - Depend on activity (Talking, singing, coughing etc)

viral load - stage of the infection in specific people.

The environment - temperature, humidity, ventilation etc

Therefore one could conclude that certain settings may dictate a better distance. In fairness perhaps why we chose a 2-meter distance might be for a one for all policy than adding the complexity of 1 meter for one location and two for another. Is that giving our Government a little too much credit?

To conclude, we could have an open society free from draconian lockdowns if we better managed basics such as having mass testing and screening for the virus at key locations and situations. A culture of rapid testing that allows us to move about when we know or are confident we are negative while also adding an extra layer of protection by utilising the best face coverings and social distancing. Pubs and restaurants etc could remain open, with distances among seating. Tracking and tracing, with a centralised system via apps like in South Korea along with access to greater data might be a step too far just yet for us… but knowing such technology exists should be subject to debate if it means we can avoid worse situations like house arrests and shut down our worlds. But fundamental to all this is a properly functioning health service that can better deal with surges in hospitalisations. The David Mc Williams podcast made an interesting observation on their April 6th show. The podcast discussed how we have the youngest population in Europe yet instead of spending the least on health (which is expected because young people aren’t supposed to get sick) our spending (per head) is the fourth highest in the EU (after Norway Sweden and Denmark) and still, we are the third lowest for ICU beds. So where is all the money going? Something is clearly wrong with the “Blackhole” that is the HSE and it is here we need to place additional reform if we are ever to handle future health crises, but that’s a topic for another Unravel