The most striking feature of the return of Dr Tony Holohan to work duties this week was the extent to which the Covid-19 landscape has changed in a few months.
As the chief medical officer himself flagged, the main changes are the rise of the B117 variant and a big increase in the number of people vaccinated since he took leave following the death of his wife in February.
But another notable difference was the optimistic tone he and other National Public Health Emergency Team officials struck at the regular Thursday briefing.
The last time Dr Holohan returned after a period of leave, in autumn 2020, it was to an atmosphere of gathering gloom as evidence of a second wave of cases accumulated. It was hard to escape the image of the Lone Ranger riding in to rescue the situation.
This week, despite a new spike in the case numbers, Holohan and other officials remained unperturbed. Despite the usual caveats, they painted a picture of broad improvement, with further progress likely due to vaccination.
In part, this is because the ability of the system to track what is happening to the virus, and to react effectively, has also changed in recent months.
As Prof Philip Nolan pointed out, officials have been crunching the numbers and following the trends for more than a year. They know their adversary, and they know how the public reacts to changes in infection rates. They believe they can tell a real trend, and the reasons for it, from a transient blip.
This explains their relative lack of concern about the rise in cases towards the end of this week. While acknowledging the increase could last for several weeks, they believe it is driven by factors that themselves are transient, such as increased vigilance in education after the last school classes returned earlier this month.
One of the reasons we are seeing more reported infections now is because more people are being tested. In the short term, this pushes up cases. Hopefully, though, it will prevent further transmission of infection over time, so eventually the graph will trend downwards again.
Walk-in success
The HSE’s initiative in opening up walk-in testing centres has been a success. By locating services close to where people need them, they have helped tackle the infection problem in hotspots that have been driving the pandemic. There is also a greater sense of public health and contact tracing teams being on top of the challenge than before.
The number of risky variant cases continues to creep up, it is true, but to date there is no sense they will supplant B117. The longer time goes on, the more this threat recedes because more people are being vaccinated.
In the Republic and much of Europe, an emerging consensus on fighting the pandemic is gathering. First – the obvious bit – vaccines work, and they need to be administered as quickly as possible.
Second, mRNA vaccines are the best bet in terms of supply, effectiveness and side effects, and so the vaccine programme should pivot towards them. This is being facilitated by greater availability of the Pfizer/BioNTech jab through the European Commission’s purchasing facility.
All of the authorised vaccines provide strong protection against serious disease, so they have a place in the overall rollout. A new UK study, for example, shows a 65-70 per cent reduction in all infections, 90 per cent reduction in symptomatic infection and reduced transmission, with no difference noted between the AstraZeneca and Pfizer/BioNTech vaccines.
However, the multiple issues around the AstraZeneca vaccine have exhausted the patience of officials and damaged the reputation of all the vaccines.
Denmark has already cut AstraZeneca adrift and other countries, including Ireland, have limited its use to certain age groups. The shoehorning of its use here for 60-70-year-olds has not gone down well with that age group.
Opt-in system
The best option as our vaccine programme continues may be to give AstraZeneca to those who want it, regardless of their age or priority status. Germany seems to be adopting this approach to use up purchased supplies, while leaning more on mRNA vaccines as the workhorses of their rollout.
Ireland has slipped marginally behind the EU average for vaccine rollout, largely due to problems around the AstraZeneca and Johnson & Johnson vaccines. We're about three weeks behind where we might have been, and there is little prospect of making the various targets set out for the coming months.
However, Europe as a whole is starting to catch up on the UK and the US, and may narrow the gap further through widespread use of the one-dose Johnson & Johnson vaccine.
There has been much grumbling in Government about the length of time the National Immunisation Advisory Committee is taking to reach a decision about the vaccine.
Spain, the Netherlands, Germany and France have all started using this vaccine or are about to, but Ireland will be able to catch up quickly if the expected green light arrives early next week.