What do people think we should do next? It’s reasonable to assume that most want to prevent a third wave of Covid-19 infections. But it’s not enough to assume – you have to ask people.
Scientists are not brilliant at listening. Communication is bilateral, and good science communication should be bilateral. If public engagement doesn’t happen in both directions, medical professionals and scientists risk seeming more like preachers or prefects.
There is extremely encouraging news about the vaccine rollout. We hear noises from the Government that vaccination will begin in January. But population immunity requires over 70 per cent of people to be vaccinated. The consensus, from sources ranging from the US Center for Disease Control (CDC) to consultancies such as McKinsey, is that we can optimistically hope for widespread vaccination by mid/late summer 2021, though it could be autumn or winter before normality returns. This also seems to be the expectation of the public.
Hospital Report
What do people really think? Look at the data. There’s much out there, including the Amárach opinion tracker commissioned by the Department of Health, the Economic and Social Research Institute analysis; and the Central Statistics Office surveys. Recent CSO data (week of November 18th) showed that, while 7 per cent of people expect normality to return in under six months, 33 per cent believe it will take six to 12 months, and 60 per cent predict one to two years or longer.
Besides having pragmatic expectations, the public show clear support for public health restrictions. CSO surveys showed that 71 per cent of people believe Level 5 was appropriate, while 10 per cent say it didn’t go far enough. As of November 30th, department data suggests that 61 per cent of people approved of the Government reaction to the pandemic, while a further 23 per cent believed it didn’t go far enough. On social distancing measures, 78 per cent of people believed they were about right, while 14 per cent thought they were too weak. There’s good evidence of social cohesion, as 61 per cent of people believe everybody or almost everybody was following guidelines.
Return to normal
Furthermore, there are strong indications that the public was willing to go further. Some 75 per cent of people thought Ireland was trying to return to normal either “a bit too quickly or “much too quickly”.
CSO surveys showed 71 per cent of people believe Level 5 was appropriate, while 10 per cent say it didn't go far enough
Christmas is of special significance. Yet 65 per cent of people reported they were “happy to have a quieter Christmas than usual this year”, while only 16 per cent of people weren’t. In response to the proposition of enjoying Christmas at the cost of a Level 5 lockdown in January, 56 per cent disagreed while 26 per cent agreed. Some 65 per cent of people preferred restrictions to be lifted in mid-December rather than December 1st, and 60 per cent of people thought that restrictions should be lifted for only one week around December 25th.
In summer we seriously dropped the ball on travel quarantine, and the public are wise to it. Some 54 per cent of people believe we should ban all travel from countries classified as “red” by the European Centre for Disease Control based on infection rates, and 18 per cent think travellers from red countries should restrict movements for 14 days, while another 17 per cent think this could be shortened to five days with a negative test result. This week, almost all European countries are classed as “red”, with the exceptions of Norway, Finland, Iceland, and Ireland; which are classed as “orange”. There are currently no “green” countries in Europe.
On November 27th, the Government announced its exit strategy from Level 5, which doesn’t draw on public opinion. The same day, the Independent Scientific Advocacy Group (ISAG) published an alternative strategy for the sustainable reopening of society, without rolling lockdowns.
The ISAG proposal involved a seven-point plan:
1. suppress Sars-CoV-2 infections to single digits or better,
2. prevent new seeding with enforced 14-day quarantine on international travel,
3. actively manage Border counties with existing public health barriers (local restrictions) and Australian-style "border bubbles" to prevent Border community disruption,
4. reduce infections with hygiene and ventilation advice,
5. better resource public health physicians and enhance the co-ordination of the test/trace infrastructure,
6. introduce regional "green zones" to protect Covid-free areas, and
7. support people affected by isolation and businesses interrupted by restrictions. Vaccines could be considered a point 8.
International travel
There is much to improve, but the biggest holes may lie in Levels 1 and 2. We cannot expect to keep the virus suppressed when we open up with hundreds of new cases per day, or when we have unrestricted international travel. But it’s these measures that the silent majority seem to want. Some call it the sustainable reopening of the economy. Some call it learning from successful countries. Some call it “zero Covid” or “Covid zero”. Some call it “aggressive suppression” or “near-elimination”. Some just call it good public health management. Some might call it democracy.
The important thing is to engage at all levels of control, and keep infections down to single digits
It’s never going to be perfect. The important thing is to engage at all levels of control, and keep infections down to single digits so that our public health professionals can suppress all outbreaks. If we can get to zero community transmission (not absolute zero) we can open fully. Failing that, we can at least live in Level 1 restrictions without lockdowns, instead of rolling between Levels 3 and 5.
The Government strategy has ignored public health advice and public opinion. Who benefits? Nobody really. We’re taking a myopic, short-term approach that creates risk and uncertainty for businesses into 2021. It also moves the burden of care to “personal responsibility”, relieving our leaders of the pressures of government responsibility.
Most of us want to avoid a third wave of infections. Nobody credibly believes that a vaccine can guard against one in winter or spring.
Government needs to start listening to the public, and take responsibility for preventing a third lockdown using a scientifically and democratically informed strategy. Lobby groups should look towards the long-term interests of their membership. The public needs to make their voices heard much more clearly. And scientists need to improve their communication skills.
Tomás Ryan is associate professor in the school of biochemistry and immunology at Trinity College Dublin and a member of the Independent Scientific Advocacy Group