Many people have taken comfort from the news that 70 per cent of our current Covid cases requiring hospitalisation are among the unvaccinated. I am always wary of a story that offers up people as masters of their own misfortune. This tendency tends to signal two well-established psychological phenomena. The first is that explanations of this sort are a salve; the second is that they are a distraction, obscuring the real issue at hand.
For the vaccinated, this thinking can be comforting. It is easier for you to return to work, send your children off to school and believe that you and yours are safe. It is a very useful psychological trick. But be aware that this is all it is. A recent report in the British Medical Journal highlighted how children too young to be vaccinated are increasingly the casualties of Covid-19. New infections are rising, and a record number of children have been infected in some regions of the US, including Dallas, which was running out of paediatric ICU beds. Here, hospitalisation among those who could not be vaccinated due to pregnancy are also now a concern.
To further undermine any feelings of security, we have seen the publication of the most significant study to date evidencing waning immunity in those vaccinated against Covid-19. And many researchers believe, just as we head into winter, that these are less likely to be characterised as mere “breakthrough” cases. In-depth analysis in the UK and Israel since their large-scale vaccination programmes suggests that where viral spread is high and vaccinated people continue to be exposed, more severe cases are likely to emerge.
So as our outdoor summer comes to an end, it is worth thinking about what any perceived emphasis on unvaccinated people as the source of hospitalisation might be obscuring in our approach to managing this new wave of infections. Focusing on individuals as a cause of any social phenomena is usually a trick used to obscure structural and systemic issues.
Balancing act
What are the systemic issues now in the mix? Well, one clear issue that has been at play since early in the pandemic was the balancing act required to manage public health and HSE capacity on the one hand, and economic activity and productivity on the other. For quite some time, public health seemed to have trumped economics.
Ventilation is good. Ventilation and regular testing is better
And though many of us may have the sense that the tide is turning now, this is still a balancing act. The vaccination programme is in pursuit of herd immunity. Vaccination rates are only one factor that predicts when we achieve herd immunity. It is also driven by the efficiency of the vaccine and the extent of the spread of the virus.
In this equation, if there are no more people to vaccinate and the efficiency of the vaccine is waning, the only thing that we can keep a handle on is the spread of the virus.
One way to do this is to limit social mixing. But we are seeing return to schools for our young people, and colleges will soon follow. There is a planned further easing of restrictions to facilitate sporting and cultural activities, due to be announced shortly. All of this will occur at the same time as the weather gets colder and there is a return to indoor living.
And though we are very worn at this stage, the reality is that none of us is safe until we are all safe
Given this likely increase in social mixing, we will have to rely on non-pharmaceutical efforts – as well as vaccines – to contain spread. Analysis has shown the protective impact of mitigation measures. And the protections are cumulative. Ventilation is good. Ventilation and regular testing is better. Ventilation, regular testing and limits on the size of gatherings better again.
Mask and test
In studies in school settings in Germany and the US, masking and routine testing are clearly evidenced as an important additional protection being shown to reduce the spread of the highly infectious Delta variant by about 60 per cent. We need to support financial improvements in ventilation in our schools, universities and workplaces. And we need to embrace routine testing. Indeed, any objections to the use of antigen testing on the basis of fluctuating utility is moot given what we now know about vaccines.
This is a pandemic and it is not over. And though we are very worn at this stage, the reality is that none of us is safe until we are all safe. The pandemic is here with us all. The vaccinated and the unvaccinated, in Ireland and beyond. Sure it is a comfort to think the virus is spreading mainly in far-flung places and affecting only the unvaccinated. We all need comfort in these Covid times. But take your comfort from masking, maintaining physical distance from others and encouraging our politicians to roll out supports for increased ventilation and routine testing wherever people are gathered. This needs to be part of our future for some time to come.