Opinion: we need to be clear about what this virus elimination approach is, how we get there and how we stay there

In response to the Covid-19 pandemic, Ireland has come together in an extraordinary demonstration of collaboration and solidarity across all sectors of society. We have successfully implemented emergency public health measures to control the epidemic and avoid a surge of cases that would have overwhelmed our health services. By June of this year, the number of detected cases nationally had been reduced to less than 10 per day and we embarked on a policy of suppression of the virus to a 'tolerable level', while tentatively reopening our economy and awaiting a vaccine. 

The worrying rise in the number of cases over the past few weeks shows the inherent limits of this approach. Clearly, Ireland needs a national strategy to allow us to get ahead of the virus: we need a Zero COVID or virus elimination approach. Internationally, other countries have successfully pursued a Zero COVID policy – New Zealand with a population of 4.8 million has had 1,654 cases and 22 deaths and Taiwan with a population of 23.8 million has had 486 cases and seven deaths to date. There is now growing support, both nationally and internationally, for a Zero COVID approach, but we need to be clear about what it is, how we get there and how we stay there.

The Zero COVID Island movement defines Zero COVID as "‘the absence for a suitable period of time (3 to 4 weeks), of community transmission of SARS-COV-2 (the virus causing Covid-19), within the Republic of Ireland, thereby allowing the safe opening up our economy, including schools, crèches, social gatherings, bars, theaters, sports and other entertainment venues." On achieving Zero COVID, there will still be a risk of imported local outbreaks, as is currently happening in Auckland in New Zealand, but these will be quickly controlled with minimal impact on other regions in the country. 

From RTÉ Radio 1's Morning Ireland, Professor Emer Shelley from the Royal College of Physicians of Ireland on why the Government should pursue zero Covid policies

The first step toward Zero COVID is the implementation of a vision and clear plan at the highest level of Government to be supported by skilled leadership and an effective communications strategy that shares this vision with the public. This outlnes in a timely, honest, clear and empathetic way that we can and should protect our vulnerable, and move toward opening up our economy with a return to near normal life within a relatively short time. 

Ideally, we also need agreement at political level, with the Northern Ireland administration on an all-island Zero COVID strategy. We have worked effectively with Northern Ireland in the past to control foot-and-mouth epidemics in cattle and the Health Committee of the Northern Ireland Executive has already endorsed the principle of a Zero COVID strategy.

In relation to the operational details, the strategy can be condensed into two core elements: 

(i) local area virus transmission zoning

(ii) increased short term physical distancing measures (up to four weeks) with a view to bringing forward the date when we return to a near-normal life.

From RTÉ Radio 1's Today with Sarah McInerney, Dr Gabriel Scally on achieving a Zero Covid Ireland

Local area transmission zoning represents a shift from the current approach of dealing with the outbreak as a single national pandemic. Instead, it views it as a series of localised outbreaks to be tackled area by area until zero community transmission has been achieved for the country as a whole. We suggest the introduction of transmission zoning (green/yellow /red) at individual county level, with green for counties with Zero virus transmission, red with ongoing transmission and yellow for counties without community transmission but bordering red zones

At outset, all counties would be red, with no non-essential travel permitted outside individual counties. For three to four weeks, all non-essential services, including pubs, restaurants, and schools, would be closed, mask-wearing would be mandatory in all public settings (indoors and outdoors) and working from home where possible would continue. Substantial further investment will be necessary to protect jobs, homes and businesses while this happens.

At the end of this the initial period, travel would be permitted between green zones (including through Red zones without contact). A gradual process of relaxation of physical distancing measures and re-opening of all sectors of society and the economy could occur in these green zones, with the opening of schools prioritised. Restrictive measures would remain in the red zones until Zero COVID status was achieved. Thus, we would move from the current strategy of "lockdown" for counties with spikes in viral transmission, to one of opening up counties with Zero transmission and allowing life to return to normal but with the capacity to clamp down quickly on localised within county outbreaks.

From RTÉ Radio 1's Morning Ireland, Prof Anthony Staines discusses a letter from doctors and scientists calling for Ireland to 'crush the curve' by continuing Covid-19 restrictions

In parallel with the transmission zoning approach, we would need to maintain tight control on inward travel at ports and airports with mandatory quarantine and testing, using new, rapid testing technologies. We would also need to intensify our systems for finding, testing, tracing and isolation support for confirmed cases and quarantine for close contacts. There would be a particular focus on high-risk industries and settings including direct provision centres and high-density urban environments. In this context, the need to invest in and support local Public Health Medicine Departments, and to provide adequate places for safe isolation is evident. 

Responding to outbreaks of infectious disease is somewhat analogous to firefighting: we maintain a zero-house fire strategy while ensuring that we have the resources and systems in place to respond quickly to fires that arise. Of course, this is not a perfect analogy and we cannot expect to maintain Zero COVID status in every region of the country at all times in reality.

If Ireland chooses to adopt Zero COVID as our national strategy, supported by Government leadership and buy-in from all sectors of society, we are likely in a worst-case scenario to achieve a high level of virus suppression with the best possible opportunity to get our lives back to normal. But if we settle now for suppression of the virus, for "an acceptable level of infection", the first Covid-19 winter in Europe and the Northern hemisphere may well be a winter of severe discontent.

This article draws on discussion and work in the Zero COVID Island Group, convened by Professor Anthony Staines from Dublin City University


The views expressed here are those of the author and do not represent or reflect the views of RTÉ