A new plan is needed to help us escape from the grip of Covid-19. So all eyes will be on what emerges next week from the Government in its new strategy for the way forward. The 'Living with Covid-19' plan published on 15 September last got us so far and it needed some surgery along the way, with tweaks and add-ons to the various restrictions levels.
People are looking for hope and a clear pathway ahead. A whole range of factors will be involved in determining the phased easing of restrictions from here on in, including a low number of cases in hospital ICU units (around 50 or less in ICU), lower daily case numbers (around 50-100) and much wider vaccination of the population, especially all of the most vulnerable.
This third wave is easing but the cost has been very high with significant mortality, especially among older people. While things are improving, daily case numbers remain stubbornly high, with concern about case levels in particular in Dublin.
All the indications from Government this week are that the intention is to move very slowly on lifting restrictions, with a phased reopening of schools , then probably construction opening, followed by some gentle easing of restrictions for people, but nothing significant perhaps until closer to the summer months.
Going by some of the reactions yesterday, the suggestion from the Taoiseach that there may be severe restrictions into April caused some shock. The obvious question is can people hold out that long? This is terribly difficult for everyone. Just listen to Dublin GP Dr Conor McGrane: "The restrictions are being broken by people who have passed the breaking point. No matter what they want, NPHET will have to accept they will not last in the present form for much longer, officially or unofficially." GPs and families will tell you that the mental health of the nation is strained.
Lockdowns are blunt instruments and this week, Dr Mike Ryan, Executive Director of the World Health Organisation's Health Emergencies Programme, returned to the subject. He remarked: "I've said this from the beginning. If you focus on cases, contacts and clusters, if you focus on restricting the movement of those who are sick or their contacts then you don't have to restrict the movement of all of society."
When this crisis is over, the one lesson will be the importance of having a fully functioning public health system, both in terms of staffing, information technology and outbreak planning. The question will be asked - if the public health system had been better resourced, and been better able to track and trace and control the virus, might we have avoided, or shortened some of the extreme measures that have needed to be introduced? Professor Anthony Staines picked up on the remarks of Dr Mike Ryan. He said that public health is case finding, good data, contact tracing, testing, supporting isolation and quarantine. "Lockdowns are emergency measures not solutions. This has been our key failure," Prof Staines said.
The vaccination programme continues and up to yesterday, there were 187,893 first doses of Covid-19 vaccine administered and 105,859 second doses given to patients. It gives a total of 293,752 vaccinations.
Overall, up to last Monday, the HSE said it had received delivery of 350,310 vaccines. It held back 52,980 for second doses, so the amount available for use was 297,330. Of that number available for use, 280,581 had been administered. The difference between what was available for use and what was administered was 69,729. The logistics of administering vaccines is not simple but the statistics do show that there are delays between when vaccines arrive here, and when they go into arms.
Vaccinations have known side effects and the roll-out of the vaccines here is being monitored by the Health Protection Surveillance Centre and the European Medicines Agency. The task for the immunisation programme will be to ensure people are aware of the possible side effects and that the instances where they occur are not used to fuel vaccine hesitancy.
An Irish survey last month found that 75% will take the vaccine, 18% were unsure and 7% said they would not. Those are strong figures and much higher than similar polls in the US. A good communications programme is vital as part of the national immunisation plan, so that any genuine questions or concerns people have are dealt with.
The European Centre for Disease Control is tracking the update of the first doses in member states. The figures are based on the number of first doses cumulatively administered to individuals aged 18 years and above, divided by the size of the population aged 18+. Late last week, Ireland was listed by the ECDC as doing reasonably well at 5.1%. Malta topped the table at 9.7%. France was at 4.3% and Germany at 4%, for comparison.
The ECDC was having difficulties regarding the information it was getting from Irish authorities last week and the HSE had to resubmit vaccine data to the European agency. Even yesterday, the ECDC data was showing that Ireland had received 520,320 vaccine doses, yet the HSE figure on doses received was 350,310. That's a difference of 170,010 doses. So a caveat - pending clarification, we need to be careful about interpreting the data about vaccinations here and also how Ireland ranks against other EU member states.
Some of the vaccination data has also thrown up questions about the pace of administration. For example, last Sunday, 2,700 first doses were administered and just 10 second doses. I asked the HSE about this and they said that in the week to last Sunday, the HSE met its target for the week.
The HSE also came back to me late this week on my long standing query submitted in mid-January about why only GPs were involved in administering vaccines to those aged 70 years and older, and not pharmacists. The HSE said that it was working closely with the Irish Pharmacy Union and the Pharmaceutical Society of Ireland to put in place an appropriate model and guidance for the involvement of pharmacists in the vaccination programme. "A working group with senior clinical representatives from the HSE, the IPU and the PSI are engaged in the development of this operating guidance," the HSE added.
The news that Johnson & Johnson has applied to the European Medicines Agency for conditional approval for its single-dose vaccine was an important development this week. A decision is expected by mid-March. That decision will be based on the efficacy, safety and quality of its product. Ireland has 2.2 million advance orders for this vaccine so we will be watching the developments closely. This vaccine is easier to handle as it can be stored at fridge temperature.
The aim of the vaccination programme here is to get at least 70% of the adult population immunised. There was an interesting point raised during the week by Professor Kingston Mills from TCD and herd immunity. He said that achieving herd immunity will mean that children will need to be vaccinated. None of the vaccines licensed so far have been licensed for children.
There was a study this week in the Irish Medical Journal on the outcomes for older people hospitalised with Covid-19. It involved a review of 86 patients over one month in an urban hospital. The patients had multiple illnesses, with functional impairment and frailty common. Their inpatient course was complex, with delirium in over a third. Inpatient falls were prevalent along with swallowing problems.
The author, Dr Aoife Fallon, of Tallaght University Hospital, found that in Ireland people aged 65 years and older accounted for 24% of Covid-19 cases, but 54% of hospital admissions and over 92% of deaths.
A month after contracting the virus, of the 86 patients in the study - 33% had died, 14% were awaiting rehabilitation and 44% had been discharged. It shows the clear vulnerability of older people who contract Covid-19.
This week we had the sad milestone of passing 4,000 deaths related to Covid-19. The impact of that is hard to fathom, as the ripples of each death move out and touch so many people in the community. It's a terrible individual loss, a great family loss and also Ireland's loss.
When this is over, we will appreciate personal freedoms and the simple things much more. Going for a day trip, a nice meal in a restaurant, a game of golf or tennis, a swim at the sea, a house party with friends.
We are approaching 12 months since the first confirmed case here.
It has been a year of living with the constant threat of Covid.
And the threat remains as great as ever.
The measures needed to deal with the pandemic have seen the biggest imposition of restrictions on civil liberties since peacetime. As noted by Richard Horton, the editor of The Lancet, during World War II, theatres, cinemas, cafes, restaurants and pubs all remained open. The scale of what we are experiencing is unprecedented.
In an editorial in the Irish Medical Journal this week, Dr John F A Murphy said that "Covid-19 vaccination is the key to our emergence from this pandemic". He says the hope is that the vaccination programme will provide effective immunity in society leading to a return to normal activities.
For this reason, nothing must be allowed delay the speedy and safe vaccination of people here, bar the physical availability of vaccines.
Increasing vaccination levels, along with reducing case numbers, are the metrics of hope.
As we all desperately wait for a return to normal living.
That's why the new plan to deal with Covid-19 must be about escaping from its captivity.