Summer is over, the children are back at school, the rain is back and it’s time to say hello to Covid-19 again.
For many of us, the last three months have been a fantastic vacation away from the worries of the pandemic. The virus has receded, no new variants have arrived to queer the pitch, and life has largely returned to normal.
Covid has continued to take a toll on society, targeting the most vulnerable and adding to existing health service problems. Large numbers of people continue to suffer from the aftermath of a previous infection, with one estimate putting the number of long-term Covid sufferers at 300,000.
Yet for most people, thanks to the protection provided by vaccination or previous infection, the virus is now an irritation rather than an existential threat.
The wheel is starting to turn once again as we head into winter, the most vulnerable season when it comes to respiratory problems. There are signs that case numbers have bottomed out and may be starting to rise again. Test positivity is also on the rise, and this is before the full impact of returning to school is felt.
With a significant flu likely to return after a two-year absence, the health service is in for a bumpy ride in the coming months. Conditions are already difficult, with staff depleted by the pandemic and waiting lists longer than ever, despite the fact that €350 million has been spent this year to reduce them.
“The health service is worse than ever,” says Anthony Staines, professor of health systems at Dublin City University. “People are terrified. We don’t know what’s going to happen, but the bet is that infections will continue at a high level.”
From now on, the burden that Covid exerts on the health system is considerably reduced. There were 251 virus patients in the hospital on Friday, up from more than 1,000 a month ago, and just a third of current patients were there because of Covid. The rest are asymptomatic, although they still require infection control procedures that may involve closed beds.
The figures show where the greatest risk lies. Unsurprisingly, two-thirds of those hospitalized are 65 or older. A quarter are not fully vaccinated, much higher than the proportion of unvaccinated people in the population.
Covid-related deaths continue to rise. There were 163 such deaths in July, about five a day. There is no breakdown available to indicate in how many of these cases Covid was the main cause of death.
There are plenty of reasons to be optimistic, or at least more optimistic than in recent winters. BA.5, the currently dominant variant of Covid, does not cause respiratory failure to the same extent as previous variants.
Although Covid continues to mutate at an alarming rate, no significant new threat has emerged over the summer. “Omicron/BA.5 is so infectious that nothing else is being controlled,” says Staines.
Meanwhile, the scientific world has nearly caught up with the virus, with adapted vaccines protecting against the original strain and Omicron on the way. The first nasal vaccines have also been developed, which could provide longer protection against infection.
Infectious disease consultant Professor Sam McConkey says: “I am cautiously optimistic. There will be several more waves in the next few years, but we hope that they will be milder and that they will not kill as many people.”
There is a “slight chance” that a new, deadlier variant will emerge, but he says the world should be able to react to such an event quicker than before. Vaccine technology is well developed and can be rapidly adapted to deal with a new strain of the virus, preventive strategies have multiplied, and treatment options continue to improve.
Staines, a leading figure in the zero covid lobby during the pandemic, believes the Omicron family of variants poses just as much of a threat as previous variants. He argues that the risk of covid long after infection does not decrease, although there is some evidence that vaccination reduces it.
“He hits everyone. It goes through the whole body, sticks to all kinds of tissue and hits the immune system in a way never seen before.”
This is a description that Fáinche Deeney, 26, could relate to, having suffered a constellation of post-viral symptoms since contracting covid-19 at the start of the pandemic. “I have gone from being fit and healthy to the complete opposite. I tried everything to combat it: I worked out, I exercised, I ate several different healthy diets. I have a pillbox full of supplements to take every morning.”
Deeney’s symptoms include fatigue “crashes,” post-exertion malaise (“a fancy phrase for ‘the consequences of doing too much'”), migraines, vertigo, gastrointestinal problems, weight gain, “brain fog,” and feeling faint when stands for a long time.
Long Covid Clinics
“There are times when my boyfriend talks to me and I can’t understand him. It’s terrifying. At first, when my symptoms were at their worst, I couldn’t even watch TV because it made me dizzy.”
The Health Service Executive is setting up a long-standing network of Covid clinics, but infectious disease consultant Professor Jack Lambert of Mater hospital has argued his model is flawed because it focuses on respiratory symptoms rather than neurological or related to inflammation.
“All I keep hearing from medical professionals is ‘rest’ and ‘avoid stress.’ It’s been 29 months for me. I think the ‘healing time’ would have happened by now,” says Deeney, who has been on an MRI waiting list “for months” and says tests for cognitive problems are needed for long-time Covid sufferers.
“It is ridiculous that HSE is only setting up six long-term Covid clinics when so many people are affected,” says Miriam Cullen, from the Long Covid Ireland support group. “Every day, new people suffer from covid for a long time, but they ignore us.”
The flu has traditionally been the biggest winter challenge for the health service, but it disappeared during the last two winters due to the protection measures in place at the time.
Forecasters traditionally look south for indications of what the next flu season might look like. Australia just had its worst flu season in five years, and one that came earlier in its winter season, though there was less pressure on hospitals than some expected.
Therefore, it seems likely that Ireland will experience significant flu activity this winter for the first time in three years. But what can be done this winter to counteract the risk posed by Covid-19 and the flu?
Covid booster shots are the first option. New tailored boosters are likely to be offered first to higher risk groups.
“We should do what we can at a systems level that doesn’t rely too much on personal agency,” suggests Professor Ivan Perry of University College Cork’s School of Public Health.
He suggests that people should be encouraged to wear masks on public transport and in some workplaces. He also wants the use of masks to be standardized, so the default option is a surgical-grade mask.
“We need to continue to optimize ventilation to reduce the risk of spreading infection, remind people with symptoms not to come to work, and maintain a high tolerance for working from home. That way, we would dilute the number of people at work and commuting to it.”
While Covid has become a distant memory for many, Perry believes we are not more than halfway through this crisis. “I don’t think anyone knows what will happen. There are so many species that can harbor this virus; it would take a brave and confident person to say that something new will not come up.”