Irish government moves to lift Covid restrictions
13 September 2021
Taoiseach Micheál Martin announcing the Government's plan to lift Covid restrictions (Image: Julien Behal)
At the end of August, the Irish government announced its plans for the lifting of almost all Covid restrictions by 22 October. The speed and scale of these relaxations are dramatic.
• From 6 September, large crowds will be allowed to gather for religious ceremonies. Places of worship and outdoor sporting venues will also be allowed to hold 50% capacity from that date.
• Indoor venues will be allowed to have 60% capacity for events for people who are vaccinated, while outdoor venues can hold 75% capacity for vaccinated people.
• The wearing of face masks will still be mandatory on public transport and in health and retail sectors.
• Live music will be allowed to be played indoors at weddings and in bars.
• Within the tourism industry, coaches will be able to carry 75% capacity from 6 September.
• From 20 September, a phased return to the workplace will begin.
• Indoor after-school activities could also resume on that date along with sports played indoors.
• From 1 September public transport can return to 100% capacity.
From 22 October:
• all remaining restrictions on indoor and outdoor events and activities will be removed from that date.
• all remaining restrictions on religious or civil ceremonies will also be removed.
• Restrictions on high-risk activities, including nightclubs will be lifted.
• Requirements for physical distancing and limits on numbers that can meet in private homes and gardens will also be lifted.
The above represents the removal of almost all Covid mitigations over the course of seven weeks. The only conditionality is that the level of vaccination of adults must reach 90% and that Covid cases remain manageable. The government also announced that the National Public Health Emergency Team (Nphet) would be shut down from the middle of October as the state moves away from an emergency response posture on Covid.
Rising cases, hospitalisations & deaths
Taken on face value these announcements suggest that Ireland is emerging from the pandemic and that Covid is on the wane. However, when the figures are examined, this optimistic impression is revealed to be far from reality. Indeed, the comments made by government officials themselves on the how the virus is likely to develop (which accompanied the announcement on the lifting restrictions) provide a sharp contrast.
The Taoiseach Micheal Martin stressed that "the pandemic is not over" and "particularly with the delta variant, great uncertainties remain". He said healthcare settings faced "a difficult winter" and other respiratory viruses including cold and flus "may be more impactful and people may be more susceptible to them after reduced exposure of last year". In relation to Covid 19 he stated that we could "expect to see an increase in case numbers over the coming weeks."
This was expanded upon in a letter written by Chief Medical Officer Dr Tony Holohan on behalf of Nphet. In it he says that he "expects the situation to get worse" before we see an improvement. The letter warns that the situation in Ireland is one of “high incidence with an uncertain trajectory.” According to the CMO:
“It is very likely that the Delta variant will continue to circulate extensively throughout the autumn and potentially later in the year, particularly among individuals that have not yet been vaccinated.”The letter also contains a number of projections, the most optimistic of which, claims that Ireland could see a peak of 2,500-3,000 Covid-19 cases a day by mid-September. This may result in peaks in healthcare demand, with possibly 500-700 patients in hospital with the virus and between 80-130 in intensive care. Central scenarios suggest 3,000-5,000 cases per day, 750-1,300 hospitalisations and 150-250 needing critical care. The situation in hospitals is described “challenging”, with reduced capacity as a result of increasing Covid patients and associated infection control measures.
An examination of the figures, and the trends, also provide clear indicators of the prevalence of Covid. For example, (in August) Ireland had the highest incidence rates of Covid-19 in the EU, standing at just over 500 cases per 100,000 population. While it has now fallen back to around 450 cases per 100,000 population this is still a high rate. This figure is the average for the whole state. However, there is wide regional variation. The Border counties of Donegal, Cavan and Monaghan have by far the highest rates of the disease. Statistics from the Health Protection Surveillance Centre (HPSC) show Monaghan has a 14-day incidence rate of 1,269 per 100,000 followed by Donegal with 1,039.6 per 100,000 and Cavan at 825 per 100,000. The highest rates remain clustered in the northern half of the State with Longford at 658.1 per 100,000, Leitrim (705.3 per 100,000) and Roscommon (615.6 per 100,000) fourth, fifth and sixth respectively.
The high prevalence of the virus is also confirmed in the first weekly analysis of Covid-19 in sewage published by the HPSC. It shows the virus is strongly present in all parts of the country and that its prevalence is growing. Since monitoring began in May, the number of wastewater facilities showing high levels of Covid-19 in the community has increased from 13 to 67 in August.
In terms of case numbers. There are currently almost 50,000 active cases in the state. That compares with case numbers of just below 10,000 at the start of July and over 100,000 at the height of the second wave in January. Daily cases have been consistently above (some days well above) 1000 cases since mid-July. While this is high it is much lower than the 8000 daily cases recorded at the height of the second wave in January.
In terms of hospitalisations. There are currently 321 Covid patients in hospital with 58 of those in ICU. This compares with figures of 44 and 14 at the beginning of July. At the height of the second wave in January the figures were 2000 and 200.
Deaths related to the virus have risen to levels not seen since April. There were 77 recorded deaths from Covid-19 in the State during August, a figure that exceeded the most optimistic projections on fatalities set out Nphet. Over recent weeks there has been a significant increase in the number of deaths with 20 reported in the last week of August followed by 43 in the first week of September. This follows a period over June and July over which no daily deaths were recorded. The number of average deaths a day in the from Covid-19 is 2.5 at present. At the peak of the first wave in April of last year it was more than 70 a day. The case fatality rate (the number of deaths as a percentage of cases) has fallen from 3.62 per cent in February to 0.14 per cent in August. The cumulative number of deaths of those with Covid-19 stands at 5,155.
A number of broad points can be stated regarding the current status of the pandemic within the Irish state.
• A third wave of the pandemic is now undoubtedly underway.
• There is a high prevalence of Covid with ongoing community transmission and a persistently high number of cases.
• Hospitalisations and deaths are on the rise. However, due to high vaccination levels - and the effectiveness of the vaccines against the current variants – these are rising at a much more gradual rate than during earlier waves.
Living with the virus?
The move to lift all restrictions is founded on the belief that the high rate of vaccination among the population – and the effectiveness of the vaccines in reducing severe illness and death – will create conditions in which the impact of virus can be managed. As it was from the beginning of the pandemic this concept of management relates primarily to pressures on health services. The great fear at that time was that a rapid spread of the virus – and accompanying rise in the number of people requiring hospital treatment – would overwhelm and collapse the health system. Such a scenario was the main justification for the instruction of restrictions – such as mask wearing, hand washing, social distancing and travel restrictions etc - that reduced community transmission. In this period the focus was very much on infection levels and the reproduction rate (the R number) of the virus. Any relaxation of restrictions was dependent on the numbers that measure the spread of the virus moving in a downwards direction. In the latest roadmap around the lifting of restrictions this conditionality has been removed. The new assumption is that the vaccines will hold the line against severe illness – and as a consequence - infection levels don’t matter anymore. As a consequence, public health measures are no longer required.
In this the Irish government is following most other capitalist states that have shifted from attempts at suppression to a strategy of – what is commonly described as – “living with the virus”. The assumptions underpinning this approach are that vaccines will continue to work in protecting people and also that the virus itself has settled into a less harmful endemic state. However, these assumptions are precarious. Firstly, while at some point the virus will become endemic (in the sense that once coming into existence it will remain in existence) there is no reason to believe that this state has been reached or that when it is reached the virus will be in a less harmful form or circulating at a lower level. Endemicity only means that a disease has a certain base level which can be either low or high. Already in the course of its two-year existence Covid 19 has undergone multiple mutations that have produced variants (most notably Delta) both more contagious and more harmful. Indeed, if the virus is allowed to circulate at a high level in populations, as the living with the virus approach implies, then the potential for further mutations is greatly increased. It also possible that some of the new variants may be more resistant to vaccines.
This brings us to the second flaw in this approach which is the assumption around vaccines. While vaccines are a powerful tool in reducing severe illness and death, they are not 100% effective. It is estimated that against the Delta variant the vaccines are 80% effective in preventing symptomatic illness and 95% effective in preventing hospitalisation. While these are impressive figures - in conditions where the virus is circulating widely - those small percentages can translate into a high number of people.
The experience of previous pandemics is that they are brought under control not though vaccination alone but through mass vaccination AND other public health measures. Such measures are essential to reducing community transmission and bringing the number of cases down to a level where they can be monitored and controlled through a system of test, trace and isolate. This is the traditional playbook when dealing with infectious diseases. That many governments have not followed these well-established procedures shows the degree of political decay that has taken place in capitalist societies and the extent to which public policy has been subordinated to financial and commercial interests. As Ireland is one of states where this trend has advanced +furthest – just think of housing - it should hardly come as a surprise that the government’s public health policy is moving in the direction it is.
A more general criticism of the strategies of governments towards the pandemic is that they have been largely national (if not outright nationalistic). While the pandemic is global the level of co-ordination between states has been minimal. This is particularly glaring in the distribution of vaccines with wealthy countries stockpiling and vaccination programmes in developing countries barely advancing at all.
Partition means that Ireland struggles even to rise to the level of a national or an all-island approach. Throughout the pandemic co-operation between north and south has been limited. The fact that the Stormont executive has completely lost control of the virus, and that Northern Ireland is recording some of the highest infection and death rates in the developed world, doesn’t even figure in the Irish government’s plans for the ending of restrictions.
The notion of living with the virus has parallels the proposition of herd immunity that had some currency in the early period of the pandemic. They share the belief that the virus should allowed to circulate without mitigation and that higher levels of illness and death should be accepted as an inevitable consequence. In the herd immunity thesis this was the price for reaching a level of immunity in the population that would act as a barrier to transmission. While his at least had some basis in science - albeit one distorted by its right-wing proponents – the concept of living with the virus has no such basis at all. It is a reckless approach that risks prolonging the pandemic and setting the baseline for Covid at relatively high level when it finally reaches its endemic stage. It also ignores the long-term health consequences (so called Long Covid) of infections even in those people who do not initially suffer a severe reaction.