Two years since Covid interrupted life as we knew it, Lisa Smyth addresses whether we should be cautiously optimistic about the coming months
It is one month since the Executive introduced a raft of restrictions aimed at reducing the spread of Omicron.
Put in place just before Christmas and amid warnings that the health service could be overwhelmed by a surge in seriously ill patients, it now appears the variant is up to 80% less severe than Delta.
In fact, in a briefing paper presented to the Executive this week, ministers were told that while hospital admissions and Covid bed occupancy increased in the last week, they have peaked and started to fall slowly in the last few days.
The document went on to explain the numbers of patients requiring supplementary oxygen, ICU occupancy and hospital deaths remained “relatively steady” and Covid-19 patients in critical care units were “still predominantly a result of Delta infection”.
It is likely case numbers are going to rise in the coming weeks as a result of the virus running rampant through schools.
This will eventually work its way into older age groups and is likely to result in more people requiring hospital treatment, but the official position is one of cautious optimism.
And that’s why, as quickly as they were put in place, measures that business leaders and a public fed with up with two years of disruption to their lives, have been lifted.
Gone are the rule of six in pubs and restaurants and the requirement for table service in licensed premises has been lifted, while the self-isolation period for positive cases has been dropped to five days.
Meanwhile, from noon on Wednesday, further rules are to be relaxed, including dropping the use of Covid certificates at pubs, restaurants and cinemas, the reopening of nightclubs and the resumption of dancing and indoor standing events.
And the First Minister has also indicated all remaining restrictions, such as legal requirements on face masks and regular lateral flow testing, could be scrapped next month.
There does appear to be a growing sense that the worst may be over for Northern Ireland.
Indeed, the World Health Organisation’s Covid chief has suggested the end of the pandemic is in sight for Britain.
And Professor Devi Sridhar, Professor and Chair of Global Public Health at Edinburgh University, has also provided a chink of light.
Writing in the Guardian this week, she said: “Delaying and preventing infection as much as possible through this pandemic was a worthwhile strategy.
“In early 2020, there were few treatments, limited testing and no vaccines.
“The cost of those lockdowns were big, but the effort to buy time paid off. In that time, sciences has transformed Covid from a deadly virus to a much less serious, nasty disease — one that is manageable at home, for the vast majority of those vaccinated.
“It has, largely, defanged, it.”
Of course, as with everything in science, this isn’t a position shared by everyone.
Dr Deepti Gurdasani, a clinical epidemiologist and statistical geneticist, has expressed alarm at the rolling back of restrictions. It comes amid an estimated 18,000 new cases of Covid-19 in Northern Ireland every day and a daily tally of more than 100,000 positive cases across the UK.
“I certainly don’t think we are approaching the tail of the pandemic,” she said.
“I have seen no evidence to indicate that and when you are recording more than 100,000 cases a day, to say the pandemic is over, it’s nonsense.
“I can’t think of any country in the world that is lifting restrictions when it’s recording more than 100,000 cases a day.”
However, Northern Ireland’s chief scientific adviser, Professor Ian Young, has said he is “cautiously optimistic” about the future.
“It is the World Health Organization that makes the call on whether it is a pandemic,” he explained.
“We may move to a position where the virus becomes part of the background here, but it is still causing big problems in other countries.
“I don’t think we’re near the end of the pandemic yet but I think in terms of the way the virus is behaving in this country, I think that we’re moving to a position where it will be endemic.
“I think I am delighted as everyone else is that we’re in a position to be able to relax some of the restrictions, no-one wants to see those in place any longer than required.
“I believe the Executive has made a very reasonable decision to take the brakes off but not throw everything out the window, and waiting to see how things go over the next three weeks before making the next round of decisions.”
So, if the statistics continue to move in the right direction and Northern Ireland comes out from under the shadow of Omicron without suffering the catastrophe threatened before Christmas, will life as we knew it before Covid-19 resume?
A major question for the Executive will be whether they keep in place the current testing and contact tracing infrastructure once the threat of Omicron has passed.
Another consideration — how long will the Department of Health continue to update its daily Covid-19 dashboard with statistics on daily cases, hospitalisations and deaths?
Most experts now agree the figures cannot be relied upon given the current testing regime, so how much do we actually learn from the daily update?
Also, will Northern Ireland remain in crisis mode even if it regards Covid-19 as endemic while other countries around the world continue to struggle?
At what stage will our hospitals be able to resume elective surgery to any degree that it stops the spiralling waiting lists?
And what threat is posed by another variant?
It is true that the vaccines are playing a major role in keeping people safe — but we cannot exclude the possibility of a vaccine resistant variant that results in serious illness.
Professor Martin McKee, Professor of European Public Health at the London School of Hygiene and Tropical Medicine, said: “It could happen next month or it could happen in 100 years.
“As we have seen throughout the pandemic, it’s impossible to predict what is going to happen.”
Prof Young has also said he cannot rule out the possibility, although he stressed “it would be unlucky”.
Assuming that we are now finally moving beyond the almost permanent crisis state in which we have existed for almost two years, what next?
It is naïve — and dare I say it somewhat selfish— to think we are going to return to a world without some form of public health measures once the worst of Omicron has passed.
While for the majority of people, Covid-19 will be a self-limiting illness that can be treated at home, there will be those who are still clinically extremely vulnerable.
Even with the vaccines and advances in treatments, the virus will still claim lives.
What measures will the public accept to ensure the tens of thousands of people regarded as extremely vulnerable to the virus don’t have to remain locked away indefinitely?
In her Guardian article, Prof Sridhar stressed even if Covid-19 is endemic, “that doesn’t mean harmless”.
She continued: “Endemic means that we accept a circulation of a disease because elimination or eradication is perceived as too difficult.
“Malaria, dengue and measles are endemic in certain parts of the world even though they are all serious diseases.
“Malaria was endemic in the United States until the government decided to eliminate it.
“This is part of a larger question about how much we continue to alter what ‘normal’ social relations are, given the circulation of Sars-CoV-2.
“Humans are social, we need to hug, dance, sing and recognise each other’s faces and smiles. A sense of community and connection are vital to wellbeing too.
“Public health is not about one disease, it is broadly about well-being, which includes mental health and being able to pay the rent, feed your family, stay warm through winter and have a meaningful role in society.”
To do this, we need to develop better ways of living alongside Covid-19.
For Dr Ultan Power, professor of molecular virology at Queen’s University in Belfast, this includes more research to establish levels of immunity and the length of time people remain infectious.
This would, he said, allow policy makers to make better and more informed decisions over the likes of self-isolation.
“If we could develop a rapid test that predicts how long someone is infectious, not whether they are still positive, that would be very helpful,” he explained.
Meanwhile, experts such as Dr Gurdasani and Dr Gabriel Scally, visiting professor of public health at the University of Bristol, are clear that measures such as air filtration systems in schools will protect children across Northern Ireland from all airborne disease.
The Education Minister has so far resisted calls for their implementation, citing insufficient evidence to warrant the £40m bill.
However, the hope is that our politicians and officials will take steps now to keep us safe in the future.
If the pandemic has taught us anything, it is that a novel virus, capable of killing millions of people around the world is not just a Hollywood concept but can become a reality within a matter of months.