Like most healthcare workers, Lisa observes strict hygiene and mask-wearing.
till, working in hospitals throughout the pandemic, she was relieved to have escaped infection.
So, a week back, when she tested positive for Covid-19, she was shocked and disappointed.
“I’ve been meticulous during the whole pandemic, and I still wear a mask pretty much everywhere,” she tells Review. “But my son goes to work on the bus and he got it. He lives with me, so I got it.
“I’m fully vaccinated but I am reasonably unwell. I have a chesty cough, aches from head to toe, and I’m freezing. I just can’t get warm.”
Lisa’s son had tested positive by antigen and registered his result with the HSE so Lisa was contacted by the track and trace team. Neither had to take a PCR.
But for Lisa, an ICU nurse, it means she is unable to go to work. She is conscious that this heaps pressure on her colleagues.
“The team is short, about 25 nurses as it is. On top of that, nine of us are out sick, about half with Covid. The team does its best to cover but really, anyone being out sick at all is a disaster.”
In the meantime, Lisa is also undergoing treatment for a breast lump. She was due to attend an appointment on Thursday, which has had to be cancelled. She is also caring for her 90-year-old father, who has early Alzheimer’s.
“He is recently widowed and he is dependent on me for company. He is very, very lonely.”
Pending her recovery, Lisa will return to work this coming week, slotting back into the nursing rota and resuming caring duties for her dad and looking after her health.
The last few weeks have seen the return of stories like Lisa’s and other familiar omens.
Twitter timelines have been full of images of positive antigen tests.
Friends, family and acquaintances have been testing positive, sequestering themselves off in the box bedroom once more.
Eamon Ryan announced he had Covid. Mick Jagger cancelled a gig because of it. Late on Wednesday, Dr Anthony Fauci tested positive.
Covid is on the rise again — and it never really went away.
HSE chief clinical officer Dr Colm Henry said on Thursday there has been a sharp rise in Covid cases and hospitalisations of people with the virus in recent weeks.
The seven-day positivity rate for people going for PCR tests has risen to 29pc, while the numbers registering with the HSE as positive after a home antigen test rose to close to 2,000 on Wednesday.
The number in hospital with Covid rose to 496, with more than half there due to complications of the virus and the rest with another illness but positive for the virus.
Elsewhere, there are worrying signals. A German health minister has urged the return of indoor mask-wearing as cases there hit 500 per 100,000.
The Guardian reports that Britain is more than likely facing a surge, and here, the Department of Health has renewed advice to wear masks on public transport and in healthcare settings amid a rise in numbers.
So, are we facing another wave of infections? Possibly, say the experts.
The trouble has arrived in the form of two new variants — BA.4 and BA.5. In the week up to June 10, it was reported that these accounted for 42pc of cases.
Both are forms of Omicron, but, according to research published in the journal Science, previous infection with BA.1 and BA.2 Omicron variants does not prevent re-infection with BA.4 and BA.5.
As Dr Denis McCauley, chair of the GP committee of the Irish Medical Organisation explains, this increases the population of people available to the virus, and therefore the potential for new cases.
McCauley says those who had Omicron at Christmas may have thought they were superhuman. “As long as there was only one Omicron, we were fine. But now, there are new variants, which can re-infect.
“The one-third of people who had Omicron are now back in the population for the virus, and you have more mixing and less mask-wearing, so numbers are increasing.”
Amidst a backdrop of high vaccination rates, and high levels of previous community infection, many might wonder how we continue to be susceptible.
The answer lies in the nature of coronaviruses and also the ability of the current vaccines to protect us from infection, as opposed to severe disease.
Dr Gerald Barry, assistant professor of Virology at UCD, says we don’t have a level of immunity in the population through prior infection or more importantly through vaccination to stop infection and to shut down the spread of the virus through the population.
“That’s ultimately a function of the virus and the way it infects and how aggressively it can spread. Herd immunity is based on a number of factors, and one of those is how well a virus spreads, and once it gets into someone, how efficiently it gets back out of that person again,” Dr Barry says.
“Some vaccines are really good at stopping infection, but we don’t have a vaccine that does that. [The vaccine] reduces the chances of infection for the first few months, but then you return to zero in terms of your risk of infection. Thankfully, what it does is reduce the risk of severe disease, which is a key thing, but as yet, the vaccines haven’t stopped infection. That’s the next level. That’s what they’re trying to do now.”
The prospect of another wave fills most people with either dread, or ennui. But almost two-and-a-half years since our first interaction with Covid, the landscape has changed significantly.
Most of the public has been vaccinated, there are effective medications to treat the sick, and perhaps most importantly, we can modify our own behaviour.
But how at-risk might we be? If we are fully vaccinated, for example, do these new variants pose any threat? That depends how you classify a threat.
“If you think of your body like a castle, when we get our booster, all the troops are lined up along the top of the castle,” explains Dr Barry.
“And we also have our snipers in the forest waiting for the virus to come and attack us, and all the gates are shut. The virus really struggles immediately after the booster.
“But over time, our soldiers get a bit tired on the walls and they start to fall asleep, the gates creak open, because naturally the amount of antibodies in our system start to relax if we’re not exposed to that pathogen again.
“And while our bodies retain a memory of the vaccine, essentially the troops go back into the castle and start to play cards, and it’s only if somebody presses the alarm button that they jump up and start to defend again. By that time, somebody has breached the gates.
“Because of the vaccine, our body should be able to repel the virus, but we’ve already been infected.
“For many people that means feeling a bit rubbish for a few days. Unfortunately, the longer you are from the vaccine, the less likely you are to be protected against infection. But your body should be able to react aggressively if it sees the pathogen, so it will stop the virus from getting into the lungs and causing severe disease.
“The nature of the vaccine is that it doesn’t maintain long-term protection against infection. [After] three to six months, you’re pretty much back to zero in terms of protection against infection.”
Although infections may increase, the good news is that we have additional defences.
New medications are available, including an over-the-counter medication, Paxlovid, which can be prescribed by GPs.
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Professor Sam McConkey hopes that we won’t have to go back to social distancing
“It’s a directly-acting antiviral,” explains Professor Sam McConkey, head of the Department of International Health and Tropical Medicine at the Royal College of Surgeons in Ireland.
“It’s like these powerful drugs we’ve had for 25 years that treat people for HIV infection, and some of the drugs we’ve had for six years that treat Hepatitis C. Another, called Aciclovir, treats herpes. Paxlovid directly inhibits the replication of the virus, stopping it from multiplying.”
However such strong medications often have quirks, and this one is no different. Doctors are extremely careful about its interactions with other drugs.
“GPs will do something called an interaction check before prescribing,” says McConkey. “But that’s not a substantial obstacle.”
There are also drugs available in the clinical setting to treat Covid — Sotrovimab and Remdesivir.
It may be that in the future we will have rolling waves of infection, rather than significant surges. In this eventuality, personal responsibility takes the place of public health restrictions but there will still be broader consequences — chiefly, staff shortages.
“My sense is that we’re facing a rolling absenteeism problem, where people are taking a test, and they’re gone,” notes Neil McDonnell of the Irish Small and Medium-sized Enterprise Association (ISME).
“We’re getting that on the HR [Human Resources] line the whole time. You can represent that in a good way, in that people are still testing themselves, and they’re not circulating when they get it.
“But it’s causing significant problems in the service industry. People who are particularly affected are in childcare. Childcare is regulated by Tusla, and it’s a ratio service, so you must guarantee one carer for eight children.
“If you can’t maintain that ratio then you’re operating unlawfully, so that’s where the problem is going to be.”
Staffing problems are also intense in nursing homes as a result of the number of Covid cases. “Like multiple sectors, the difficulties for the private and voluntary nursing home sector with regard to staffing are acute,” comments Tadhg Daly, CEO of Nursing Homes Ireland.
“Staffing pressures with regard to availability of healthcare assistants is particularly pronounced.”
He says there is a national shortfall in the availability of healthcare assistants, and where pressures arise, the flexibility of staff ensures care standards are not reduced.
It seems inevitable that staff shortages due to Covid-related absenteeism will cause problems.
A surge will not be without consequences, but will it require a return to restrictions, or lockdowns?
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Healthcare worker Nithya Rajendran receives a Covid vaccine in Dublin in 2020. Photo by Marc O’Sullivan/POOL /AFP via Getty Images
Most think not. “Compared to where we were in February 2020, there are three ways we can control Covid,” says Prof McConkey.
“One is good vaccines, which we’ve got.
“Two is small molecule inhibitors, which we’ve been talking about with Sotrovimab and Remdesivir, both are intravenous and operated through hospitals. But Paxlovid is available through a GP.
“The third way is social distancing and pandemic control. But I hope that with the widespread availability of tool one and tool two, we don’t have to go back to tool three. None of us want that, none of us likes it.
“It was very invasive in our lives. Back in February 2020, we only had that measure.”
Another possibility, Dr McConkey says, is to amend how we exercise infection control to focus on individual cases, rather than the entire population.
“As we’re doing with monkeypox, we could have more focused contact tracing and focused restrictions on the people who have Covid and their contacts, rather than widespread population-wide restrictions.”
The one note of caution is that while we may be relatively well-prepared for another surge of Covid, the same might not be the case for another virus, according to Prof McConkey.
“I think we’ll be fine, even in the case of another Covid variant. What I warn against is even a new strain of influenza, or a different pandemic. We had Ebola, HIV hit us particularly badly in the 1980s. We had swine flu.
“The lesson is that every five or 10 years, we can expect a pandemic. And I’m not sure we’re prepared for a new one. Do we have in place laboratory capacity to scale up diagnostics quickly for a new pathogen? I don’t think we do.”
Back to the present. Dr McCauley says that those who are worried about a new surge during a period of heightened summer activity should ensure elderly or vulnerable family members get their booster from their GP.
For those ineligible for boosters, the advice is to take antigen tests before visiting anyone who might be vulnerable.
A wave may be coming, but for a mild variant, we’ll be well prepared.
