latest Nphet doesn’t rule out the requirement to reintroduce Covid restrictions in the future

A return to more restrictive public health measures such as lockdowns may be needed once again if current measures do not have a “sufficient effect” on the profile of Covid-19, Nphet has said.

The public’s compliance with basic public health measures will be “critical” in avoiding a return to more restrictive measures once again, Nphet said in their letter to Health Minister Stephen Donnelly on Monday night.

“The NPHET cautions that the re-imposition of public health restrictive measures may be warranted should the application of the above measures not have sufficient effect on the profile of disease,” the letter signed by Chief Medical Officer Dr Tony Holohan said.

This comes just days after Taoiseach Micheál Martin told the Sunday Independent the Government will not be reintroducing restrictions to curb the surge in Covid-19 cases, which is once again putting a significant strain on hospitals and ICUs around the country.

In the exclusive Sunday Independent interview, Mr Martin said: “We do not want to go back, and we are not contemplating going backwards. The only issue facing us now is going forward.”

Government is hoping an extension of the vaccination ‘booster’ programme to over-60s, and a new initiative to encourage unvaccinated people to get the jab will rule out a return to restrictions once again.

A ramping up of spot-check inspections in pubs and restaurants to stem the rise of Covid will also take place in the coming weeks.

In their letter to Minister Donnelly, Nphet reinforced their view that it’s unlikely that vaccination alone will bring the reproduction number of Covid-19 below 1 and effectively suppress coronavirus.

An avoidance of further restrictions on the future remains dependent upon “public understanding and buy-in to the basic public health measures in order to minimise opportunities for this virus to transmit,” Nphet said.

Meanwhile, daily Covid-19 cases could potentially increase to a peak of between 2,500 and 3,000 per day with up to 1,000 people with the virus in hospital in the course of November, chief medical officer Dr Tony Holohan warned.

In his letter to Government after yesterday's meeting of the National Public Health Emergency Team (Nphet), he said if this occurs, we could expect a peak of 800-1,000 people in hospital in late November, of whom 150-200 would require critical care.

There would be approximately 2,000 new admissions to hospital and more than 300 admissions to ICU between now and the end of the year.

These projections are in line with a "pessimistic" modelling projection.

He said a "a conservative scenario" could interrupt around 30pc of potential cases.

This could happen where effective social contact at the end of October 2021 is similar to that seen in December 2020 – but with the population maintaining basic measures (such as self-isolating when symptomatic, good respiratory and hand hygiene, and masks in crowded settings).

Nphet could also not rule out the reintroduction of restrictions in the future.

Mr Holohan said working from home has played a very important role in containing the spread of Covid-19 throughout the duration of the pandemic.

With the easing of social and economic restrictions, a majority of employees have already or will need to return to the workplace on an at least partial basis over the coming months.

This should continue to be phased and cautious, and Nphet continues to recommend that all who can work from home should continue to do so.

He said that given that over 90pc of adults are fully vaccinated, a key determinant of the spread of infection is the extent to which unvaccinated children transmit the virus. The models examined two fundamental scenarios – one where it is assumed that children and adults are equally likely to become infected and to transmit the virus, and one where it is assumed that children under 12 years of age are 50pc as likely to transmit the virus as adults.

He said Nphet looked at the progressive de-escalation of public health restrictions to date which has been cautious, gradual, and phased, with – crucially – sufficient time between phases to assess the impact.

This approach has been critical to ensuring the protection of those most vulnerable, and the protection of health and social care, education, and childcare services.

It reiterated its position that, based on past experiences, we cannot predict with certainty the future trajectory of the disease and emphasised the importance of continued monitoring in this regard.

It was further cautioned that we cannot fully rule out the reintroduction of measures in the future and that we must continue to ensure our response is agile and flexible, with an ability to pivot rapidly and respond to any emerging threat, Mr Holohan said.

Indeed, it has always been the Nphet’s position that the public health management of the Covid-19 pandemic must evolve in light of changing circumstances, risks, and emerging evidence, and this will remain the case over the coming months, he said.

“Nphet met earlier today to consider whether we could safely proceed with our planned transition in approach to the public health management of Covid-19, having due regard to the transition criteria as agreed on August 25.

“Nphet concluded that the epidemiological situation has deteriorated and is now uncertain and precarious. Nphet further concluded that the transition criteria as set out above that would facilitate the removal of the majority of the public health measures still in place have not been met, with a deteriorating disease profile, hospital and critical care occupancy increasing, and continuing sustained pressure on the provision of non-Covid health and social care services. It is therefore not recommended to proceed with the easing of public health restrictions on October 22 as previously planned.”

It considered recommending a full pause on the easing of remaining economic restrictions, with a further review in 3-4 weeks’ time.

However, it concluded that there is unlikely to be a sufficient improvement in the disease profile over the short-term and, therefore, did not believe it tenable that any pause now would result in a further easing of measures in November.

It recommended:

• The remaining aspects of the hospitality, entertainment and night-time economy sector can reopen only with the full range of protective measures in place and the wide and robust implementation of the Covid-19 pass.

In this regard, guidance should be developed or updated as appropriate by the relevant sectors.

• The range of public health protective measures currently in place across sectors should remain, including the appropriate use of masks, physical distancing, ventilation, and mitigation measures; Nphet does not foresee these being removed until at least February 2022.

• There is a focus on increasing vaccination uptake in hard-to-reach and vulnerable populations, including a potential booster programme, to mitigate further risks to the healthcare system, which may be impacted by influenza and other respiratory viruses across the winter period.

• Sector specific guidance and protocols with regard to hospitality, cultural and sporting events be reviewed, and strengthened where necessary, such that there is assurance with regard to institution and maintenance of high levels of basic infection prevention and control standards including in relation to promotion and facilitation of hand and respiratory hygiene, ventilation, and protection of employees and patrons.

• Nphet gave specific consideration to the use of the Covid-19 pass.

It noted the results of the recent SAM study from the ESRI which suggests that, notwithstanding the efforts of many businesses to adhere to sectoral guidelines, the Covid-19 pass has not been appropriately implemented across the hospitality sector in its entirety.

Visit our Covid-19 vaccine dashboard for updates on the roll out of the vaccination program and the rate of Coronavirus cases Ireland

Given the current trajectory of the disease, it strongly recommends that:

Compliance with this measure be reviewed and strengthened, along with the other protective measures currently recommended for the hospitality sector.

In addition, it recommends it to be implemented more widely and robustly than is currently the case, including in hospitality and for indoor events.

It said that subject to operational feasibility that the pass be adopted as a requirement for visitation to healthcare settings with a provision for exemptions on compassionate grounds.

It asked that the Rapid Testing Expert Advisory Group be requested to examine the potential role and feasibility of rapid testing as a component of the pass for those for whom, on medical grounds, it is not been possible to get fully vaccinated.

With the easing of social and economic restrictions, a majority of employees have already or will need to return to the workplace on an at least partial basis over the coming months.

This should continue to be phased and cautious and Nphet continues to recommend that all who can work from home should continue to do so. All other protective measures currently in place, as set out in the Work Safely Protocol, should continue to be adhered to by workplaces, employers and employees. In particular, there is a need for an ongoing partnership approach between employers and employees to ensure that the importance of self-isolating when symptomatic is understood, communicated and facilitated, such that employees are not disincentivised to identify themselves as symptomatic, and stay at home where appropriate.

It cautions that the reimposition of public health restrictive measures may be warranted should the application of the above measures not have sufficient effect on the profile of disease. In this regard, compliance with basic public health measures by the general public and across sectors will be critical.

"As noted in its letter of September 16, 2021, in the context of the highly transmissible Delta variant, it is unlikely that vaccination alone, even at the high levels of vaccine coverage that we have now achieved, will bring the effective reproduction number below 1 such that we will achieve suppression of the disease.

"This means that through this coming autumn and winter, possibly in the face of high levels of infection, we will remain dependent upon public understanding and buy-in to the basic public health measures in order to minimise opportunities for this virus to transmit.

"In this context, Nphet noted the results of the most recent SAM study in relation to mitigative behaviours like mask wearing, hand hygiene and keeping physical distance; while most people still recognise that their risk of infection is linked with how many people they meet and which locations they go to, the data suggests that people are discounting the potential value of mitigative behaviours in reducing their risk, with more than one-quarter of people reporting that they are not engaging in mitigative behaviours most of the time when leaving home,” Mr Holohan said.

It recommends that continuing efforts are made across all sectors to ensure clear guidance and communication with the public on the need for a cultural shift towards embedding individual and collective strategies to mitigate against Covid-19 and other respiratory infections. This should involve a strengthening of the ongoing co-ordinated approach to communications across Government and relevant agencies, ensuring a consistent and coherent message.