Analysis: as we prepare to spend more time indoors this winter and kids return to school, we are likely to see another Covid-19 wave in Ireland

"With the latest wave of Omicron, people younger than 50 have for the most part done very well and the translation into severity and hospitalisation across all age groups is even lower, even in the older age groups. So the build up of this background immunity that we have in general, is giving us a high level of protection against severity," says Prof Christine Loscher, Professor of Immunology at DCU. Loscher established the DCU Covid-19 Research & Innovation Hub.

Right now the HSE is rolling out booster doses for specific groups of people, including those over 50, those with underlying conditions, those over 12 who are immunocompromised, healthcare workers and pregnant people. The uptake has been "pretty poor" so far and the biggest thing we need to do is drive that booster campaign home in the same way we did this time last year, says Loscher.

"What the boosters do, is they give you an additional layer on top of the severity protection [from severe illness, hospitalisation and death], in that they do initially provide, for a number of months, protection against actually getting symptomatic infection. That's because they boost your level of neutralising antibodies."

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We're likely going to experience another wave of a sub-variant of Omicron but it's too early to say whether we need to boost the entire population, says Loscher. "If we decided to boost the rest of the population too early, say if we boost everybody now, in three months time, in the depths of the winter with another variant there, you may find that our neutralising antibodies from our vaccine wane. We won't have as much protection."

"So my sense of this is, that timing is everything. We've just finished a wave, our numbers are low, our incidence is low. We don't know what the next wave is or when they come, but if we look at the way Omicron has developed over the year, we could probably expect another one in October. If that's the case, and it's a new sub variant, most people would probably do as well as they did beforehand in that they'll have background immunity."

The European Medicines Agency (EMA) recently backed two new Covid-19 booster vaccines, from Moderna and from Pfizer and BioNTech, which have been updated to target the Omicron variant. This type of vaccine is based on the original strain of the virus plus the BA1 Omicron strain, which is why it’s known as a bivalent vaccine. Right now we don’t know when that booster might become available in Ireland.

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But waiting for it to arrive isn't the answer. "Because we might have a wave in the meantime and that means you've missed a chance to have good neutralising antibodies against that wave," says Loscher. "Waiting isn’t a good strategy for people. We also don’t know if the next wave will be an Omicron sub-variant or not."

Denmark recently stopped recommending vaccines for those under 18 if they don’t have underlying conditions or aren’t immunocompromised. The HSE is still offering a first booster shot to all people over the age of 12, as well as 5 to 11 year-olds that have a weak immune system, but we don’t know yet if they will be recommended a second dose.

"The biggest issue around children is that they have high numbers of children classrooms," says Loscher. The previous wave around Christmas had a huge impact on children in schools, before they were able to get vaccinated. "Most people will say, well if they get the infection again and they're protected against severity then what's what's the problem? Why would we need to give them a booster?"

The issue is, that as we learn more about Covid-19, we learn more about other complexities of infection. "Therefore my view would be, if we have a way of minimising infection in children and therefore giving them a layer of protection against a possible complication of long Covid, then we should be doing that."

Christine’s two children under 18 have been vaccinated and had their first boosters in the last round. "The younger child that I have, has had two rounds. If boosters are recommended in that age group, I would get a booster. For that very reason; that while it would not be about whether she would get very, very sick if she got COVID, it would be about an additional layer of protection against her getting it, so that we don't have at risk of long Covid."

The UK is reporting 2 million cases of long Covid and the biggest problem we’re facing is how to define what the symptoms are and finding out what the impact is long-term, says Loscher. People are seeing a huge impact on the cardiovascular and neurological systems, on top of fatigue, brain fog, and hearing problems. "We're only two years in and we're still finding that people in the first wave of covid are still presenting with some with some of these issues. So we have a long way to go in research to figure out what the best way of managing this new chronic condition is."

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From RTÉ Radio 1's Drivetime, Professor Jack Lambert talks about long Covid in Ireland

"That’s the bigger picture piece. It’s more than just people getting sick with Covid now, it's it's the consequences for people. That's a big risk for people that I think has been underplayed. The only reason why Omicron is very mild in people at the moment is because of the background immunity we have from vaccines and previous infection and the fact that it's preventing severity."

Speaking to Drivetime on RTÉ Radio 1, Professor Jack Lambert in the UCD School of Medicine said the Long Covid Clinic at the Mater Hospital is seeing about 25 to 30 patients a week now and about 20 new patients a month. Lambert said 20 to 30% of people can have persistent symptoms for six to 12 months after their original Covid-19 infection, but while some of them are mildly affected, some of them are seriously affected and unable to return to work. Lambert previously told the Oireachtas Committee on Health that Ireland needs "a new plan" to tackle the condition, because the current one has serious gaps.

"When you have very strong initial messaging, if you want to try to change that message, you have to work ten times harder to shift it and and I don't think that has been done," says Prof John Wenger, Professor of Physical Chemistry at UCC. "That’s the problem. I think people are stuck with the original message — all of that wash your hands and surfaces — good hand hygiene is obviously very important generally, but there’s virtually no evidence to indicate that the virus is caught from your hands. It’s breathed in, the virus is inhaled. Clean air is much more important than clean surfaces if we want to combat Covid."

The best way to reduce transmission in the community and in other places like healthcare settings is to remove the virus from the air, Wenger explains. The best way to do that, is source control; wearing a good quality mask, like an N95 or FFP2, to reduce emission of the virus. "Masks really are the first, most effective, preventive measure. The problem we have is that many people across society have tired of wearing masks."

"In areas where there is no masks, the only other measure we have to reduce transmission is ventilation and air filtration. Ventilation removes a virus by effectively diluting the air with fresh air. Filtration sucks the air in and filters out the virus and then sends cleaner back out into the room. Both of these work together and they can be additive," Wenger explains. "So in a place that, for example, already has some ventilation, you could add an air filter, like a HEPA filter, and you will increase removal of the virus overall. Those are real tools that we can use to reduce transmission."

At home or at work, this means having a flow of air by opening windows or doors at opposite sides of the room to ensure you’ve got a cross-flow of air. "If you are worried and you do want to clean the air further, then you can invest in a HEPA filter. These remove a 99.99% of the particles in the air not just the virus particles, but also all other particles; from dust, from cooking, from smoke, from pollen. They're very good anyway, just for cleaning the air. If there is somebody in the house that is immunocompromised or at high risk, and you want to add another safety measure, then invest in a HEPA filter," says Wenger.

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"We have a million schoolchildren, the scale of it is huge. So measures that you implement in the classroom, multiply across the whole of society. So if we are talking about community transmission, then we need to really target schools to reduce transmission," says Wenger. "Teachers and the principals in schools were one of the groups in society that responded best to the airborne challenge." As we begin a new school year and head into winter, it’s important that schools revert to following the guidance on ventilation and air filtration, to use this as a guide to see how fresh the air is and if they need to act to improve ventilation, he says.

A circular was recently sent out by the Department of Education, advising that recommendations for schools on Covid-19, ventilation, CO2 monitors and hygiene remain the same. There is no requirement to wear masks. Wenger encourages schools to spend the grant for "enhanced cleaning" on air filters and ventilation improvements if they can, rather than on surface cleaning.

"We've been having surges every three to four months. So we can expect a surge in October, we can expect a surge in February, so that’s two surges at least in the academic year ahead of us, as well as a potential flu season as well. So we need to take these protective measures very, very seriously," he says. Schools are "high risk environments," explains Wenger. "High occupancy and longer exposure time make it higher risk. [HEPA filters] are very important, not just in schools but in residential care facilities and nursing homes humans. I’d like to see a focus on not just ventilation but on air filtration."

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From RTÉ Radio 1's Today with Sarah McInerney, Prof John Wenger on the role of airborne spread of Covid-19 (first broadcast 8 July 2020)

"The messaging still hasn't shifted to emphasise the role of airborne transmission and the importance therefore of ventilation and filtration. Over the last few months we’ve had a general relaxation of protective measures as a whole, across society. People want covid to be over, but it's not."

"What the pandemic has really exposed is our complete lack of attention to the quality of the air that we're breathing every single day. 85% of our time is spent indoors. but there’s no air quality standards, per se. I think that a paradigm shift is what is needed. We need to treat the air that we breathe like the water we drink. We do need to fast-track indoor air quality standards and ventilation and it needs to be legislated."

The views expressed here are those of the author and do not represent or reflect the views of RTÉ

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