‘Give new antivirals to unvaccinated’

One of the Ireland’s leading health experts believes new and expensive antiviral drugs may be best targeted at saving the lives of unvaccinated people who become seriously ill due to COVID-19.

It was announced last week that COVID-19 antiviral drugs can be used in Ireland before clearance by the European Medicines Agency (EMA). Health Minister Stephen Donnelly coupled the announcement with a commitment to spend close to €90m buying antiviral pills from drug companies Pfizer, GlaxoSmithKline and Merck (MSD).

Professor Samuel McConkey, Associate Professor and Head of the Department of International Health and Tropical Medicine at the Royal College of Surgeons in Ireland, considers, with the national vaccination programme advancing, that the “best use” of the rarer antivirals might be to treat people not yet vaccinated.

Speaking to The Anglo-Celt, the Clones native, also a consultant at Beaumont Hospital in Dublin and at Our Lady of Lourdes Hospital in Drogheda, says it “isn’t unusual” for hospitals to deal with people making “life choices” that lead to ill-health.

“If people drink too much alcohol and crash their car, we still stitch them together. In hospitals we don’t discriminate. In Irish hospitals the ethos is to treat everyone, even if [their admission is caused by] potentially destructive behaviour.”

He adds: “Unvaccinated people are at risk of getting very, very sick, so they might be a good group to prioritise for these drugs. Obviously, if they don’t want the drugs, that’s fine, that’s their choice, we can’t force them.”

Fifth wave

Prof McConkey sees Ireland as very much only still “in the middle” of what is the fifth wave of Covid infections sweeping across the country.

While the severity of illness caused by the new Omicron variant has proven to be less severe, Prof McConkey points to cases, especially among the older population, where infection has caused “delirium”, leading to falls, thus causing other secondary medical crises. “There is less respiratory failure, less deaths from lung failure. It’s presenting in a different way, more about the brain dysfunction and delirium that people get with any infection - they go off their feet and fall.”

Unfortunately some of those who have fallen have broken their leg, their hip, their pelvis.”

Prof McConkey, whose opinions over the past two years - based on informed observations on his main field of study - have been profound, dismisses what he says in an increasingly misunderstood theory regarding so-called herd-immunity.

Noting the ongoing vaccination programme is geared more towards preventing deaths and serious illness due to the Delta variant, he suggests the main concern regarding Omicron is the pressure an unchallenged rise in infections might have on the health system overall.

“As everyone I think has realised, you can still get infection even if you’ve been vaccinated. The basis of herd immunity is that previous infection stops transmission, but we all know loads of people who’ve got this thing twice even. So herd immunity is more wishful thinking than a reality.”

Prof McConkey suggests, at an individual level, people might be “better off” getting both vaccinated and contracting the Omicron virus, quickly drawing short of recommending people deliberately expose themselves to the virus as reportedly happens with chickenpox.

“It is true that if you get Omicron you’re partially immune. But you’re better off getting the vaccine and Omicron, rather than just one. Omicron is a booster really, but my advice to everyone would be to get the booster vaccine. There is huge demand where nearly two million people have got it already. If Omicron gets you, it gets you, I’m certainly not saying ‘go out get it deliberately’, but it would boost your booster if you like.”

The likes of Prof McConkey and other Covid commentators have often come in for sharp and sometimes unkind criticism on social media for their views and analysis.

But when asked about the opprobrium, and the impact this can have, he simply brushes it off as being of similar value to scrawlings on the rear of “toilet” cubicle doors.

Many of the most “extreme opinions” Prof McConkey feels are driven by digital broadcasters located across the Atlantic, where there is an increasingly influential “anti restriction, anti-science, anti-media” lobbying voice.

“There was all sorts of graffiti, rude drawings and poems, all personalised, all over the top, and Twitter is just the same,” Prof McConkey says of any of the abuse directed at him and others. “Twitter is the modern day equivalent of the back of the men’s toilets in the Trinity Arts’ block. So I don’t get offended, no.”

Instead, Prof McConkey says he is more focused on delivering a straight and accurate message, though the emergence of Omicron, and the rate at which it spread, caught everyone, including him, by “surprise”.

It’s a “lesson”, he hopes, can be learned from, particularly as Ireland looks to develop a long-term, multi-sectoral approach to dealing with pandemics, with detailed and tested continuity plans for essential services, and major investment in contract tracing and surge capacity in testing, tracing and ICU.

“We weren’t ready, we weren’t well prepared,” Prof McConkey says of Omicron. “That’s one of the lessons we need to take out of the last two years. We need to make detailed public health preparations for these emergencies. I’d like to see big investment in such planning. South Korea had a good plan, Japan had good plan, even China, albeit authoritarian and I’m not suggesting that’s the route to go down. New Zealand also had a good plan, as did Australia. We didn’t have a SARS plan. We just had an influenza pandemic plan, and the two are completely different.”

He even goes so far even as to express his belief that the global community might need to begin readying itself for a new and emerging pandemic, to varying degrees, at least every five to 10 years.

“The last one we had was Ebola, that was in Sierra Leone, Liberia and New Guinea, about 2009. Then we had Swine Flu in Mexico, thankfully that wasn’t too bad. Then of course, back in the 80s, we had the HIV pandemic. So in my working life I’ve lived through at least four pandemics, and there are going to be more. So we need to expect new ones every five to 10 years, and we need to have plans in place to counteract.”