Bearing all of this in mind, and taking into account this revised information and aetiology, COVID-19 still represents a considerable and potentially insurmountable disease burden if left unchecked and infections must be managed in some way. This therefore begs the question: if what we are doing is not working as we would like, and the disease has a particular character, should we not change our strategy so that those who are at least risk live their lives as normal and those who are vulnerable are protected? Is this a feasible approach and what would it encompass? Would it mean that those who are classified as 'vulnerable' (a significant portion of the population) would be expected to hide away indefinitely, cutting off all contact with possible vectors until it was safe for them to re-emerge from isolation? On the other side, how long would it take for the virus to rip through the rest of the population, those deemed 'non-vulnerable'? Can we estimate how many of these individuals would become seriously ill and require hospitalization ('non-vulnerable' is not the same as 'invincible')? In addition, what are the long-term impacts of COVID-19, even if someone only has a 'mild' version of the illness? We still don't know for how long prior infection confers immunity (if it does at all) and if the much-maligned concept of herd immunity is even possible. And finally, does the dogma of 'Testing, Tracing, Isolation' really work in a democratic society, particularly when such a high number of infections go unreported, either through willful lack of engagement with the system or because individuals are pauci-symptomatic and unaware of their infected status? These are the questions that need to be addressed as a matter of urgency, rather than imposing ever-more convoluted restrictions on fatigued and confused nations.
It is surprising that there hasn't been more debate on this issue within the mainstream media - of course, there is plenty on the alternative or social media channels but this is often fraught with mistrust of authority and the pursuit of agendas and a reluctance to engage non-emotively or constructively with the matter; people are scared and angry and frustrated at being in such a powerless situation and this is probably their sole outlet to express that - and my only conclusion is that debate is deemed unhelpful as it could undermine the public health message that we are being told to adhere to. I understand this and sympathize; the consequences of getting this wrong are huge and sticking to the simple social distancing, hand hygiene etc. measures as outlined in the early days of this pandemic seems to be the safest message to give. However, my feeling is that this isn't sustainable and something has to change. There is a growing awareness that we cannot live like this indefinitely and even though many prefer not to question things too much as it could be construed as being callous or irresponsible, my instinct is that people will quietly stop caring, not out of badness or lack of social responsibility, but just out of sheer necessity - when the initial panic and fear has dissipated, constant vigilance is wearying and unhealthy. Behavioural data collected in Ireland on a weekly basis on our collective attitude towards the pandemic and the guidelines/restrictions that are in place show that compliance is still very high here (this is self-reported but perception of others' compliance is also scored) and that there is strong support for such measures. I'm not convinced this captures the entire picture, however - I don't want to generalize or stereotype Irish people here, but many can be highly averse to public disapproval of their behaviour and will then do their own thing when it suits them without making a big song and dance out of it (for example, see the 'Irish Goodbye'). We also need to acknowledge that COVID-19 massively discriminates between socioeconomic groups, with those who are less well-off being disproportionately affected both in terms of suffering from the disease (as seen by a reported increase in the incidence of outbreaks in high-density disadvantaged urban areas) and its economic fallout. It is therefore conceivable that strong support for restrictive measures is largely driven by an older demographic, who may be more financially secure and at greater risk of illness, and the middle-class who can still work safely from home and have access to technology, with those who have no voice or opportunity for dissent simultaneously experiencing the most difficulty in adhering to restrictions and also bearing the brunt of these. In this regard, the real challenge may be when the pandemic and the management thereof starts to affect the jobs and lives of those who are currently financially resilient. My worry is that this will be too late (the employment situation in Ireland is extremely precarious, dependent as we are on foreign direct investment, employment by the government, and small businesses, with the latter sector already absolutely savaged by this crisis and only just about surviving because of temporary state supports) and any damage done could be irreversible.
Sweden is currently being feted as the poster child for how to deal with COVID-19, despite fierce earlier criticism of its approach. The Swedes adopted a so-called 'soft lockdown' where citizens were advised to minimize their movements, large gatherings were banned, and informal social distancing was encouraged. Masks were not mandated and social venues and primary schools did not close. High levels of serious illness were seen initially, attributed to a delay in putting measures in place to protect the elderly and other vulnerable groups, but thus far Sweden has not encountered the second COVID-19 wave currently engulfing Europe and people have not had to change their day-to-day lives unduly, preserving both societal cohesion and the national economy. It is worth considering whether this approach could work elsewhere but differences between countries in terms of culture, demographics, geography, and healthcare systems will have a huge impact on the efficacy of various models - again, there probably is no 'one size fits all' answer to this problem.
So, where does this leave us? It's hard to know and I really don't envy our decision-makers at this point in time; there's no obvious way out of this as every strategy has an inherent risk attached and there is large disagreement on how to proceed. Time will tell, I guess, if we've made the right decisions - let's pray that we have.