The Covid-19 pandemic is about solving a series of problems – not just one.
And how has the disease killed more than a million people, while 60pc of those infected have had mild symptoms and 20pc none at all?
It’s time to see that this disease can be the driver to address many long-standing issues in our society. As 68pc of cases are linked to local transmission we need to get at the root cause of why so many hotspots are emerging in Ireland.
In Ulster, increased transmission highlights the importance of designing measures acknowledging the frequent interactions between people in the two neighbouring jurisdictions.
In parts of Dublin, large increases in transmission are believed to be influenced by crowded living conditions.
In the past two weeks, more than 6,400 people have tested positive for Covid-19. One third live in Dublin, a county with a population density 21 times higher than the national average.
The Central Bank estimates that we need to build 34,000 new homes every year until 2030 to meet housing demand.
But new-builds are becoming smaller in size, leading to more crowding. Between 2019 and 2020, the average floor size of private dwellings in Ireland reduced by 10-17pc.
Currently one in 10 of the population lives in dwellings with more people than rooms. This matters because people with Covid-19 tend to infect a quarter of the people they live with.
Our first lockdown measures eased when Phase 2 began, exactly 100 days after Ireland confirmed its first case. Back then 250 private house clusters had been confirmed. Within two weeks, that figure doubled. By the time schools reopened in early September, Ireland had 2,000 private house clusters. Since then, the number has been growing by 3pc each day.
This isn’t unusual. During the 2009 H1N1 swine flu pandemic, the reopening of schools was associated with a resurgence in European cases.
These lessons cannot be ignored as Covid-19 is not a seasonal disease. Transmission will persist all year round if we do not create conditions for safer interactions between people indoors and outside.
Covid-19 hotspots are characterised by crowded and confined spaces with poor ventilation. This is how super-spreading becomes a possibility. These factors strike right at the root of how Covid has infected 38m people within 10 months. Knowing this means we can better foresee where transmission can accelerate in the future.
Ireland has the youngest population in the EU. One in seven children now lives in an apartment or flat. Most are in urban areas, where the population is growing 2.5 times faster than in rural Ireland. Responses to Covid-19 cannot overlook the importance of creating the conditions that make healthy living possible for everyone, everywhere.
Of people hospitalised with Covid, some four-fifths have an underlying clinical condition. This is twice the level seen among people who self-manage at home.
Most underlying conditions associated with worse outcomes from Covid-19 are preventable. These include hypertension, diabetes, lung disease, obesity, and many cancers. In Ireland, 10pc of people aged 30-70 die prematurely due to these diseases. Rapid unplanned urbanisation and unhealthy lifestyles are the biggest drivers of these trends.
As a society, we must now begin to address the factors that increase the risk of these largely preventable diseases or face similar consequences to emerging health threats in the future.
Ireland has invested more than €15m in research projects to advance its Covid-19 response, but none of these seeks to advance people’s health by addressing the contributing factors that make Covid-19 so deadly.
Some of these problems will take longer than others to address. But that can’t continue to be a licence to never start.
Almost 87pc of school children do not meet the recommended physical activity levels. Even in schools, 77pc of children do not receive the target for physical activity set by the Department of Education. This increases our need for community facilities and sports clubs. These also provide essential services to some of the 27pc of over-65s living on their own, most in the south and west of Ireland.
Generic measures such as national lockdowns buy time and successfully prevent transmission from person to person because everyone, everywhere has their interactions heavily restricted. But cases inevitably rise in the future if this time isn’t used to address local conditions that drive transmission.
We need to see the Covid-19 pandemic for what it is: a series of problems to solve – not just one. Viewing it this way engages people and their creativity to address the conditions that caused the disease to emerge, spread, and harm so many.
No single profession owns all of these problems or can be expected to create all of the solutions. Our response must bring communities together with experts from multiple sectors to address the range of issues driving our Covid-19 outcomes.
Mark Roe is a post-doctoral researcher at the UCD school of public health, physiotherapy and sports science