Dr. Tony Holohan:

I thank the committee for the opportunity to discuss the public health implications of international travel. NPHET met last Thursday, October 29, and reviewed the latest epidemiological data. In the interests of time, I will just refer to the data rather than going through the details, given that they will have changed ever so slightly over the course of recent days. The data are set out in the first two pages of my submission.

Internationally speaking, our national epidemiological profile is occurring in the context of a widespread resurgence of this disease across Europe. We have seen reports and have shared concerns at the deteriorating situation globally, particularly in Europe and North America where governments are facing common challenges, which have required many countries to reintroduce restrictions of the kind we have in place. Some of the worst affected places at present are capitals and major cities in Europe and there is pressure on ICU capacity in several cities. The average seven-day incidence across EU and UK countries is 241 per 100,000 population, which compares with 169 in the previous seven-day period, indicating the deteriorating situation across Europe. Data reported by the European Centre for Disease Prevention and Control, ECDC, on 28 October rank Ireland 17th out of 31 countries in terms of 14-day incidence rates. In terms of the seven-day incidence rate, the epidemiological situation in Ireland compares more favourably with European counterparts. According to NPHET’s figures from last week, there had been a 20% decline in the seven-day incidence rate in Ireland. Indeed, it has declined further in the intervening time. This at a time the majority of countries are experiencing an upward trend.

The most recent rapid risk assessment, which is the ECDC’s instrument for setting out its assessment of the disease on an approximately monthly basis, is dated 23 October. It highlights that all EU-EEA countries and the UK have implemented various “non-pharmaceutical interventions”, which is its term for social restrictions, but that these have not been fully successful in controlling transmission and the epidemiological situation is now rapidly deteriorating. Implementing stricter non-pharmaceutical interventions, which proved to be effective in controlling the epidemic in all EU-EEA countries and the UK during spring 2020, appears to be the only available strategy that may have a moderate, as opposed to high, impact on the disease for individuals and healthcare provision. This results in an overall assessment of the general population across Europe as being at high risk.

The landscape in respect of restrictive measures is rapidly evolving, with significantly more restrictive measures having been introduced or proposed in a number of European countries over the past week. This includes stay-at-home recommendations and overnight curfews, limits on numbers of individuals that may gather in indoor and outdoor settings as well as mixing of households, and restrictions or closure of the hospitality sector and other non-essential services.

The WHO, for its part, in its weekly epidemiological update from 27 October stated that the number of new cases in Europe is increasing exponentially, with over 1.3 million new cases recorded during the most recent seven-day reporting period. Against this backdrop, there is a substantial risk associated with international travel at the current time.

Our focus, as a country, is now very much on suppressing the spread of the disease domestically. We have moved early in our efforts to break the transmission cycle. Many European counterparts are now following a similar path and we have seen daily reports on the reintroduction of restrictions by European governments, in some cases quite stringent measures such as curfews. Once we bring the disease back under control in this country, it will be necessary to manage very carefully the risks of importation, among other risks to that status. In circumstances of sustained low levels of domestic transmission, the relative impact of imported cases is all the greater, as was seen in this country at times during the summer when travel-related cases increased and accounted for up to approximately a quarter of cases on occasion.

International travel will represent a prominent area of risk as the disease comes under control nationally and we subsequently aim to maintain suppressed disease activity and low incidence rates. I am aware that agreement has been reached at EU level on a common approach to intra-EU travel and that the Government has decided on how these recommendations are to be implemented in Ireland. Senior officials from across Government, including from the Department of Health, are engaged actively in discussions on its implementation. Acknowledging the likely duration of the pandemic, countries are transitioning from emergency management of Covid to more sustainable strategies such as the EU agreement, and it represents an important step for that reason.

It is important that countries adopt approaches that facilitate travel, especially essential travel, while ensuring that those who need to travel are not posing an additional risk to wider populations. I stress that countries which have adopted PCR testing as part of their travel policies in those circumstances have tended to do so as part of a suite of measures applying to international travel, often including more restrictive measures than apply here such as travel bans, mandatory quarantines and border closures. Our experts and many of their counterparts internationally consider that, should testing of asymptomatic passengers be introduced, a five- to seven-day period of restricted movement, with a symptom check and test on day five, is the most efficient means of containing importation of the virus. This approach can still miss up to 15% of potentially imported cases.

At the request of NPHET, HIQA recently undertook a rapid health technology assessment on the use of alternatives to laboratory-based PCR testing. HIQA found that these tests offer possibilities to enhance prevention and control, including expanding of testing capacity, reduced test turnaround times and improved access. These tests work best where there is high prevalence and incidence of the disease, particularly amongst symptomatic patients. HIQA's findings confirm the WHO advice which shows that the currently available rapid antigen detection tests are not suitable for use in screening asymptomatic populations with unknown levels of disease, such as would be the case with arriving passengers.

The HSE recently established an expert group to review the antigen tests currently available and how they might be deployed in clinical and non-clinical settings. Validation studies in respect of these with two rapid antigen tests are already under way in Ireland in connection with their potential use in vulnerable populations. I emphasise that, over the course of the pandemic, NPHET's advice to the Government has been informed by the latest scientific evidence. As evidence accrues and our understanding of the disease develops, our advice to Government develops alongside the evidence base.

It is essential that people who arrive in this country or who have returned from travel pay close attention to maintaining the basic public health measures of 2 m distancing, hand hygiene, wearing face coverings and avoiding crowded situations for a full 14 days, even if they are not asked to restrict their movements for that period.

In returning to the risks associated with international travel, while we recognise that long-term travel restrictions are, of course, difficult, we need only look to the travel policies of countries that have achieved sustained low rates of transmission, particularly countries in Asia, to see the importance that this has in helping to control importations. Our core national objectives are to maintain the safe reopening our education and health sectors, and to protect our vulnerable people in particular. Achieving these goals is predicated on maintaining low rates of community transmission and avoiding an ongoing reseeding of cases through whatever means, including travel.