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Professor Philip Nolan of NPHET told a media briefing on Friday before new restrictions were announced, that because so little is known about the new [Omicoron] variant, it was very hard to tell what demand for healthcare it will cause.
The day after the announcement of the new restrictions to curb the spread of the Omicron variant and to keep the people safe over Christmas, the government released the news that there were 7,333 new cases of Covid-19, a significant jump of 3,628 cases the day prior, and a fair increase on the average of 4-5,000 that had been seen throughout December.
Unfortunately, no immediate information was available as to whether any or many of these were legacy/delayed cases – an important piece of information to be omitted, while the surge of cases arrived at a convenient time to buttress An Taoiseach’s state of the nation address from the evening before.
Plus ca change and all that.
The more interesting revelations came during An Taoiseach’s appearance on the Brendan O’Connor show on RTÉ Radio 1 on Saturday – much reported across the news as he talked about his grief at the death of his two young children. An Taoiseach and his wife, Mary, suffered the death of son Ruairí, who died of cot death at just five weeks old. In 2010, seven-year-old daughter, Léana, died due to cardiac problems. Such tragedy no doubt shapes a person in many ways and An Taoiseach talked in brief about the losses he and his family have endured as he broached the issue of the finality of death in his own life.
There was a range of additional insights through the lengthy and cordial discussion into the relationship between the government and the various advisory bodies that are supposed to support and advise the Cabinet in shaping their decision making to manage the pandemic.
While it is assumed that NPHET is an advisory body, the language used by An Taoiseach in his discussion with O’Connor, points to a different dynamic. Referring back to an initial meeting where NPHET first raised the issue of new restrictions where they were due to discuss omicron, An Taoiseach said the government put it to NPHET their view that closing pubs would drive people into houses. He said that NPHET took this on board.
This is an inversion of what the dynamic ought to be. NPHET should advise and the government take their advice on board along with all the other considerations in order to frame policy. The perception is already in existence that NPHET is in loco government is at the moment and this admission from An Taoiseach reinforces it.
Similarly, discussing antigen testing, An Taoiseach stated that he wanted to see Antigen testing much earlier but another advisory body, NIAC (the National Immunisation Advisory Committee) was against it. While An Taoiseach ought not be able to put his personal preferences in place as policy, the power given to the Cabinet by the Oireachtas to deal with the pandemic puts this power in the hands of a small group of people. It is not given to NPHET or NIAC, but to An Taoiseach, An Tánaiste and a few others.
The resistance of NIAC should be a consideration but if An Taoiseach was in favour of Antigen testing earlier then it must have been the case that other members of the Cabinet were not.
All of this is a discussion in the midst of uncertainty with the threat if the omicron variant is going to rip through the population with NPHET and others advising the government that there could be a range of possible scenarios from the mild to the catastrophic – with all consideration being given to the catastrophic however likely/unlikely it may be (we are never told).
In mid-November, NPHET advised that the optimistic trajectory would be that 200,000 people would become infected in the month of December before there was even talk of omicron. The pessimistic trajectory was that 400,000 people would get Covid-19, which would translate to 450 people in intensive care. We are on track for about 150,000 cases in December and ICU numbers are still just over 100. The modelling failed and failed badly.
The advice continues for January 2022, with the new fear-inducing projections for January and omicron released in advance of the government announcement or new restrictions: patients in hospital will rise to between 650 and 2,000 next month due to a massive surge of Omicron variant cases. That is a wide margin of error and the 650 figure is not a large jump from the current level between 400 and 500, so any increase will effectively see the lower number come to pass but the upper-limit will still be far off. But NPHET will somehow be right.
Critical cases are project to exceed 200 if things go bad – much less than the 450 projected for December that never materialised. Philip Nolan (he of the antigen snake oil perspective) said that even this estimate for critical care patients could go “way beyond that” if the variant turns out to be more transmissible than officials have estimated.
This of course is to state the obvious. If the variant is infinitely transmissible it will be infinitely bad for the country. Such catastrophising statements are not very helpful but we are further warned that there may be a rapid increase in symptomatic infections due to omicron and a rise to between 8,000 and 20,000 cases a day in January. These figures are very similar to the numbers of cases that would have been needed in December to achieve the range of cases between the optimistic and pessimistic scenario.
These uncertainties come through in An Taoiseach’s interview on RTÉ Radio 1, as he readily admits that much is unknown but at the same time he is of the view that we cannot take any risks with all that is unknown – begging the question as to the risks that are being taken by shutting down the economy, forcing drinking into the domestic setting etc. He says that the number one priority is to prevent people from dying and this has to be the number one metric. He is concerned that the language is becoming how many deaths can we tolerate.
He said ‘It is about preventing death. About preventing serious illness.’
This exchange was held with O’Connor as a lead up to the discussion on his own grief and the devastation that death brings to a family. He noticeably said that such loss makes you a more anxious parent, and that your certainties are removed in life. He admits readily – and this is natural – that the loss of his two children has changed him.
Such tragedy in life, such trauma, of losing one’s children, does not occur for every family, and O’Connor rightly notes that those who have not had such tragedy cannot understand it, and this is correct. It is difficult ground for a parent to discuss and to navigate.
It is unfair and very risky to try to analyse these words in tandem with his understanding of the need to prevent deaths and serious illness as the sole metric and reading many of the reports of the conversation it felt as if these subjects were very much intertwined.
Listening to the report on playback, it is not so clear that they are connected, nor that the losses An Taoiseach has endured impact on how the Government is approaching the pandemic.
Certainly, there is an abundance of caution in the face of uncertainty at play in how the government is responding, but there is also the feeling that indeed death with Covid-19 has become the only metric. The challenge with this metric is that death exists across society. There are deaths and severe illnesses due to the Covid restricting measures; economic contraction and job loss has an impact on society that correlates with increased mortality and morbidity.
However, such metrics are not so easy to measure, nor so immediate and they are not so easily attributable. The government and many who take a safety first approach refuse to acknowledge or engage the counter-risks and other metrics that ought to be considered. Discussions around the impact on cancer care – as one example – seems to be a side note. The 856 who died having caught covid in hospital may not have been as a direct result of Covid restricting measures but many who died in nursing homes certainly were. Yet the hubris of positive-only benefits of covid measures remains as we move into the third year.
But life is not just about preventing death. Traffic regulations to reduce deaths are balanced with the benefits of vehicular travel brings as just one example. The It’s 150 years since the world’s first-ever death in a motor car crash when Irish scientist Mary Ward died on August 31, 1869, in Birr, Co Offaly. In 1896, Bridget Driscoll became the first pedestrian to be killed by a car. The coroner, Percy Morrison, said he hoped “such a thing would never happen again”.
There are over 1.2m deaths a year across the world from road traffic deaths. In order to prevent all deaths would require unlimited control and restrictions and even in something as manageable as road traffic, the political and societal decision is not accept preventing death as the only metric (although there are arguments that the number could be massively reduced with limited increased controls).
Watching the Salisbury Poisonings, in trying to contain the spread of the nerve agent that was targeted at Sergei and Yulia Skripal, the officer in charge, upon finding a swan with signs of possible poisoning, wanted to dredge a river to reduce the risk of the poison spreading through the waterways – although it had very likely that horse had bolted. But her colleague advised that doing such a thing would only be an attempt to demonstrate that the Police were in control, but such measures would show that it was actually out of control. It feels the response of the government to Covid is exactly that – scrambling to try to control what it cannot or has lost the ability to.
The role of NPHET and NIAC ought to be to advise, but it is for the government to take this advice under consideration and weigh up the other factors. An interesting parallel occurs in the UK where SAGE provides the Tory government with advice and modelling but without the same perceived level of power and influence.
An interesting exchange reported in The Spectator by Fraser Nelson, as he caught up Graham Medley, the chair of the Sage modelling committee, on Twitter, to challenge the gloomy scenarios released to justify potential further restrictions in the UK.
The first point to note is that the studies are made available to the public – thus the calculus can be challenged along with the assumptions on the different variables. One challenger was able to tweak one assumption (severity) and the justification for lockdown disappeared.
No such modelling (as far as this writer is aware) is available publicly from NPHET to be dissected and challenged (or peer reviewed). Thus, large numbers can be stated as possible with little or no scrutiny – unfalsifiable because no one knows the assumptions contained within them. Professor Turlough Downes, from the School of Mathematical Sciences at Dublin City University, says Covid-19 modelling is very sensitive to changes. If you change the input even just a little bit, the output change is huge. “It is really, really, sensitive to some of these parameters which is why some of the models seem kind of ludicrously wrong occasionally.”
The second point that Nelson was able to ascertain from Medley was that Sage is responding to government requests for modelling for scenarios, rather than making predictions as to most likely best or worst case – or reasonable cases – as to what may occur. Indeed, Medley stated baldly that Sage does modelling and does not do predictions. It cannot predict for people’s behaviours even within restrictions.
The last and most salient point is that Medley was willing to talk somewhat freely and engage in a discussion on Twitter rather than simply making pronouncements as seems to happen with NPHET. In Ireland, we do not know whether NPHET is driving policy or the government is asking NPHET to simply model as Sage is doing.
An Taoiseach, in his discussion on Radio 1, talked repeatedly of the uncertainty we are in with Omicron, and the need to manage that risk, yet his language belied a certainty that there was only one option to hand – which was to introduce severe restrictions to manage that risk, and ignore the risks that come with those restrictions.
On a positive note, as Prof Nolan noted that Omicron seems to cause great problems to the vaccines just as vaccine efficacy seems to be waning in any case, the narrative of this being a pandemic of the unvaccinated seems to have been put on hold for now. At the same time, the need for a booster vaccine has been buttressed by the arrival of Omicron. Reported in The Irish Times:
“Two doses of AstraZeneca vaccine give “little protection” against becoming infected by the new variant but protection against disease remains significant. Omicron reduces the protection against infection offered by mRNA vaccines (Pfizer and Moderna) by at least one-third, but a booster shot brings back protection to about 70 per cent and “probably” increases protection against severe disease, he said.”
Dualta Roughneen
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