A member of NPHET – the expert group established by the government to manage the national Covid-19 strategy – has published a paper which makes devastating criticisms of the approach adopted by the Irish authorities during the lockdown.
The paper, which can be read here, was presented by Prof Martin Cormican to Irish Society of Clinical Microbiologists, and is a no-holds-barred assessment of what Ireland’s response “ought to have been and therefore, how Ireland and the EU could do better if this happens again.”
As calls increase for an inquiry into the handling of the Covid response, his conclusions are compelling and informative, particularly in relation to the failure to strike a balance between preventing immediate harm and taking longer-term negative effects of policy into account.
He says the use of the phrase “follow the science”, was “both misleading and amoral” – and that “mask use in schools, like so much else that deprived children of their education and childhood, was done to placate powerful interest groups at the expense of the children’s fundamental rights”.
He is scathing about the use of fear to persuade the public to accept policies he says were ineffective – and says that the decision to deprive those who were very ill or dying from seeing their loved ones was wrong.
The microbiologist also posited that those who benefitted “in terms of status, power or wealth” from the lockdown and the Covid-19 response need to consider if that influenced their thinking.
Dr Cormican is professor of bacteriology at the University of Galway and was for many years a HSE national clinical lead in relation to infection control.
He says that policies were made during the Covid crisis which did not adequately factor in overall health gain and health loss over the longer term – and asks if NPHET ‘frightened’ themselves and the public so much about Covid-19 that ‘perspective was lost on the wider issues’.
“Fear is a dangerous tool when it comes to influencing population behaviour,” he wrote – pointing out that daily news reporting on case numbers generated “disproportionate fear” long after the number of people dying or in ICU had fallen sharply.
While the virus did lead to thousands of deaths – far fewer than predicted – it was understood from early in the crisis that older people or those with underlying conditions were most at risk, and some 99% of confirmed Covid cases were not fatal.
The scientist was sharply critical of decisions which had closed schools and isolated older people.
“[In] the continued pursuit of managing case numbers we did not achieve a good balance with the loss of health and wellbeing imposed on society. The measures taken had profound impacts on the short-term and most likely long-term health and wellbeing of those, old and young people who were deprived of opportunities for access to social interaction, physical exercise, childcare, education and indeed to healthcare.”
“The negative impacts were greatest on those young and older people already most marginalised in terms of opportunities for health and wellbeing and those family members who provide care and support for them. Children from areas of deprivation and those with special needs and their families were effectively abandoned for months. For many of them the harm will continue for years and decades if not for life,” he wrote.
When the Covid crisis first broke in early 2020, Prof Cormican was a member of the NPHET Expert Advisory Group monitoring research and development, before becoming a full member of the national body months later.
One of the first criticisms Prof Cormican makes in the paper goes to the heart of how the decisions NPHET made were enforced by telling the public that they needed to “follow the science”.
“One of the expressions I came to dislike intensely during the pandemic response was “we have to follow the science”. This maxim is both misleading and amoral,” he wrote.
“In an ideal world, science allows us to measure, estimate and predict within defined confidence limits the outcomes likely to result from different actions,” he said, arguing that while scientific methods were “used to predict rates of infection, morbidity and mortality in different groups of the population and to assess how policy options would impact on these metrics”, it could have also been used “to estimate the unintended health consequences and social and economic consequences of different policy options.”
“In many cases, the ability to predict outcomes with confidence was poor. The “follow the science” mantra tended to communicate to the public a degree of certainty about the expected benefits of certain measures that was not supported by evidence,” he said.
“Science is morally neutral. Public policy should not be morally neutral,” he argued, saying that care and compassion were core values.
“Whatever scientific rationale could be advanced for lowering risk of introduction of SARS-CoV-2 by preventing people in healthcare settings and other similar settings from seeing the people they loved it was simply wrong in human terms and should never have been done. There are higher values than infection prevention and control,” he said.
The Galway-based scientist also argues that “the perspective of overall health gain and health loss over the longer term was not adequately factored in” to the Covid response in Ireland.
“There was an overwhelming preoccupation with short-term metrics such as the number of cases of SARS-CoV-2 infection and the number of deaths among those people who were cases of COVID,” he wrote.
“[C]crude mortality associated with SARS-CoV-2 infection is easy to count. It is very limited as measure of harm. Deaths associated with SARS-CoV-2 infection were often interpreted as deaths that were caused by SARS-CoV-2 infection. For some people expectation of life was very much shorted by SARS-CoV-2 infection and SARS-CoV-2 was the cause of death. There were also many for whom the expectation of life before infection was already very short and it was very unclear to what extent if any SARS-CoV-2 infection contributed to shortening their life.”
“Excess mortality, that is the number of deaths in excess of what could be expected within a specific period is a useful measure. This measure was not adequately used in planning and communication.”
And the professor of bacteriology had a thoughtful question for those in authority: did some people benefit from the pandemic – and does that impact their view on how policy was decided.
“It is worth considering at a national and global level if institutions or individuals may have benefited in terms of status, power or wealth from the continuation of pandemic measures. This is not to suggest that there was incompetence, malice or corruption but only that where we stand influences how we see things. This is as true for me as it is for anyone else.”
He also rubbishes the media’s preoccupation with “long Covid” – saying it doesn’t exist.
While the scientist acknowledged that it was easy to see mistakes in hindsight he says that NPHET should have been more conscious of “collateral damage” – adding that while he had “the privilege of contributing to the key meetings I had to live with the decision even when I did not agree with them.”
“At the very first meeting of the expert advisory group, I was making this point about the consciousness of collateral damage or unintended consequences,” he wrote.
The collateral damage – to older people who died alone, to children whose education has been harmed, to the thousands now dying because they could not access medical assessments for cancer and other conditions for so long, to those whose freedoms were suppressed – is enormous, and must be the subject of an inquiry, precisely because this government, and the nodding-head Opposition, need to learn from its mistakes.
If we do not learn from mistakes, we will make those mistakes again. That’s probably more of an incontrovertible fact than much of what was claimed to be true during the Covid-19 crisis.
Last week, the head of the European Medicines Agency, Emer Cooke, an Irish woman who led the roll-out of the Covid-19 vaccine across Europe supported the establishment of a public inquiry into the State’s response to Covid-19. Ms Cooke told the Irish Independent that we “all have to be accountable”.
In a stunning summary Prof Cormican lays bare the need for that accountability: “We focused too much on simple short-term metrics. We imposed measures that excessively limited basic freedoms for too long. Our process for providing scientific advice to Government was not sufficiently robust. Our Dáil committee system for democratic accountability of advisors and service providers is adversarial and dysfunctional. We did not take adequate account of the collateral damage to health and wellbeing, especially for those already most disadvantaged and vulnerable.
“We gave too high a priority to maintaining and restoring international travel. Our communications with the public in some cases gave the impression of greater certainty than was supported by evidence. We depended too much on fear to influence behaviour. We did enduring damage to the environment through use of testing and PPE in the absence of evidence or sound rationale for proportionate benefit. We have undermined many of the foundations of rational infection prevention and control and have a long road back.”
Prof Cormican’s conclusions should be read by Minister Stephen Donnelly, and could form the basis of long-overdue Covid-19 inquiry. This devastating critique from an expert member of NPHET cannot simply be ignored.
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