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On the virus, Ireland seems to be trapped in a hamster wheel of failure

Five months ago as the coronavirus pandemic kicked into swing I wrote that the narrative around flattening the curve or getting to zero versus herd immunity provided no clarity on where Ireland was going with its response.

Five months later we are none the wiser. The government introduces new measures, a knee-jerk reaction, to an uptick in cases around country over the last week. So, until September 13th we are back in increased restriction mode. And maybe by September 13th we will be back to where we were two weeks ago, with cases in the single digit figures daily.

And then what? Does the cycle repeat itself? Society continues to exist or subsist in a form of never-ending uncertainty with jobs and lives on hold, repeating the same thing over and over again as case levels wax and wane as the government releases and tightens its grip on the lives, freedoms and livelihoods of the people, toying with emotions, building expectation then cruelly taking away.

Maybe it is necessary. We were previously talking about flattening the curve. That was done. There was no scenario equivalent to Bergamo. The health system coped. We gave ourselves time to put the systems and processes in place to manage the situation.

But where are the systems and processes? Why are we entering into a repeat panic situation with a slight increase in cases? The residual fear that has been planted in many with the talk of impending doom in March remains for now and this round of restrictions will be generally accepted. How long will that last?

There should be no doubt that these restrictions are cover for the inability of the government to put in place a sustainable strategy to manage the outbreak. Clearly there is no endgame articulated. Where are we going? Are we aiming to get to zero cases and eliminate the virus? Are we going to have to return to the discussion about herd immunity? Or are we going to drift along for one, two or five years ‘managing’ the residual caseload while destroying the certainty needed for economic activity and relying on the possibility of a vaccine that maybe will work sometime in the future?

It is about time the government told us what the aim is. Pick a strategy. Tell us.

Get to zero? Eliminate all cases with very severe restrictions and minimise the chances of new cases arriving into the country. Close the airports?  Maybe not, but with 100,000 people arriving weekly, then something better than filling out a form is needed. The narrative that the virus doesn’t respect borders is only true if they are porous.

Aim for herd immunity? That term has bad connotations because it is suicide for a government but it can be done in a managed way that protects those that are vulnerable. Do we have any idea of how many people have contracted the virus in Ireland or if we are making any headway in that direction? Probably not.  Rumour has it that New York has achieved herd immunity in part – as John McGuirk discussed yesterday – with the loss of 6,000 lives more (pro-rata) than here in Ireland. Is that palatable? Is it worse than Ireland dragging this out for years? It is not cut and dry but the calculus is not finished until the virus is gone – will we end up losing more lives over time to the virus, but also losing lives to suicide, to other untreated health issues, and the multiple knock on effects – including economic contraction which correlates to life expectancy reduction and death rate increases. We cannot ensure absolute safety from the virus just as we can’t assure it for car accidents. Just as we work to minimise traffic deaths without requiring everyone to drive at 5mph, we have to work to minimise the virus without destroying the country. This is not callous, it is how society works all of the time. It is how individuals live their own lives. They live them balancing risks – they don’t lock themselves away. The balance cannot be years of this boom and bust cycle of easing and imposing restrictions.

In the UK, double the number of people are reporting to be suffering from depression compared to normal. The numbers of people dying at home is increasing while those dying in hospitals is dropping. In Ireland, do we know what is happening? Are there illnesses going untreated? In the UK, the numbers dying from summer flu are reportedly fives times higher than those dying from the coronavirus – although these numbers are 50% lower than for the same weeks over the last five years, indicating a knock-on positive impact of social distancing.

The approach of the government to date seems to be the third strategy – a non-strategy – of reacting to cases figures with a sledgehammer to drive thumbtacks – bludgeoning all around them through a series of diktats and restrictions. This is not a strategic response to the virus. It was initially meant as a sticking plaster. Now it seems the sticking plaster is all that there is in the first aid kit. It may have been a sign of great leadership to take the tough decisions of shutting down the country once. To resort to the same tool repeatedly is no longer leadership but laziness or ineptitude. The government response seems to simply be to follow the curve. If it goes down, we relax. If it goes up, we panic.

Where is the nuance? Where is the analysis? There seems to be very little talk of what it means to the strategy that the median age of the new cases is dropping all time. There is little in terms of a targeted response to address the specifics. Three counties are locked down when there is an outbreak in specific meat plants. Instead, there are distractions and bogeymen. The pubs are bogeymen. Churches were bogeymen for a while but that seems to have eased off. It’s the pubs. Even though most of them are not open and eating food seems to mean you won’t get infected or infect others.

Distractions: the green list. Where can or can you not go on your holidays. Facemasks: they didn’t work a few months ago and now they are held up as a panacea to all our ills. Is there any evidence that coronavirus is spread in a shop at all? In March, the fear was all about touching things in shops and disinfecting everything. That seems to have been left behind and replaced by wearing masks. No reason given.

Strategically, distractions are super. They work nearly as well as fear. Much more time has been spent discussing facemasks than there has been on introspection on the government response in general or into the disaster that was deaths in nursing homes. Don’t get me wrong, I think masks are probably useful, especially when people are packed into buses and breathing on each other. It seems fairly clear by now that the virus spreads in confined spaces when people are in close contact with each other (for a prolonged period of time?)? Surely that should be the basis of the response. Has any evidence been shown that masks work when walking around a shop, with the wearer adjusting his/her mask and then touching a box of cornflakes with the same hand? I don’t know. But the discussion distracted me again. Distractions are super.

In fact, much more time is spent discussing how bad the UK is doing, or attempting to portray Sweden as a basket case, compared to the amount of energy expended in looking into how Ireland managed to have one of the highest % death rates due to the virus in care homes. In Ireland, as of end of May, 62% of all deaths occurred in care homes. In Sweden, where they apparently threw their elderly to the wolves (so we were led to believe because the Swedish example cannot be countenanced as being successful), the figure was 49%. In Sweden, the government apologised for this. In the UK, an inquiry was held. Just about every country made a mess of this aspect and many lives were lost due to incompetence or negligence, but mainly due to panic. It was not unforeseen. People had warned about it. It had already happened in other countries. In Ireland – no inquiry, no apology. We were too busy transitioning that government out and a new one in. Different folks, the slate washed clean.

It is time the response moved beyond restrictions and imposing fear. The time is for a positive response to move forward one way or another with a clear goal at the end. The country will not be able to sustain this perpetual uncertainty. Businesses are closing. Jobs are being lost even as they are sustained by government funds. Those that are hanging on are being given what seems like false hope. How many publicans absorbed debt in an attempt to keep their businesses alive under the expectation they would open in July, only to see the finish line kicked further down the road, closing with more debt than they would have if they knew their fate earlier?

So, come September 13th, the government may well decide that we can revert to the scenario of pre-August 17th, as the daily caseload drops to 5 per day. And then what? We wait a few weeks until the numbers creep up again. Then repeat? And then what? Is this the strategy? What is going to change to make it unnecessary next time around? We were told 5 months ago that breathing space was needed. It was given. It worked. The curve flattened. But to what end? Just to do it over again? When will it end? How will it end? It is time that it was figured out how to protect the vulnerable while allowing life to go on. Maybe there is a plan for beyond September 13th that amounts to more than crossing fingers and hoping it will go away. It doesn’t seem to be about getting to zero nor about herd immunity, so what is it? Just tell us, please.

 


 

Dualta Roughneen 

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