It’s a time for questions; answers not so much. Some questions are personal and come more from a sense of entitlement than obvious deprivation. My version of the above might substitute Belgrade for Paris because I have two young grandchildren there and like many grandparents at this time, there is a sense, as weeks grow into months, that separation will weaken bonds. However, there are questions far more deserving of sympathy.
Older people living out the last months and years of their lives in nursing homes may well ask when they will have the comfort of a family visit. Their relatives may ask if time will not run out for them first. At this moment, deaths in care homes here are close to 70% of total covid deaths.
But there are wider questions too. This is the pandemic that came for the old. Ireland was not the only country to react by turning its back on,’the most vulnerable, the most precious’ among us, in the words of Simon Harris, and focus attention almost exclusively on preparing hospitals for the expected onslaught. Will Simon Harris admit we ‘failed to protect our elderly’ as his Swedish counterpart did when care home deaths reached 30% of covid deaths in Sweden? That particular question is largely rhetorical.
The strategy we took sadly made sense because in the words of, consultant oncologist, Dr John Crowne, in a Newstalk interview, ‘ I don’t have confidence in the ability of our (healthcare) system which has been incredibly overstretched’. He went on to list its deficiencies,’ the iniquity of waiting lists, of patients routinely being seen by trainee doctors, of cancer patients on trolleys’. The big question here is how these unfortunate people are faring now? If our hospitals couldn’t cope with them before covid19 pushed them aside, how will they cope when the crisis subsides? How will the patients cope?
Back in January, our health concerns were centered on the pressures the ‘flu season was putting on an already strained system. The situation was so fraught that a no-confidence vote in the Minister for Health hung over the government and became the catalyst for the general election of early February.
In an Irish Times article on January 31st, HSE Assistant National Director, Dr Kevin Kelliher, told the newspaper that the Health Service had been planning for a ‘long time’ for the kind of threat posed by the virus. No problem then. It would be interesting to know what provisions were in place and why we were so short of PPE for hospitals, let alone care homes, that we had to grovel to China for them?
On the cover page of the same edition of the newspaper, Professor Nigel Stevenson, an immunologist of Trinity College Dublin, said Ireland needed to start screening passengers arriving into the country and make quarantine preparations. Given this level of preparation, ‘it was very unlikely the virus would spread in Ireland’ he said. Professor Stevenson was advocating the pre-emptive approach successfully taken by Taiwan.
That advice fell on deaf ears. Even though the first diagnosed cases of covid19 here were among a school party who had been on holiday in Italy, the government continued to allow plane loads of people from the affected region into Dublin without let or hindrance. The same can be said for Cheltenham racegoers.
Leo Varadkar has tried to deflect the questions on the government’s risk-taking by speculating that a potential covid carrier could have come here from China sometime in late December. Even if his speculation is correct, does that justify the decisions on travel the government made against the advice of independent medical experts?.
Complicated graphs, jargon, and carefully curated statistics are the smoke and mirrors of experts and politicians alike. They aim to defuse questions and confuse the layman. It is the job of the media to pursue the full story and not settle for over-dressed spin. In defending lockdown strategy against the more liberal approach of Sweden, Dr Philip Nolan pointed out that Sweden had a higher death rate than the US. This was even more true for Ireland at the time. Yet the media did not challenge him.
In the last week, Dr Tony Holohan was asked the same question. He chose a different point of comparison. Adjusting for population difference, he showed that the numbers in ICU were far lower in Ireland than in Sweden. They were the statistics that mattered he claimed.
It is the duty of commentators to interrogate these assertions and not repeat them as holy writ. The median and average ages of those admitted to ICU in Sweden, are almost identical. This suggests that ICUs in Sweden may not discriminate against the elderly in the arbitrary way as we do. When the virus took hold in Ireland, nursing homes were told not to send patients suspected of having the disease to hospital. Those who were already hospitalised for other conditions were sent back to their nursing homes, carrying the virus with them in some cases, according to nursing home spokespersons. The only traffic encouraged from nursing homes were their nurses to fill positions in mainline healthcare.
There is also the important difference that the criteria for admission to ICU varies according to capacity and contingency. Sweden’s hospitals and ICUs have capacity that we don’t have. Would it be surprising if that capacity was reflected in both their hospital and ICU admissions policy ?
Comparing Sweden unfavourably to Denmark is another meme. Denmark has more of less the same population as Ireland. Its death toll doesn’t even reach 300. If our commentators weren’t so politically driven, they would be asking why Ireland isn’t Denmark, given they, like us, imposed lockdown. Perhaps Denmark’s success is due to their early decision to close their borders? Now,that is a question worth asking. That is another policy that differentiates them from Sweden but more to the point, from Ireland too.
Why don’t we ask about the runaway success of the Czech Republic, a densely populated country of 10.6 million ? Here too they count their deaths in the hundreds. Truly extraordinary, but our media prefers to obsess about countries that seem to care too much for civil liberties, the US, the UK and Sweden. What did the Czech Republic do differently to many other European countries? They made masks mandatory.
We heard Dr Honohan dismiss the protective value of the public wearing of masks. In this, as in travel advice, he took his cue from the WHO. Masks, he said, ‘only protect others from you’. He might as well have said, driving carefully only protects others from you. How about we have the same rules for everybody? Not one person in a roomful of journalists asked that question. Perhaps, press conference protocol didn’t allow it?
Now, as we prepare for lockdown easing, Dr Honohan sees a role for masks. They will not be ‘healthcare grade masks’ he said. So can we assume that the downplaying of masks up to now was about protecting the supply line for healthcare workers? That can be defended but is advice like this not based on logistics rather than healthcare? It was not presented as such. Pity someone didn’t point out that the masks used by Czechs were largely sewn up at home, using coffee filters or vacuum bags as interlining.
A fundamental question we need to ask as we emerge from the first phase of this crisis is how we prioritise health spending. In a world of limited resources, how do we justify paying abortion providers double the fee they receive for providing care throughout pregnancy? How do we justify paying family planning clinics the same amount when they, unlike most GPs, don’t need to be bribed? And surely the plan to make contraceptives free for all in 2021 is now problematic?
This prompts my penultimate question. During lockdown, the nation’s second biggest talking point seems to be a TV series called ‘Normal People’. Has anybody thought to ask aloud how hook up culture can work in the socially distanced world of the future ?
And my final question: is there any point in asking questions at all if answers continue to be served on a smoggy smorgasbord of models, charts, stats and jargon?