19 – We have to get out of this place

Is this the longest January in history? It certainly feels that way. The first month of the year has seen a mixed picture with Covid-19.

After the increase in cases, the daily numbers are fortunately starting to decline, but only very slowly.

The impact on the healthcare system continues, with significant admissions, ICU numbers and, sadly, a high number of deaths.

Vaccination remains the big game in the fight to defeat the coronavirus. Official figures were updated Thursday to show that 121,900 people have been vaccinated with a first dose.

Although we are promised that more detailed vaccination figures will be provided, there is no official data beyond those published on the Covid-19 Data Hub.

It would be nice to know the number of people vaccinated in each priority group, the percentage of that group it represents, a breakdown of the regional / county distribution of vaccination, and all relevant data.

The public wants this information. It is the other side of the coin of daily case numbers and deaths from the virus.

By tomorrow, the promise is that 140,000 people will have been vaccinated. Although the supply of vaccines is an important factor, some frustration is expressed that the program is too slow.

We also see various groups and individuals competing for a higher priority on the vaccination schedule, and it bothers us that some people have received the vaccine outside of the official schedule.

Some people have also criticized the European Union for its approach to the vaccine program and also the European Medicines Agency for the pace of its approval system. It was therefore notable that this week the European Commission called on member states to accelerate the rollout of vaccination across the EU.

He wants to see by March that at least 80% of people over 80 and 80% of health and social care professionals in all member states are vaccinated. It is ambitious and challenging for countries to adopt a greater sense of urgency.

The commission says that by the summer, member states should have vaccinated at least 70% of their adult population. He says the vaccination program needs to be sped up to help deal with Covid fatigue.

The commission also called on countries like Ireland to develop tests to account for the new variants and increase contact tracing and coordinate travel restrictions. We must do better.

Our country has not only been infected with a terrible virus, but our use of language has also been infected at times. Whether it has to do with vaccination or track and trace, we seem to regularly hear terms like “step up”, “roll out” or “learn” from events.

These phrases may seem exciting to some people, but they offer little in terms of hard facts. If we could go back to some direct messages, please, that would alleviate some people’s inclination to want to hit the radio or television with frustration.

At this stage, everyone knows the public health advice on social distancing, wearing masks, and hygiene measures. In fact, the latest outbreak data shows some interesting trends.

The number of outbreaks rose in the last week to 293, up from 220 the week before, and the locations were interesting. The main increases were observed in residential institutions and hospitals.

Also, in workplaces, the number of outbreaks increased from 25 to 41. However, private homes saw a reduction in outbreaks for the second week in a row, which was welcome. These data from the Health Protection Surveillance Center were for the week ending January 16.

It was also compiled during a period when the HSE temporarily suspended close contact tracing due to the recent increase in cases. Although this may have had an impact on the overall number of outbreak cases, we can still see a trend.

We also see that during this lockdown, the traffic volumes are higher. Unlike the first lock, there is a 5km limit, not a 2km limit. Also, there are more open construction sites. Those over 70 are not asked for ‘cocoons’. So this block feels different than the others, but it also seems like it will be the longest and most difficult.

The campaign for a ZeroCovid approach continues, despite the government’s view that it would not work. Dublin City University Professor Anthony Staines, along with others, has argued strongly that Ireland has used only one tool really against Covid-19 and that is lockdown.

We know that it is a very forceful instrument and a huge burden on people. Professor Staines says that we should make better use of other elements like testing, tracking, tracking and isolation, as well as airport quarantine and proper management of the Northern Ireland border. From one perspective, it appears that we have left huge gaps in our defenses for many months.

Although things are difficult, Professor Staines says there are ways out. People can feel a bit overwhelmed hearing the increase in cases, the increase in ICU numbers, and the increase in deaths. But he says the answer is intensive public health measures. Each country has to decide for itself what it wants to do.

Professor Staines believes that many countries are moving towards the same conclusion, that there is a need to control the virus drastically, but that countries are looking for someone to go first. If Ireland doesn’t, he thinks Germany will likely go for a ZeroCovid strategy.

“We have ways out of this. We have routes out of this. If we don’t take those routes, the consequence of that is in our heads. But there is a lot of hope out there, for all of us,” he said. said.

The concerns about other new variant strains arriving here are very great. We know that the UK variant and the South African variant are here already. Surely it must only be a matter of time before the Brazilian variant arrives, if it isn’t here yet.

In the five weeks to the middle of this month, 3,000 people from Brazil and South Africa entered the state plus 37,000 from the United Kingdom. Like many other EU states, Ireland is currently sequencing only 1% of positive tests to see what strains are here. Are we seeing the tip of the iceberg with this approach?

NPHET has made it very clear that there should be no discretion for individuals, when it comes to the need to restrict movements and PCR testing after arrival in Ireland. In August, NPHET advised the government to ban nonessential travel from countries with high Covid-19 rates, but that was not implemented.

There are many decisions made, or not made, that will require an evaluation in the cold light of day when this is over. However, as in any war, leaders must always have the ability to change direction, implement new initiatives and, if necessary, replace people who do not perform. Just look at the early days of the Biden administration.

Cabinet will meet Tuesday to review current restrictions. There is little doubt that they will continue through February, and indeed probably well beyond.

The decision so far not to make the quarantine mandatory may over time be judged as a bad move that has fueled the viral spread, fueled and extended the third lockdown, and increased the impact on people and the economy.

This third block could also result in the most profound impact on non-Covid care, including mental health.

Hospital admissions for eating disorders rose 66% last year, according to a new study published in the latest Irish Medical Journal. The authors say that several factors are likely to have played a role in this significant increase, including malaise, pandemic-related anxiety, pre-existing illnesses, the interplay of social and economic factors, the impact of restrictions, and loss of life. protection. factors.

“Social restrictions may mean that some young people are less able to interact with protective factors. For example, more time online can facilitate greater exposure to erectile dysfunction.[eating disorder]-specific or anxiety-provoking media, “says the study.

The authors point out that adequate funding for psychological medicine teams in pediatric centers and the training of pediatricians interested in this area are vital and urgent needs.

The debate over whether schools should reopen has been difficult and sometimes divisive. The impact on students and their parents is really great. With current levels of virus transmission, schools will not be open for some time.

HSE Clinical Director Dr. Colm Henry said yesterday that transmission rates were simply too high for schools to reopen, ten times what they were in December.

The hospital system and its staff have come under unprecedented pressure this week. This is likely to continue, given the current high rates. The implications are stark.

This week, Dr. Catherine Motherway, president of the Society for Intensive Care, said she did not know if there will be enough ICU beds in the coming weeks to treat the anticipated level of critical care.

In a recent article in the Medico-Legal Journal of Ireland, Dr. Barry Lyons, consultant to the Department of Anesthesia and Critical Care Medicine, Children’s Health Ireland at Crumlin, spoke about Covid-19 and intensive care funding.

He said that the current pandemic, with overloaded services and inadequate resources, presents us with a real moral dilemma, where all options have a negative side. He said that prioritizing lives or years saved will inevitably have a negative impact on the level of treatment provided to those most vulnerable to the effects of Covid-19.

He says that an alternative metric like sickest first, or FCFS (first come, first served) will likely result in excess death toll, as (a) some who would be statistically likely to survive if admitted to the ICUs will die due to a lack of availability and (b) will admit a greater number of patients with a statistically lower probability of survival.

“Assuming a persistent situation of insufficient resources, tragic decisions will have to be made in some direction,” said Dr. Lyons.

He added: “The question that remains is whether the inability to arrive at a universal solution that respects the rights of all individuals represents some degree of moral failure.”

It is a grim observation.

Next month will mark the anniversary of the first officially recorded case of Covid-19 here. At the time, no one could have written the script for what would come next.

So many things have been sacrificed. And the pain is not over. We are in a difficult place now, from which we have to get out.

When this is all over, none of us will ever take anything for granted again. We all live history as it happens.

It is being written now, every moment, at a dizzying rate. The battle every day with this virus is to make sure that none of us become history, before our time.