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Nature offers a stark contrast right now to what is happening in the human world with Covid-19.
Spring is busy doing its thing: full of birdsong, buds and new life.
It is an opposite pole to humanity, which has to mainly observe, but not enjoy, the growing light station.
But if nature tells us something, it is that change is always happening and much is beyond our control.
It is the loss of control around the world that has made people, ordinary citizens and even prime ministers, captured by the virus, and hostages to uncertainty nervous.
But there are important things we can control, such as our attitude to the viral threat and feeding our minds with facts.
At this stage of the outbreak, the days seem to mix with each other and it can be difficult to know what part of any week it is. It is difficult for everyone, especially parents with children and vulnerable family members, single people, and older people living alone.
The health system is remarkably under strain now, with increases in admissions to hospitals and intensive care units, and some nursing homes under significant pressure. But it’s worth noting that the ICU admissions rate has dropped and that’s a generally positive indicator, although it’s still early in real terms for our commitment to the virus here.
The sight of large numbers of people searching for places of beauty suggests that the tension created by the virus in society is beginning to show itself. This is the 42nd day since the first confirmed case was reported here in the Republic of Ireland. The measures introduced a few weeks ago have now been extended until May. They have had a valuable impact.
Understandably, some people are restless, out of place, and frayed at the edges. It is difficult to find a mental distraction. Even hardware stores are closed, as health officials do not consider them an essential means. Some DIY jobs need to wait a little longer.
The behavior of people during this emergency is as important as the behavior of the virus. Some of the key measurements can only be lifted when the testing capacity is such that testing and close contact tracking can be done very quickly.
When cases first arose here, health authorities understandably focused on hospital readiness through capacity building.
A great effort was made to develop test capabilities and fight to secure personal protective equipment. There were successes but also problems, especially with obtaining personal protective equipment and reagents for laboratories.
One question to be asked is whether the system was slow to respond to pressures from nursing homes. There have also been more than 109 nursing home groups and home deaths. Some of those deaths were from residents who needed to be transferred from nursing homes to hospitals. Those deaths would be recorded as occurring in the hospital.
Private and voluntary nursing homes care for some 25,000 vulnerable residents.
In late February, before the first confirmed case of coronavirus was reported here, the representative body Nursing Homes Ireland says it wrote to Health Department officials, expressing concerns about the sector.
Around March 10, the official opinion in the department was that the unilateral general imposition of restrictions on visitors by some hospitals and nursing homes was not necessary at the time and should be lifted.
On March 19, Nursing Homes Ireland wrote to Health Minister Simon Harris, seeking an urgent meeting or conference call.
In that letter, NHI Chief Executive Tadhg Daly wrote that residents’ vulnerability increased as Ireland delved further into the Covid-19 crisis. He called for an immediate commitment “to ensure NHI can continue to provide safe, high-quality care to the 25,000 residents in the care of our members.”
Six days later, NHI issued a press release requesting an urgent meeting with the government to discuss the problems facing households, and expressed disappointment that no meeting had taken place, despite a series of requests.
On March 30, NHI met with the minister and his officials, and nursing homes welcomed the engagement, but noted that “he was late in the crisis.”
The next day, the National Public Health Emergency Team met to consider measures to help nursing homes; That was the day that the Medical Director, Dr. Tony Holohan, fell ill at the night’s briefing, saying “he was not feeling well.” Fortunately, her hospital stay was short and she was able to return to her crucial report.
The NPHET recommended a range of measures. This included additional household staff, ensuring they had adequate supplies of personal protective equipment, temperature controls for staff and others twice a day, and supervision.
On April 4, the department and NHI agreed on a set of measures that are being implemented.
Last week, nursing homes repeated a call to increase testing for nursing home staff.
The question of whether the system was slow to respond to pressures from nursing homes is one for another day, when various decisions made throughout the crisis will be reviewed so that any lesson can be learned.
To be fair, during a crisis, nobody does everything right. It reminds me of a remarkable comment from the Sligo man, Dr. Mike Ryan, who has been doing an excellent job at the World Health Organization. He reflected at a press conference recently that if he needs to be right before acting he will never win. Speed triumphs over perfection, he added.
The past week has seen very difficult times. Official test figures are given once a week, usually on Tuesdays. More than 50,000 tests have been performed. The plan is to get up to 15,000 per day. Along with the tests that are carried out in Ireland, around 2,000 are processed per day in Germany. German figures have not always fed the daily figure headlines here. This is because they are “old cases,” they were cleaned up a while ago and shipped overseas for analysis, but not to be viewed as new cases. As of yesterday, when all the figures were added, there have been 8,089 confirmed cases of Covid-19 here.
I continue to receive many communications about delays in testing or obtaining results. Some of these cases have involved vital health personnel. There is also palpable frustration among some journalists at daily briefings on the inability of officials to provide clear figures on how many people await the test. What is the delay? While people understand that they must abide by self-isolation tips while waiting for their test results, the wait is terribly frustrating.
Data on the number of people not evaluated were included in the forecast model provided at the end of last week. German test result figures were also incorporated into the forecast model. While the forecast was able to tell us what things would look like under certain circumstances, with 100,000 cases per day in the worst case scenario of no action, it was still not possible to say how everything will work. Or how long can it last.
During the week, I received an email from the daughter of a woman who is a cancer patient and has already been waiting around 22 days for her coronavirus test. Although the family appreciated that there were problems with laboratory capacity and with obtaining sufficient reagents, they felt that this delay was ridiculous. It has also made them very anxious.
Another patient had his exam on March 25 and obtained the result last Thursday. The result indicated that the test result was invalid, leaving the patient confused. In another case, a health worker said they got their test result after a few days and it was negative. Good news, for a while anyway. Several days later, in another phone call, they were informed that they had tested positive. Some confirmed cases have also raised questions about whether all of his close contacts were tracked by public health officials. Clearly, the system is flawed and there are problems, especially due to the scale of the tests involved.
Not only testing in the community can take time. Last Wednesday, there were also 476 suspected Covid-19 patients in hospitals awaiting test results. However, for those in the hospital, the response time is usually much faster, about 48 hours or less.
There was positive news regarding the tests on Friday, with an agreement involving HSE and Genomics Medicine Ireland to supply reagents for the production of 900,000 tests in the coming months. Testing is one of the keys to unlocking the so-called lock.
The masks have been the subject of some debate. There have been mixed opinions on whether the general public should wear masks to prevent the spread of Covid-19. The masks are certainly important for those who have the virus and the health personnel who treat them.
A report in the British Medical Journal yesterday reviewed the known evidence.
He asked whether policy makers should apply the “precautionary principle” and encouraged people to wear face masks, arguing that we have little to lose and potentially something to gain from this measure.
It is argued that sometimes we should act without definitive evidence, just in case.
It is questioned whether the masks will reduce the transmission of Covid-19 in the general public.
The BMJ authors say that even limited protection could prevent some transmission of the virus and save lives.
Therefore, the British report concluded that “because Covid-19 is such a serious threat, the use of masks in public should be recommended.”
Our Government takes the lead in health advice from the National Public Health Emergency Team. There are also other considerations that should be in the mix, including the survival of the economy and ensuring that there is a reasonably functioning country to reopen. Getting the right time on how to relax restrictions will be a very difficult thing to do. With that in mind, we must look at what is happening in other countries that are more advanced in terms of the virus’s trajectory and see what has worked for them.
Yesterday we saw the decision to postpone the Leaving Certificate exams until at least the end of July or the beginning of August. They are also testing times for all students and the country feels for them. We are in this very difficult period for a few months to come. There was no surprise when the measures already in force were further expanded.
When the country returns to a certain appearance of normality, there will probably be another wave. This wave will come from patients who have non-Covid-19 related conditions and illnesses that have deteriorated because they may have been afraid to go to the hospital. These patients may end up in GP surgeries or even in emergency departments. We are likely to see very large waiting lists for non-Covid-19 related health problems, both in the public and private systems. That will be another test for the health service. In addition, official advice on what private patients with private health insurance should do during this period is also overdue.
Covid-19 will leave lasting scars in Irish society and healing will not be easy.
People have lost loved ones, treasured souls.
Life is in limbo and full of uncertainty.
Jobs have been lost and people are vulnerable.
It is a terrible moment.
But there are reasons for hope. Optimism seems part of human DNA and has resulted in human survival up to this point, despite other dire challenges.
There will be an antibody test for Covid-19 that will show if people have been infected with the virus and have built up immunity.
Scientists will develop treatments and vaccines will also be available on time.
These are the weapons experts from around the world who work around the clock.
When historians come to write the chapter of these difficult days for Ireland, let it not be a story of no failure, but a prologue to a collective uprising that met the greatest test of a nation.
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