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Many people spent Monday scratching their heads trying to understand what had happened since last week to justify their escalating concerns from the National Public Health Emergency Team.
Last Thursday, Dr. Ronan Glynn, acting medical director, wrote to the government pointing out a number of worrying trends, but said that “current epidemiological data does not strongly support a move to Level 3 nationwide at this time.”
Just three days later, medical director Dr. Tony Holohan, back at the helm after a period of personal leave, recommended Level 5 measures nationwide for four weeks.
In tone and content, the two letters are similar, and many of the trends highlighted by Holohan are the same as those mentioned by Glynn the week before, with some deterioration in the numbers over the few days.
However, the second letter highlights other trends not mentioned in the first, and these may have solidified the argument for Sunday’s meeting of public health officials. These include a “sustained increase” in cases among older people, seven new outbreaks in nursing homes last week and an increase in deaths, from four in August to 34 in September.
The whole world will be haunted by the scale of deaths that occurred in nursing homes last spring. The specter of a possible repeat of this fiasco must have loomed large when officials were considering what to do next.
Sudden jolt
Otherwise, the proposal to skip three levels of the Government’s framework plan does not make sense. We are supposed to be nimble and nimble to respond to this virus. A tiered approach would see areas steadily rising and falling according to prevailing trends, without suddenly wavering almost from one end of the constraint spectrum to the other.
An alternative explanation would look for the authors of the two letters; the first written by an interim incumbent, the second by an experienced and frank medical director, well versed in dealing with ministers. Dr. Holohan’s prescription is arguably more internally consistent in that he paints a dire picture of the damage done by the virus and then proposes to administer strong drugs to treat it.
Cases are generally on the rise across Europe, but Ireland is ahead of the curve in entertaining proposals for a second lockdown. Infections in Spain and France may be increasing, but other countries (Germany, Greece, most of the Nordic countries) appear to be facing more modest increases.
In most of Western Europe, death rates remain comparatively low despite the increase in cases. For example, smaller countries like Luxembourg and Iceland have higher case rates than Ireland, but there are virtually no deaths to speak of in recent months.
Extended health service
Here, officials consistently say that cases among vulnerable older people are unavoidable, although this is not the experience in other countries. The question arises whether everything possible has been done to reform work practices and improve infection control in some nursing homes.
Perhaps it is Ireland’s exceptionally widespread health service that is behind the decision to opt for another lockdown. Holohan’s letter refers to 243 of the 281 intensive care beds that are currently occupied; It’s easy to imagine that capacity will be exceeded if hospitalizations continue to rise.
However, the capacity is elastic. Each winter, elective work is canceled to free up space for flu sick patients. The same would happen with Covid-19 if pressure increases in ICU beds. Additionally, another 17 beds are supposed to be opened under the winter plan.
Is the system capable of supporting a significant increase in virus cases? We just don’t know because the modeling that has been done has not been published.
And if it’s the lack of ICU beds, why aren’t more provided? Intensive care beds are not cheap, but they cost much less than blocking an economy, forcing businesses and workers to close on welfare.
At best, Holohan’s spirited return to the public arena could serve to surprise some people into better observing social distancing rules. It has also revealed a chaotic decision-making process that is ripe for reform.
It actually shows how divided society is on how to deal with the virus, how much detail is still missing about the overall costs and benefits of the public health-based approach, and how uncertain the path out of this crisis is.
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