A tale of two countries

In the darkness of the coronavirus crisis, most people are doing the best they can, in the worst case.

Some may work, while others wait to see if their jobs will ever return.

Daily tasks may seem like a bigger task than ever.

Even the basics of life, sleeping and eating can be difficult, in this troubled new world.

There is some good news with the virus under limited control here, for now.

The infection rate is reduced and admissions to the ICU are low.

It is the actions of citizens that have brought Ireland to this precious position.

This is an amazing feat, one that is not easily wasted.

There has also been great sadness for all families who have suffered the loss of loved ones, whether in the hospital, in the community or at home.

Today, let us remember all those who have died at this time, from whatever cause and under what circumstances funerals should be held.

Each loss is personal and also a void in our collective.

Also remember that our individual survival through this dark period is inexorably linked to the success of our people in general.

We are in this together and we cry for each other together.

Today, with the coronavirus, Ireland is a kind of history of two countries.

There are parts where there has been real success in fighting the virus, but also in other places where there has been terrible loss.

Nursing homes have experienced a particular tragedy.

This despite the heroic efforts of health personnel there, amid unprecedented challenges, including the struggle to obtain personal protective equipment.

In late February, when Covid-19 had not yet officially arrived here, the government and health officials had to do what were in effect, war plans.

Those plans were based on the coronavirus experience at the time in other countries: China first, and then the parts of Europe where it first struck, with a devastating impact, such as in northern Italy.

Our plans were also designed based on what was known about this new virus, as well as how past pandemics were defeated, or at least dropped.

But Ireland had more time to prepare, more than many other countries, which have seen devastating levels of infection.

Being an island nation, it may also have helped us a little.

There are some countries that seem to have acted slowly, unprepared, and are now paying a horrible price.

We must also learn from those images.

Covid-19 poses a new threat of war, without parallel in world history.

So it’s like facing a battle against an army general with a battalion of unknown forces and capabilities.

And as in all wars, there are also front-line changes, defeats and victories, big and small.

Here the hospital’s defenses were strengthened by ensuring there were enough beds and staff.

That HSE job was successful, and we now have about 2,000 vacant public beds, plus critical care beds and enough staff, to meet current demand and additional pressures.

Physical arsenal in the form of personal protective equipment was also a priority, although some areas experienced severe shortages or the equipment they obtained was inadequate.

Keeping supply lines open in wartime is an ongoing challenge.

Despite the setbacks, the tests were also a first line of defense, to identify the enemy viral threat in the community, as soon as possible.

Here there were also some important gaps.

There was an element of decreased morale in the test delays and I know of some patients who never got their results.

But overdue work is cleared and hopefully the tests will be expanded soon with a quick results system, as part of the key to unlocking some restrictions.

The key area of ​​special vulnerability has been nursing homes and here are important questions about preparatory defenses.

We must take into account the sad reality that 90% of all deaths from the virus are among those over 65, making this an extremely vulnerable group.

It is also the group most affected during the influenza season in terms of mortality.

There have been more than 160 Covid-19 outbreaks in nursing homes; no other facility has seen so many groups.

To date, about 62% of all Covid-19 related deaths have been in nursing homes.

And there were advance warnings.

Last week, in my column here, I established the timeline and documentation of communications between Nursing Homes Ireland (NHI) and the Department of Health, about nursing home concerns for residents and staff.

The first such communication to NHI to the Health Department was in late February, around the same time that the first confirmed case of Covid-19 arose here in the Republic of Ireland.

It would be April 4 before a specific measures agreement was announced between the state and these households. Until yesterday, some nursing homes still expressed concern that they had not yet received all the promised support.

Health officials say they were involved with this vulnerable sector from the start and that it was in late March, before individual households posed specific problems.

The focus is now safer on nursing homes and there are some very distressing stories about the scale of losses in individual homes.

In recent days, new measures have been promised to help nursing homes, and a national HSE study of the coronavirus scale will be conducted in community residential facilities, including mental health and disability services.

More than 300 of all deaths have been at community facilities.

Of these, more than 250 have been in nursing homes.

There have been great challenges in treating coronavirus cases in hospitals, and sadly hundreds of patients have died, many of them with an underlying disease.

More than 280 people with Covid-19 have been admitted to intensive care units.

The positive news is that more than 77 have been discharged, which is encouraging.

We can see that the impact on residential homes of the most vulnerable has been greater.

The entire hospital system in Ireland is also in unknown territory.

Under a voluntary agreement reached last week, with various unions, reinforcements from public health workers are being sent to nursing homes to help with the effort.

While welcome, some may ask if you are being a little late in the crisis.

For this crisis, our public hospitals are reasonably staffed, have many empty beds, and have been waiting for the increase, which may or may not come. That is not their fault.

The agreement to take over the private hospitals was a necessary precaution, but their services have not yet been significantly required.

Who would have known that? It could have been very different. That situation could also change in the coming weeks or months if reinfection rates rise sharply.

Nothing is certain with this virus.

Some may ask whether it would have been better if the state had also temporarily taken over private nursing homes, as they did with private hospitals, as a precautionary measure.

To protect the most vulnerable, from the beginning.

To be fair, this has been uncharted territory, even for the most experienced health officials, and these are questions to be pondered at another time, not while we are in a state of emergency.

The decision to take over private hospitals has also had unintended consequences. The SláinteCare plan envisioned that this would happen for many years, not overnight.

Thus, it has also caused complex problems and complex effects.

A group of around 600 private consultants only have problems with temporary contracts proposed by the state, under which they would do public work.

While some procedures may be performed in private facilities, several million people are currently unable to take advantage of their private health coverage. They are also in a kind of confinement.

All hospitals are effectively public facilities, on a temporary basis.

The overall result of these changes will be very long public and private waiting lists, especially if this continues for a long period.

Over the past week, I was given details about a private patient awaiting cancer surgery.

The patient should be operated soon, but there is a delay due to the current situation.

There must be many other people in this uncertain position, wondering when they can be seen in a clinic, or if they have an important and urgent procedure.

The question arises as to what provision was made for all private patients, who need procedures or appointments, to be seen during the crisis, so that they have continuous care.

Temporary reimbursements of underwriting costs by private health insurers will be a welcome financial relief for many, no doubt.

But it will not provide relief to people suffering from chronic pain or other conditions that cannot be evaluated or treated at this time and for whom the deterioration of their disease must be a true fear.

Furthermore, the number of people, not yet quantified, who stay away from hospitals, with conditions that should be seen now, is a real concern.

Emergency departments have never been calmer, and most hospitals report that there are no patients waiting in cars.

There will be a price it will pay for some who are understandably reluctant to attend hospitals, including for emergency care.

That price could be fatal.

Everyone should be aware that doctors, nurses, and beds are there, through emergency departments, for people who are feeling sick right now, with any condition other than Covid-19.

Efforts should be made to prevent all deaths, regardless of illness, whenever possible.

The coronavirus is a living organism that hides with the naked eye, with the will to survive, through each human host.

He is a ruthless enemy, not found before. And he likes close encounters.

This battle with Covid-19 is at an uncertain stage.

As with all wars, there will be victories and defeats.

Ireland has been very successful in reducing the spread of Covid-19 so far.

The country has not been invaded and the numbers of victims predicted in the first figures have not been met.

The decision on relaxing measures and raising defenses is not enviable.

The coronavirus can easily open another attack front in Ireland, or even return for a second wave of assault.

Some people are tired, lonely and distressed and are looking for a way out of the “confinement”.

It is human and understandable nature.

There will be calls for an early lifting of the measurements and some relaxation may be possible.

But we must remember the story of the Pied Piper of Hamelin, who came to help in a different plague.

The withdrawal of the Irish into their homes and the sacrifices made were not a surrender.

You have bought valuable time against a great enemy.

There are signs of hope in the latest Covid-19 figures and in the news that people’s collective efforts have saved many lives.

It is something to be proud of, while we also regret the loss.

People have been asked a lot and still more is required.

There is no manual for treating the new coronavirus.

We don’t know how it ends.

That book is still being written.