Minutes that Changed our Lives – The Meetings of the National Public Health Emergency Team

National Public Health Emergency Team

I spent last night reading the minutes of the National Public Health Emergency Team’s meetings, published to date, on the GOV.IE website. There is a certain morbid fascination in reading documents from late January and early February knowing how it all kinda ends – but legalistic language can wear you down – even with subject-matter as engrossing as the coronavirus.

Minutes of governmental gatherings have a certain style. Action Points and recommendations mainly. Heated argument tends to be recorded as a robust exchange of ideas. The opinion of particular individuals are rarely on display but rather the consensus that the group eventually decide on. You know that kind of page-turner.

As we walk back in time, through the journals of these meetings, I was reminded of something. The general election. One of the elements of the Irish crisis, is we tend to overlook the significance the general election must-have played during our initial response. The uncertainty of who was going to lead it.

The outbreak was only declared a Public Health Emergency of International Concern by the W.H.O on 30 January 2020. Yet, the Irish task force was up and running, and already two meetings deep by this stage of world affairs. All the while, the noise of a General Election was the backing track to their deliberations, as the last days of the #GE2020 campaign played out. The ambiguous results resulted in another two weeks of political no-mans land. A quick scan on the social media of Fine Gael Twitterati indicates a party, seeing out its last days in government.

In the post-election period, the Health Minister was engaged in a trip to the EU for an emergency summit of EU Health ministers. There are also regular WHO retweets and standard information sharing about what is going on in relation to the coronavirus on his twitter feed. But both he and Leo Varadkar still have time for the occasional jab at Sinn Fein and other matters of state. The evening bed-time chats, these personalized vlogs had not yet become a feature, in this mid to late February period.

Leo Varadkar was still flip-flopping on government formation, and talking about flood relief as well as the occasional social media tweet on coronavirus. Even on March 3rd, a couple of days after Ireland’s first case, the political language was still framed in the economics of the old world.

Meanwhile, NPHET, tasked with responding to the emerging threat was quietly and methodically working away in the background during all of this time. Dozens of the best people our administrative state has to offer. The first indication that the coronavirus was fast approaching comes in the form of an ad-hoc meeting of NPHET on February 23rd. The normal, steady heart-beat of weekly meetings, suddenly interrupted by this Sunday evening teleconference call. The Italian outbreak was quickly getting out of hand.

The response is one of calm, re-assuring competence if meeting minutes are anything to go by, as the various and complicated strands of a Health service are sewn together in a carefully constructed pattern. The only criticism one can have in the late February period is that many of the decisions taken required time to execute. Testing capacity and contact tracing for example, but time, as we know now, is the first luxury the coronavirus takes away.

For some reason, I thought the Minister of Health would be the mainstay of these meetings. It seems to me, he’s attended one or two and that the committee then sends him their deliberations. The Chief Medical Officer drafts a letter with the group’s recommendations and guidance. Obviously he has other communications with them and other groupings informing him but I erroneously thought he was central to the meetings.

As you are well aware now, matters and actions heated up significantly in the intervening period from those chilly February days to present. Hindsight is 20/20 vision as the saying goes but if there is one criticism I would have of the NPHET -it’s that the group is top-heavy with medical experts, scientists, and health officials. I know that sounds contradictory considering it’s a health emergency response but allow me to explain.

In the early to mid-March period, as the momentum picks up, the minutes of these gatherings indicate very clearly that social distancing was the central plank of our proposed response. This decision, while obviously the correct one, had not just health implications but massive social, judicial, financial, and economic repercussions too.

I’m not saying any decisions would or should have been changed but perspectives from the legal, banking, social welfare, travel, economic and private sector economy should have been brought in at that stage. A whole of country approach. A nuanced consideration of how to effectively destroy and then redeploy the economic fortunes of our country. It is something that has never been done before and that no country seems to have hit the bullseye on.

One interesting fact, from the minutes of March 10th, is the Society of Infectious Disease Consultants called for a full quarantine of the country.

” The HSE Chief Clinical Officer presented correspondence received from the Irish Society of Infectious Disease Consultants, which asks that full quarantine be declared in Ireland. This proposal was discussed. It was agreed that there is no epidemiological case for a full quarantine at this time, but that the situation will be kept under review “

As this particular period, of meetings and time progress, the recommendations and public health measures advocated rapidly increase in both quantity and detail. Indeed, almost verbatim, the minutes of these meetings have become the template for living our lives.

There are occasional oddities on reflection. The Italy vs Ireland rugby international is talked about in detail and guidance provided. But Cheltenham is not. On the whole though, there is very little in these meetings that isn’t on the Six One News. And that speaks well of all concerned.

In fact, I pretty much conceded I had wasted my time reading these ” Notes from a Crisis ” until I watched the Six-One News this evening. All residential care data was finally broken down, into granular detail, and GOV.IE has it all laid out in bite-sized chunks.

I am going to bang this drum one last time. Nursing homes.

On March 27th, a little over a month ago, the chief medical officer drafted and sent the Minister for Health a letter. In it, he outlined the current state of play in coronavirus Ireland and pointed to the emerging problem in nursing homes and residential care facilities. It wasn’t the first such noting of the nursing home situation in his reporting.

March 27th was a significant date. The day before, on March 26th, double-digit deaths were recorded for the first time. As the letter was drafted, the overall number of coronavirus deaths in Ireland was 19. How long ago that seems now.

I recall writing at the time, that it marked the end of the beginning of our coronavirus fight in Ireland.

The collection of NPHET meeting Minutes and Letters to the Minister Click Here

By March 27th and before, The National Public Health Emergency Team had spotted the emerging trend of clusters in nursing homes and residential care facilities and again on this occasion highlighted it out. This was the second letter in which the Chief Medical Officer highlighted the risks in the sector.

Often times in correspondence and note taking it’s what isn’t said that is most revealing. Tonight’s stark nursing home picture reminded me of that. All through the last two weeks of March the nursing home situation was discussed in detail at NPHET meetings. The group was on top of it and responding to it with proposals. Problems with PPE, staffing, and even funding arise at various points in these meetings. However one subject that never seems to be discussed or recorded about nursing home patients – is a simple one.

What do we do with them?

Was this policy already decided and not in the remit of the NPHET?

Now, let’s jump into this evening’s data, April 30th, 2020. As mentioned, the government website gov.ie has published a breakdown of nursing home statistics.

The most startling statistic is that 630 nursing home residents have died. The phrasing above is a little ambiguous but I would interpret it as 630 have died in the actual nursing home.

The other relevant fact here: 233 nursing home patients have been admitted to the hospital system. Think about that for a second.

3,679 nursing home residents have contracted coronavirus and only 233 of them have found their way to a hospital. Our most critically vulnerable group. Even if we assume that every one of the 233 nursing home residents admitted to hospital died, It is obvious that at least 400 nursing home patients have died without having recourse to a hospital environment, ICU bed, or ventilator.

Now, as I said, my reading of the government statistics is that 630 have died in -situ at their care residence, but even allowing for ambiguity, based on the statistics they have published, 400 definitely did. As death approached why did nobody act.

It couldn’t be clearer that this is a systematic approach to dealing with nursing home cases. It is too staggering a number of deaths to have been the human agency, of a systems failure or maltreatment of the elderly by nursing homes on a home by home basis.

I have a simple question. Who made the decision to leave nursing home coronavirus patients in nursing homes and not with recourse to the full resources of our hospital system and professionals? – You know those snazzy, empty private hospital beds we are paying millions and millions for a month.

Was this a political decision or a HSE decision – who made the call?

Perhaps, nursing home patients got caught up, in the tens of thousands of unprocessed tests from that period. When time from test to results was taking two to three weeks and more. Was the nursing home patient data, cloaked in the fog of this late March test backlog?

Was a positive coronavirus test result – a requirement or pre-requisite to gain access to a hospital bed and our hospital system, for those that needed it, from a nursing home?

If not, why were these people left to die in nursing homes up and down the country with recourse to only nursing home level care?

Is this how we deal with the elderly?

One thing is for sure, a 75-year-old person stricken with coronavirus that lives independently seems to get treated a hell of a lot differently than one living in a nursing home environment. If you have a parent or relative in a care facility, I would ring that care setting and ask a very simple question.

If my mother gets the virus with you – does the system prevent her from gaining access to a hospital bed?

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