Before we get to Mr. Harris and the ease and comfort with which he and the group managing coronavirus Ireland are adapting to unlimited power, we should start at the beginning. Also, from the outset, I do acknowledge that all concerned found themselves in the midst of a crisis not of this country’s making, a rapidly developing and changing one. A catastrophe where decisions are required thick, fast and sometimes on the fly.
As a result, not all of these decisions will be perfect and in hindsight a lot of them will look plain wrong. So to be fair, to the parties involved, we should not flippantly disregard the rationale applied when taking them. Even if that rationale might look erroneous – a little over a month later.
The first 10 days of March 2020 saw a growing sense of unease in Ireland. We had our first coronavirus cases on the island, both North and South within days of each other at the end of February. Remarkable as it seems now, we all had time to digest and investigate these individual cases just a few short weeks ago .
By March 9th as cases started to build so too did the public tension. There was, if anything, a growing feeling that maybe Fine Gael, as the caretaker government weren’t acting quickly enough. A light-bulb switch in attitude occurred that week though and our fight against this terrible affliction began in earnest with the announcement of the closing of the education sector on March 12th. This was followed a day later with a less memorable but more profound decision.
A combination of the HSE and the Health minister announced an adjustment to the coronavirus testing threshold. In essence we moved away from targeting people that had exposure to an oversea’s visit or to an oversea’s visitor. The increasing number cases forced a reality. The virus was spreading in the community. I will allow the Irish Times to explain the battleground as it existed a few short weeks ago.
” The demand for testing exploded from Friday 13th, when the threshold for eligibility was lowered. Anyone with symptoms was advised to contact their GP, who, after a telephone consultation, refers their patient on for testing. The removal of consultation fees was good public health policy, but inevitably increased the demand for testing “ – Irish Times (March 24th)
The concept of this expansion to community testing was to grasp the nettle and admit to how big a problem the country potentially had now. The battle cry was: Test, test, test – contract trace the positives – and rapidly repeat.
It was a grand goal to have no doubt. But almost every country in Europe has failed to meet it, bar Germany and maybe Austria. It only works if you have the infrastructure in place and ramped up to the max ready to cope with a huge surge in testing.
The surge took less than 10 days to emerge, with a backlog of 40,000 people seeking a test. Added to the ones who had already successfully gained one on the new, lower testing threshold. The emergency situation back in March was to broaden capacity to deliver the tests. How we would process them didn’t receive nearly as much coverage. The mistake, if you can call it a mistake was that the steering group massively underestimated how many people would be in that initial surge for testing. Fear and unease, country-wide, panicked the public to race for testing in addition to toilet paper.
The government website GOV.IE provided a testing update yesterday (April 15th 2020) that is relevant to what we are talking about here. And we should take a look at it now.
As of midnight Monday 13 April, 90,646 tests have been carried out.
Of these tests:
- 62,952 have been completed in Irish laboratories
- 27,694 completed in a laboratory in Germany
The HSE have been telling us ad nauseum that the majority of these tests are from weeks ago. I believe them. The reason I do is that broadly speaking the numbers add up. Paul Reid, the HSE CEO, stated yesterday that the backlog of tests will be completed by the end of this week and that the backlog is now down to about 11,000. Adding this figure to the near 28,000 completed tests above, tallies with with the 40,000 figure widely reported around circa 23/24th of March.
” With a backlog of 40,000 people awaiting a test, to succeed, the State’s success hinges on a plan to ramp up the testing capacity to 15,000 a day in the coming weeks – roughly an entire seven-month flu season’s worth of testing – every day, for months on end “ – Irish Times March 24th
Now what happened next is important. On March 25th, the day following on from the Irish Times excerpt above, the HSE again changed their testing thresholds. In essence ripping up the community testing model and 15,000 tests a day target. The simple truth is we didn’t have the capacity to process the tests even if we had the capacity to deliver 15,000 tests a day. We also know that a number of the originally scheduled tests were most probably cancelled based on the new, updated testing threshold.
Suspected patients were now required to fall into one of these priority groups to be tested first.
- Anyone who has been in close contact with a confirmed case
- Healthcare staff that are fighting to help patients on the frontline
- Vulnerable groups of people – including those with underlying health conditions
As well as ticking those boxes, patients to be tested also had to show two main signs which are fevers or shortness of breath.
This of course savagely reduced the state’s commitment to testing. Looking back, this updated testing threshold decision, is a de-facto admission that community testing had swamped the states resources within a matter of days and couldn’t be continued until resources were expanded.
Now, lets be fair and say that of those 40,000 people tested, under what we will broadly categorize, as community testing guidelines, a very low percentage of them were positive (6-8%). And for a country in crisis with very limited resourcing in this area, community testing became a luxury we couldn’t afford.
Insofar as we can tell from the available data – how these 40,000 were treated – is the proof that proves the equation. A very sizeable majority of these mid to late March tests ended up in a laboratory in Germany. The time delay between test and confirmation of a positive/negative has been for the majority of the 40,000 anything between 14 and 24/25 days.
The HSE and government bodies have done an excellent job delivering the data they possess on testing and differentiating between the German tests results and the Irish labs is the most transparent method of delivering the results. It also though, inadvertently reveals what went wrong.
There is a repeated line on the HSE website that is really, really annoying me. And I’ll quote it here from April 12th data set.
” An additional 297 confirmed cases of COVID-19 reported by a laboratory in Germany (these represent samples taken weeks ago) “
This reckless mention of positive samples ” taken weeks ago” indicates the person who wrote it doesn’t fully understand the implications of the huge time delay.
In the first instance, by officially stating these are weeks old, it is an admission that of the 1,200 or so positive samples that have returned from German diagnostics – a certain small number of people must have died before their official positive result returned from Germany.
The other point is possibly even more problematic, if you can imagine such a thing. The whole contact tracing operation for these people was also sacrificed. And let me explain why. This point has been raised in the media but not the specifically problematic issue.
Yes, when a person gets a test they are supposed to self isolate for the official period in question or until they get a test result. The issue isn’t the person that was tested. The issue is the people those 1,200 people infected prior to doing the test. Those people gave the virus room to breathe by passing on the cycle of transmission. Is there any point in contact tracing them now 14, 21, 28 days later now that the horse has bolted? – A portion of them will already have passed on the disease to the next group.
By losing control of the testing we lost control of the test processing. By losing control of the test processing we made a eunuch out of our contact tracing operation. Especially for the period of those 30- 40,000 tests and specifically for those 1,200 positive cases.
The good news and the bad news is that we are catching up. It is great that the backlog is almost cleared. Because the turnaround time from test to first call from the contact tracing teams needs to be in low single digit days not low single digit weeks. We are now in a position to deliver on that across the board.
Over the past week, 20,468 tests were carried out in Irish laboratories and of these 4,233 were positive, giving a positivity rate of 21%. The fact that our labs are in a position to now process 20,000 tests a week is very good and a 21% positivity rate indicates that the new testing threshold is eking out more positives is also a good sign in a round about way.
The bad news is that the Irish coronavirus strategy needs to move dynamically to a different focus. Ironically while testing is still important it is now not the only consideration. It may not even be the most important consideration anymore.
Many of you will feel, as I do, that things could have been a lot worse at this point – a month into the new reality. A lot more deadly. The group of politicians, scientists and most particularly health workers deserve great credit for this. And nothing I write is meant to overlook the successes.
However, the bottom line is we are still playing catch up after 5 weeks. I might add so are many, many countries, so there is no specific criticism in that. But, to get to this point, relatively safely, we have wrecked our whole economy and the finances of the country. The 533,000 people currently on the emergency COVID-19 unemployment payment paint a picture of ordinary workers paying the price for our solution both with their jobs and with their personal liberty with social distancing. Very few have grumbled about doing so but they will very shortly I feel. Every week our economy is shutdown from this point is going to do two things.
First of all, each week that unemployment number is going to rise and inch ever closer to breaking point and people will begin to realise that while the weekly Pandemic payment is temporary their unemployment situation is not.
Second and again more worryingly, more and more businesses that were underpinning those jobs 5 weeks ago will cease to exist forever.
All efforts on the health front now need to factor in what is happening on the economic and financial front. We need to be hearing as much from Pascal O’Donoghue as from any of the scientists.
So to take as one example that hasn’t been mentioned much as of yet – the construction industry – they currently have over 70,000 people temporarily unemployed. I ask myself how many infrastructure projects, building and road projects will survive on the other side of this bridge across the abyss. Not many is the probable answer – as things stand. Private sector brain-power across all sectors need to be formally added and aiding the good work that has been taking place on the public side.
On the economic and financial front the last 5 weeks have been a suspension of reality. A required one I hasten to add but one that is being sustained by central banks printing money. Printing money in an environment where no-one is producing or supplying much and where no-one is asking for much on the demand side due to the restrictions on our movement. It can not be sustained even if it was desirable to sustain – which it most certainly is not.
So I get very worried when I hear Simon Harris talking about social distancing becoming a fact of life until we get a vaccine. It indicates to me that he is not exhaustively looking for Irish solutions, that he is – to steal a quote from Morgan Kelly, relying on the kindness of strangers to get us out of our predicament.
Again I am using an Irish Times article to reference this point. And it is well worth re-reading so let’s do that now
People in Ireland will have to learn to live alongside the coronavirus and social distancing measures will need to stay in place until a vaccine or effective treatment is available, Minister for Health Simon Harris has said.
The Minister also raised the prospect of the current restrictions being “tweaked” in three weeks’ time if enough progress is made in tackling the pandemic.
Let me now go back to the headline of this piece by stating what social distancing is – social distancing is a temporary gift of the people.
Emphasis on the temporary. There is no guarantee that a vaccine will ever arrive. Gradually the group of people managing this crisis have become more and more comfortable infringing on our personal liberties.Whether it’s a statement like the one above or the granting of temporary additional powers to the Garda Siochana. For the common good and our own we have allowed it. For the moment.
It is not a long term strategy because very quickly we become little more than a police state going back and forth to the few jobs that remain. People have done an outstanding job on social distancing not withstanding the few bad apples in every barrel.
There are already, at least three known strands of the current coranavirus touring the world in a little over 3 months. There may very well be more. If Simon Harris is proposing on taking social distancing from the temporary to the permanent he will need to have a referendum to ask for the right to remove our personal liberty and freedom of movement. Maybe people will agree with him and maybe they won’t but it is our decision.
I don’t want to labor this point any further but instead move back to strategy.
The coronavirus has had a jump on the world from the get-go. To resume any sort of normalcy we must get ahead of it. We now need to rapidly spend the majority of our time identifying the best anti-body testing available and create a methodology to implement it very quickly to work with virus testing and then overtake this testing. We are moving close to the phase where it is more important to know who has had the disease rather than who currently has it.
Our faint hope of a near term exit is that the asymptomatic spread of this disease has been far more widespread than we know about. If we are to be prayerful for anything in this moment – it should be that.
Any logical, orderly and long-lasting re-opening of society and our economy rests on getting people that have developed anti-bodies to coronavirus back up and out into the world. This needs to be done in tandem with building a firewall, as much as we can, around the vulnerable and the elderly while we continue the fight. Suffice to say our success at this and in particular protecting nursing homes has not been stellar. The recent 8 deaths in one psychiatric over Easter weekend emphasis the problem and horror. That is an article or series of articles all on it’s own.
But for the purposes of this one, we now need to think about deploying thousands of the medical volunteers, who offered their services to this particular sector. For the immediate issue and the longer term requirement.
And at some point the rest of us are just going to have to take our chances with infection.
Waiting for a long term vaccine and social distancing ourselves off the face of the planet is not a decision Mr Harris or any scientist is empowered to make, so please don’t ever do it again without consulting the people of this country.