Will the Government regret not following NPHET’s advice?

The unified front the country presented in the initial surge of Covid-19 appears now to be well and truly over with a serious division having emerged between the Government and the national public health emergency team (NPHET) over the path to follow to curb the spread of the virus.

Perhaps this unity was only ever superficial. Outbreaks across nursing homes, direct provision centres, and meat factories showed that Covid-19 did not affect everyone equally.

Talk of solidarity, and everybody playing their part, is only talk when the most vulnerable members of society are not protected. Tensions also arose early on with many private consultants regarding what they saw as an unfair deal with the State to secure additional capacity in private hospitals. This has resulted in the HSE having to negotiate in future with individual private hospitals rather than as a group for capacity requirements associated with the pandemic.

There has been high-profile criticism of restrictions, such as from the now former Clinical Director of the Dublin Midlands Hospital Group, Dr Martin Feeley. Dr Feeley who termed restrictions as “draconian”, resigned from his role following the negative reaction to his Irish Times article on the subject.
But the decision by the Government not to move the entire country to level five restrictions for four weeks, to curb the worrying rise in cases as recommended by NPHET, represents the most significant rupture at official level of Covid-19 policy.

On RTE’s Claire Byrne Live, Tánaiste Leo Varadkar criticised the NPHET proposal, which was supposedly not discussed with the Government before being published in the media, for not being “thought through”. The Tánaiste’s argument was that NPHET had not considered the wider implications of such a move on the economy and society as a whole.

According to the Tánaiste, the HSE CEO Mr Paul Reid said the health service did not appear at risk of being overwhelmed in the short-term. The Tánaiste also said locking down the country at this point would make Ireland an outlier in Europe. A move to level five was not in keeping with the graduated response previously agreed, so the Government decided to move to level three restrictions instead.

In his letter to the Minister for Health Stephen Donnelly, Chief Medical Officer and NPHET Chair Dr Tony Holohan outlined why the group felt the measures in place were not “sufficiently controlling the disease as evidenced by a high volume of community transmission and sustained increases across key indicators”.

Dr Holohan pointed out that the total number of cases increased by 6 per cent in the week up to 28 September; the number of cases had increased by approximately 50 per cent in the week to 4 October, with 3,063 cases notified.

Over the latter period, the five-day average of reported cases had increased from 310 cases per day to 462 cases per day. If the current trend continued, Dr Holohan warned, between 1,600 and 2,300 cases would be notified per day.

Imposing a strong lockdown now would act as a “circuit breaker” to achieve a drop in the infection rate, according to Dr Holohan. While NPHET’s recommendations should be open to challenge, the Tánaiste’s claim that the proposal was not fully considered was at best unfair, at worst disingenuous. It is NPHET’s job to consider the epidemiological evidence. While its advice can have huge economic implications, this is not specifically within its remit.

While other European countries might not be entering another national lockdown, few of their health systems are as vulnerable as Ireland’s, with the lack of ICU beds a particular worry despite recent additions. The main reason our very vulnerable health system was not overwhelmed earlier in the year was because of the strength of restrictions imposed.

The Tánaiste said later in the week that a move to level five cannot be ruled out if cases continue to rise. The decision taken by the Government means there will be few places to hide if the spread of Covid-19 is not contained and our health services and hospitals are swamped in the manner feared when the coronavirus first hit our shores.