‘Living with the virus’ has not worked – we need a better plan

There is huge frustration among frontline staff that the Government failed to listen to NPHET’s concerns about reopening the country before Christmas

As I write, we are in the eye of the storm – the third and worst wave thus far of the Covid-19 pandemic in Ireland. Non-medical friends text and call to ask, “are you okay?” I am not okay. We are not okay. This wave is different.

We are exhausted. Adrenaline carried us through the first wave. We were learning about a new disease, in real time, as the pandemic spread from country to country. We were afraid, but we put on our PPE, washed our hands, and went to work. Colleagues got sick.

Some recovered quickly and returned. Others were not so lucky and are still unwell with long-term consequences. There was a strong sense of political and societal cohesion. The Government and opposition spoke as one. We went to work. People stayed home. Our last line of defence held. The economy took a battering, but society was together.

=This time is different. Many of us in the frontline feel frustrated that NPHET concerns about the December re-opening were not listened to. We want the Government to acknowledge this, not because we want to say “I told you so”, but because each day they don’t do that we trust them less to have the integrity, humility, and agility necessary to guide us through this with the least lives lost possible.

To err is human after all. We understand that they were dealing with uncertainty and they were trying to balance the impact on the hospitality sector with what the health service would withstand. But to deny that better decisions could have been made undermines credibility. This frustration with our leaders makes this surge much harder to accept.

Childcare

Over 6,800 healthcare workers got infected with Covid-19 in the first two weeks in January. Covid cases, close contact status, and school closures have decimated the frontline workforce. The lack of back-up childcare for the children of healthcare workers and a plan for their education has been the straw that broke the camel’s back for many of us. Some 79 per cent of Irish healthcare workers are women.

We know from international research that the burden of childcare disproportionately falls to women. When in the first lockdown the schools closed, we were told to improvise; we were disappointed, but we understood it was unexpected. That 10 months later the Government still would have no plan in place to support healthcare workers in the setting of a repeat lockdown, when in the interim healthcare workers had literally re-invented how we deliver care, smacks of either indifference or incompetence.

Many of us are afraid we will spend 2021 as we did 2020, oscillating from one rolling lockdown to another without a plan. We come home from work late and then try to homeschool. Our children are anxious and falling behind and we have little left in the tank as we try to complete assignments with them long after bedtime.

We have risked our lives every day we go into work for the past 10 months. Is it too much to expect that the Government would have a plan activated by now to support our children in the setting of a second schools closure, as has been put in place in Northern Ireland and other countries?

Many of us are afraid we will spend 2021 as we did 2020, oscillating from one rolling lockdown to another without a plan

The truth is that women are the silent majority that are carrying the country through this pandemic. We are woefully under-represented at the decision-making table and it is not surprising that as a result issues which disproportionately affect women have been so poorly managed. But we have had enough. We cannot handle a fourth wave and make no mistake: It cannot be handled without us.

It has long been apparent that the lack of a coherent strategy regarding border control and specifically mandatory quarantine for incoming arrivals is our Achilles’ heel. To be fair to our public health specialists, they are the canaries in the coalmine. The WHO’s Dr Mike Ryan, and his colleagues, have repeatedly warned that the lack of vaccination in low income countries, as well as being a threat to us all, is a threat to global security. When a vaccine resistant strain is imported and rapidly spreads we will have no one to blame, but our own poor policy.

Zero Covid

Let us do what needs to be done. Mandatory enforced quarantine for 14 days for all incoming travellers is essential. We need to invest in public health staffing and infrastructure to ensure we can identify new clusters as they emerge and shut them down. Zero Covid/no Covid/aggressive suppression. Whatever name we give it, it is clear that ‘living with the virus’ has not worked and has propelled us from one lockdown to the next.

Our strategy so far has been loosely public health “inspired”. It is now time for a strategy that is public health-led with support from all the relevant interdisciplinary expertise at our disposal. It is also time for the coalition Government to function as one and end the petty interparty point-scoring.

There should be less focus on the next election and more focus on the task at hand, which is to lead us through 2021 with the minimum excess deaths.
There has been huge damage inflicted on the morale of healthcare workers over the past 10 months.

We went into the pandemic with the worst waiting lists in the EU and those lists have been further exacerbated by the necessary infection control measures. There has also been the cancellation of non-urgent scheduled care to allow staff to be diverted to acute Covid-19 care and to minimise the spread of Covid-19. Our patients are suffering from this lack of access.

In hospitals, nosocomial transmission of Covid-19 is rife, in no small part due to our aging infrastructure, specifically the lack of single rooms. As healthcare workers we need to know that the Government will learn from this pandemic and invest in modern hospitals with single rooms that allow for modern healthcare. We need to know that when this is over we will work in a system with capacity to meet need and where staff can see a future leading and innovating; not being burned out.

Commencement of the roll-out of the vaccination programme brings hope. As we see frontline staff and nursing home residents receiving first and now second doses, we have again hope that hugs will be part of our daily life. It is to be expected that there will be bumps in the road, mainly related to vaccine availability, which is determined by the EU level agreements. What is also apparent is that once again, healthcare workers are going above and beyond to deliver for the people of Ireland.

I have many times felt a sense of pride in the service provided by my own team for patients, but not since I returned from Boston have I felt this level of pride in the system. That feels good. I hope that we can build on this and look to embed the good changes in practice seen in the past 10 months, such as telemedicine and e-learning, as we move forward together.

It is time for the Government to look to the agility and innovation demonstrated in healthcare and replicate it in the political sphere. In short, it is time to woman-up.