Nature offers stark contrast at this time to what is going on in the human world with Covid-19.
Spring is busy doing its thing – bursting with birdsong, buds and new life.
It’s a polar opposite to mankind, having mostly to observe, but not enjoy, the season of growing light.
But if nature tells us anything, it’s that change is always happening and much is beyond our control.
It’s the worldwide loss of control that has unnerved people, ordinary citizens and even prime ministers, captured by the virus and hostage to uncertainty.
But there are important things we can control, such as our attitude to the viral threat and feeding our minds with facts.
At this stage in the outbreak, days appear to blend into each other and it can be difficult to know which part of any week it is. It’s tough for everyone – especially parents with kids and vulnerable family members, people who are single and older people, living on their own.
The health system is noticeably under strain now, with increased admissions to hospitals and intensive care units, and some nursing homes under significant pressure. But it is worth noting that the rate of admissions to ICU has fallen and that is a positive indicator overall, although it’s still early days in real terms in our engagement with the virus here.
The sight of large numbers of people breaking for beauty spots suggests that the strain created by the virus on society is beginning to show. This is day 42 since the first confirmed case was reported here in the Republic of Ireland. The measures introduced some weeks ago have been extended now into May. They have had a valuable impact.
Understandably, some people are restless, out of sorts and frayed at the edges. It’s hard to find a mental diversion. Even hardware stores are closed, as they are not viewed by health officials as an essential outlet. Some DIY jobs must wait a while longer.
The behaviour of people during this emergency is as important as the behaviour of the virus. Some of the key measures can only be lifted when the testing capacity is such that tests and close contact tracing can be performed very quickly.
When cases first emerged here, there was an understandable focus by health authorities on preparing hospitals by building up capacity.
A big effort went into building testing capabilities and battling to secure personal protective equipment. There were successes but problems too, especially with securing personal protective equipment and reagent for laboratories.
A question that will be asked is whether the system was slow to respond to nursing home pressures? There have been over 109 clusters in nursing homes and deaths in homes too. Some of those deaths were of residents who needed to be moved from nursing homes to hospitals. Those deaths would be recorded as occurring in hospital.
Private and voluntary nursing homes look after around 25,000 vulnerable residents.
In late February, before the first confirmed case of coronavirus was reported here, the representative body Nursing Homes Ireland says it wrote to officials in the Department of Health, raising concerns about the sector.
Around 10 March, the official view at the department was that the general unilateral imposition of visitor restrictions by some hospitals and nursing homes was not necessary at that point and should be lifted.
On 19 March, Nursing Homes Ireland wrote to the Minister for Health Simon Harris, seeking an urgent meeting or conference call.
In that letter, NHI chief executive Tadhg Daly wrote that the vulnerability of residents was heightened as Ireland headed further into the Covid-19 crisis. It asked for immediate engagement “to ensure NHI can continue to provide high quality, safe care to the 25,000 residents in the care of our members”.
Six days later, NHI issued a press statement calling for an urgent meeting with Government to discuss the problems being faced by homes, and expressed disappointment that no meeting had happened, despite a number of requests.
On 30 March, NHI met with the minister and his officials, with nursing homes welcoming the engagement but noting that “it came late into the crisis”.
The next day, the National Public Health Emergency Team met to consider measures to assist nursing homes – that was the day when Chief Medical Officer Dr Tony Holohan became ill at the evening briefing, saying he did “not feel well”. Thankfully, his hospital stay was short and he was able to return to his crucial brief.
The NPHET recommended a range of measures. These included extra staffing for homes, ensuring they had adequate supplies of personal protective equipment, temperature checks for staff and others twice a day, and oversight.
On 4 April, a set of measures was agreed between the department and the NHI, and they are being implemented.
Last week, nursing homes repeated a call for increased testing for nursing home staff.
The issue as to whether the system was slow to respond to nursing home pressures is one for another day, when various decisions made during the whole crisis will be reviewed so that any lessons can be learned.
To be fair, during a crisis, no-one gets everything right. It brings to mind a notable comment by Sligo man Dr Mike Ryan, who has been doing sterling work at the World Health Organization. He mused at a press briefing recently that if you need to be right before you act, you will never win. Speed trumps perfection, he added.
The last week has seen very testing times. The official figures on tests are given once a week, usually on Tuesdays. Over 50,000 tests have been performed. The plan is to get up to 15,000 a day. Along with the tests being performed in Ireland, around 2,000 a day are being processed in Germany. The German figures have not always fed into the headline daily figures here. That’s because they are ‘old cases’, swabbed a while back and sent abroad for testing but not to be viewed as new cases. As of yesterday, when all the figures are added, there have been 8,089 confirmed cases of Covid-19 here.
I continue to receive many communications about either delays in people being tested or getting their results. Some of these cases have involved vital health staff. There is palpable frustration also among some journalists at the daily briefings over the inability of officials to provide clear figures on how many people are waiting for testing. What is the backlog? While people understand that they should abide by the self-isolation advice while waiting for their test results, the wait is terribly frustrating.
Data on the number of people not tested was factored into the forecast model provided late last week. The German test result figures were also built into the forecasting model. While the forecast was able to tell us how bad things would have looked like in certain circumstances – with 100,000 cases a day under the worst case of non-action – it was not possible to say yet how it will all pan out. Or how long it may last.
During the week, I received an email from the daughter of a woman who is a cancer patient and has already been waiting around 22 days for her coronavirus test. While the family appreciated that there were problems with laboratory capacity and getting enough reagent, they felt such a delay was ridiculous. It has also made them very anxious.
Another patient had their test on 25 March and got the result last Thursday. The outcome stated that the test result was invalid, leaving the patient confused. In another case, a health worker said they got the result back from their test after a few days and it was negative. Good news, for a while anyway. Several days later in a further telephone call, they were informed that they had tested positive. Questions have also been raised by some confirmed cases as to whether all of their close contacts were tracked down by public health officials. Clearly the system is imperfect and there are problems, not least due to the scale of testing involved.
It’s not only testing in the community that can take a time. Last Wednesday there were also 476 suspected Covid-19 patients in hospitals waiting for test results. However, for those in hospital the turnaround time is normally much faster, about 48 hours or less.
There was positive news regarding testing on Friday, with an agreement involving the HSE and Genomics Medicine Ireland for the supply of reagents for the production of 900,000 tests over the next few months. Testing is one of the keys to unlocking the so-called lockdown.
Masks have been a subject of some debate. There have been mixed views on whether the general public should wear masks to prevent the spread of Covid-19. Masks are certainly important for those who have the virus and health staff treating them.
A report in the British Medical Journal yesterday reviewed the known evidence.
It asked if policy makers should apply the ‘precautionary principle’ and encouraged people to wear face masks, on the grounds that we have little to lose and potentially something to gain from this measure.
The argument is made that we should sometimes act without definitive evidence, just in case.
Whether masks will reduce transmission of Covid-19 in the general public is contested.
The BMJ authors say that even limited protection could prevent some transmission of the virus and save lives.
So the British report concluded that “because Covid-19 is such a serious threat, wearing masks in public should be advised”.
Our Government takes it lead on health advice from the National Public Health Emergency Team. There are other considerations that must be in the mix too, including the survival of the economy and ensuring that there is a reasonably functioning country to reopen. Getting the timing right on how to relax restrictions will be a profoundly difficult thing to do. With that in mind, we must watch what is happening in other countries which are more advanced in terms of the virus trajectory and see what has worked for them.
Yesterday we saw the decision to defer the Leaving Certificate examinations until at least the end of July or beginning of August. It’s testing times for all students too and the country feels for them. We are in this very difficult period for some months to come. There was no surprise when the measures already in place were extended further.
When the country does return to some semblance of normality, there will likely be another wave. This wave will be of patients who have non-Covid-19 conditions and illnesses that have deteriorated because they were perhaps afraid to attend hospital. These patients may end up in GP surgeries or even in emergency departments. It’s likely that we will see very large waiting lists for non-Covid-19 health issues, both in the public and the private system. That will be another test for the health service. Also, official advice on what private patients who have private health insurance are to do during this period is also overdue.
Covid-19 will leave lasting scars on Irish society and the healing will not be easy.
People have lost loved-ones, treasured souls.
Lives are in limbo and full of uncertainty.
Jobs have been lost and people are vulnerable.
It is a terrible time.
But there is reason for hope. Optimism appears part of human DNA and has resulted in human survival to this point, despite other terrible challenges.
There will be an antibody test for Covid-19 which will show if people have been infected with the virus and have built up immunity.
Treatments will be developed by scientists and vaccines will also become available in time.
This is the weaponry experts around the world are working on day and night.
When historians come to write the chapter of these difficult days for Ireland, let it not be a story of any failing, but a prologue to a collective rising that met the biggest test of a nation.
Nature offers stark contrast at this time to what is going on in the human world with Covid-19.