It is almost ten weeks since the coronavirus emergency erupted here, following confirmation of the first case of Covid-19 in Ireland. Our world has changed in the most unexpected ways.

It is almost ten weeks since the coronavirus emergency erupted here, following confirmation of the first case of Covid-19 in Ireland.
Our world has changed in the most unexpected ways. Odd things are happening, in the midst of these strange times.
We have heard stories of clandestine meetings with underground hairdressers.
Employees putting on aftershave or perfume before Zoom meetings for work.
Adults that have developed new hobbies, like collecting acorns. Bizarre does not begin to describe it.
With the fine weather and the easing of advice for older people on cocooning, it’s nice to see more people about. The battle against coronavirus is a cross-generational effort.
There was criticism by leading gerontologist Professor Des O’Neill that some things had gone too far in respect of our older citizens.
He was talking about the official advice that if people over 70 were taking short walks, that they should avoid all people and not stop and talk when exercising. He described this as overreach.
Older people are the citizens who helped build this State. They are a seasoned, sensible group, not children, and certainly not rash in decision making.
And as a group, they can be as fearsome as young people. Remember the now legendary protest in 2008 in Dublin outside the Dáil by the over-70s, when a previous government moved to take away medical cards from them?
It was notable this week that Chief Medical Officer Dr Tony Holohan remarked how those who had been cocooning had followed the advice well, perhaps better than some other groups. ‘We are in this together’ must be more than a slogan if it’s to be a true collective effort.
Older people have also suffered. The nursing-home sector has experienced over 700 deaths among residents, over half of all the deaths so far during the emergency.
There have also been over 225 clusters in nursing homes, so it’s the sector with the most outbreaks. While the situation in nursing homes may have eased somewhat now, it remains serious.
When the time comes to officially review what occurred in nursing homes here, it will be important to examine the policies and records kept in relation to all deaths in these facilities.
If a decision was made in any cases not to refer a resident to hospital for care, that would have to be documented.
It would also need to have been discussed with the family, as consent is very relevant here.
The reason for this is because under these circumstances, a decision not to hospitalise a resident of a nursing home who is ill would be equivalent to a ‘Do Not Attempt Resuscitation’ (DNAR) order – a document issued and signed by a doctor.
Clearly it’s a very serious area of practice and the spotlight will fall, in time, on how well protocols were followed.
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Attention is also turning to when and how the normal day-to-day work of the health system can resume, for both hospitals and primary care.
People ask – where have all the heart attacks, strokes and other major illnesses gone? Of course, they have not disappeared and this is a huge worry.
The number of people attending emergency departments is beginning to rise but only very slowly.
Yesterday, there were just 33 patients waiting in emergency departments for admission to a bed.
There are several reasons why patients may have stayed away from hospitals, including fear, because some hospitals have a large number of confirmed, or suspected Covid-19 cases and why would someone go near such an environment?
People have been reassured that there are separate pathways for Covid-19 and non-Covid-19 patients in hospitals.
If you attend an emergency department now, the entrances should have separate ways in for these two distinct groups. Inside precautions are taken until staff can be assured of the health status of the patient and they are triaged accordingly.
It’s important to trust health professionals, the doctors, nurses and other health staff, who are putting their own lives and that of their families at risk too, to do what is a very challenging job, even in normal times.
Because Covid-19 is such a new illness, and the science is still developing around it, unintended mistakes may be made and events may occur that could not have been foreseen.
A report in the British Medical Journal in the past week detailed how there have been unexpected consequences from the coronavirus pandemic.
The skies are bluer, there are fewer car crashes, other infectious diseases are reducing, including hospital acquired infections, and the crime rate is falling.
However, doctors are alarmed at the drop off in ED attendances for major conditions.
There is also concern about a rise in alcohol and drug use at home, and people’s general mental health.
Some people may also have a poorer diet and a lack of exercise due to being cooped-up at home. The health and other impacts of the virus will be long and deep in society.
The future of our health system is also set to change, radically in some ways.
Hospitals will have to find a way to manage ongoing Covid-19 cases for the foreseeable future and also deal with non-Covid-19 care.
The patient and staff experience of the healthcare environment will be different from now on.
For as long as this virus poses a major threat, there can be no return to packed emergency departments, or busy outpatient departments, for obvious reasons.
This will result in stark organisational changes, which have yet to be figured out fully.
It will also likely result in longer waiting for consultations and new patient care streams. The environment will be very different for both patients and staff. GPs have already seen big changes in this regard, with telephone consultations, and patients being assessed in special rooms, or in their cars.
The first phase of the Government’s reopening plan, 18 May, is coming soon.
Outdoor workers will return to work, and some outdoor retail and other services will resume, all subject to social distancing.
Small groups of people will be able to meet outdoors. But the overarching rule of ‘no unnecessary journeys’ will continue until 20 July. So the pace of change will remain slow and cautious.
Lots of individual sectors are looking to the National Public Health Emergency Team for direction.
Some are looking in the wrong direction. Dr Tony Holohan made it clear during the week that NPHET will not be prescribing rules on each sector of society.
He also said yesterday that he did not believe pubs would reopen in June. It will be up to various sectors to understand what the rules are as set out by Government and apply them, when the time is right.
Commonsense will be important here too. NPHET also emphasised that there will be all kinds of considerations to be taken into account by Government when it makes decisions and all these decisions will not be made on purely public health grounds.
While Ireland has followed lead advice from the World Health Organization, the European Centre for Disease Prevention & Control and others, it has also taken its own public health decisions.
The country has significant expertise. There are judgement calls to be made.
The rule here initially on people not undertaking a journey of beyond 2km, and recently extended to 5km, is not based on any published scientific paper per se, but on how health officials in Ireland have determined safety should be applied.
The overall approach here has been cautious and careful, especially in the early stages of the virus. The dividend is clear for all to see at this point – reducing deaths, new cases and the number of patients in intensive care units.
Many lives have already been saved and more can be protected too.
In the weeks and months ahead, the health system will need built-in capacity to deal with the virus threat in the future.
It must also have the capacity to return to managing planned cases and clinics and reducing overall waiting lists. Before the coronavirus really took hold here, there were over 770,600 patients on some kind of hospital waiting list and the end of March.
The system also has to return to full operation of the vital cancer and other screening programmes. Whatever changes come will probably involve a mix of using the public and private system in a new way.
The first wave of coronavirus has been largely been controlled here.
However, the personal price has been high. We have still seen over 1,400 deaths, almost 400 people in intensive care units and over 22,000 cases.
Families have been turned upside down, friends separated, relationships strained.
The sense of individual pain, anxiety and powerlessness will not be forgotten, for a long time to come. There is still a long road to travel and we will all need energy for it.
There remains much uncertainty, about the future progress of this virus, people’s employment prospects and how Irish society will cope, in the years ahead. We can only do this together, the task is so great.
There is a danger that we will experience further waves of Covid-19 and these could be mixed in with a flu outbreak during the winter to come, putting huge pressure on the health system.
So as we all survey the Irish social, economic and political landscape this weekend, our next decisions, individually and as a people, are critical.
Like moves in a game of chess. We must all think critically and be disciplined.
Chess is often called the game of life – there are short- and long-term plays, to stay alive. It has a special dynamic of threats and defences – a bit like what we are experiencing now.
But unlike chess, this is no game, and the stakes involved are the highest imaginable. One bad move and it could be fatal.
With Covid-19 as an opponent, we must be grandmasters in strategy.