It’s too early to assess how authorities have managed the crisis – only historians can tell the full story – but let them be inspired that we did our best to fend off an unwelcome visitor.
A clear night sky is a beautiful sight. When you look to Orion, you can often see some of the brightest stars.
Things are especially clear now, above the human world, with much of the air and light pollution reduced as a result of Covid-19.
Stars should remind us of something else, crucial in the world today – facts. Facts exist, they should be a constant truth and while they may be hidden for a time, they always eventually shine.
You can’t flatter the stars, or put a spin on them. They will outlast us all. The truth is in our stars. It’s where we came from.
And so it is with the coronavirus pandemic and our national health emergency. We know a lot of facts about the virus now, but there is still a lot we don’t know.
It’s also too early to assess how authorities have managed the crisis. All those facts are not in yet, either.
A sober assessment can only be made after these dark and terrible days are over. Then people can review the true number of cases, deaths and how testing and other systems operated.
Health staff and public officials are mostly very dedicated people, trying their best in unprecedented times. They too are under enormous professional and no doubt personal strain, given the risks of going out the door every day. That must be factored in to any judgment.
There is a well-known point made by a Guardian editor in 1921 and it’s worth remembering now too. He said that comment is free but facts are sacred. It’s a fundamental of journalism. Of course there is room for analysis and commentary. Like this article. But informed by facts, too.
Stepping back in time
It’s worth stepping back a little. The world first heard about this coronavirus at the end of December last. Ireland saw its first confirmed case on Saturday, 29 February. It all appears such a long time ago, despite many of us feeling we are frozen in time.
According to the European Centre for Disease Prevention and Control, there have now been over 2.6 million cases of Covid-19 and over 190,000 deaths. That’s since the case definition for the virus was applied by countries from the end of December.
Here, up to the time of writing this, Ireland had seen 829 laboratory confirmed virus-related deaths plus a further 185 probable cases. There have been over 18,184 cases here.
The daily figures in relation to coronavirus come at us all very fast and there is a degree of information overload. We have to absorb graphs, tables, maps, epidemiological experts, medical and scientific views.
It’s like looking at the night sky and trying to count the stars. Together, all too daunting to comprehend. But each on its own is a story – individual, precious.
For each person who has encountered Covid-19 there is a personal story, too. The cold facts cannot tell those tales. We have had wonderful news of the thousands of people who have recovered here, which should give us hope.
That is tempered by the pain and sadness for those who have died and the loved ones left behind. Here, facts have less resonance. This is the human side of this disease. When we look to the skies we should remember this too, lost souls. The pain people are enduring, it’s part of our collective humanity.
The light we see from the stars, left those objects a long time ago in history. It’s the past we are looking at. Those stars have seen a lot of turmoil on this planet since our birth. We are still here, despite all that and the current trauma caused by the pandemic. More reason to hope.
The story in nursing homes
From the wealth of facts we have, hospitals have been managing well and have not been overrun with cases. The story for long term residential facilities, mainly nursing homes, is different.
Health officials say that, initially, the virus took hold in the community and only at a later stage did it enter nursing homes.
While this may point to the early efforts to control the virus in the general community, it may suggest there might have been more time to plan and act to protect nursing homes. There were advance warnings.
It was always known that residents in these locations were an especially vulnerable group. Back on 3 March, the National Public Health Emergency Team announced at that evening’s press conference, that four sub-groups had been set up, including a ‘Vulnerable People Sub-group’.
While the outcome of the formation of a new government is still unclear, from the stance being taken by the Green Party, we are likely to have Oireachtas hearings of some kind into how the health service and the State managed the crisis. That review may not be possible for some time as the crisis remains with us.
It would be important that any review would be about learning and preparing for further Covid-19 waves or other pandemic. If anything, the coronavirus has exposed the frailty of humans, blind as the virus is as to who it attacks, prime ministers and ‘ordinary’ folk.
While the outcome of the formation of a new government is still unclear, from the stance being taken by the Green Party, we are likely to have Oireachtas hearings of some kind into how the health service and the State managed the crisis.
It’s the heartwarming initiatives we have seen on television and social media, of ordinary people in extraordinary circumstances, coping somehow, that is so life-affirming. In these worst moments, we see the best.
Where do we go from here?
We are deep into the crisis and such is the national anxiety and concern, on so many levels, that it’s hardly a good time for pure rational analysis.
Some of the facts we have at hand are valuable – and should help guide us on the path ahead. Like the projections about where we are now – and where we might be by 5 May, if the current restrictions are adhered to.
There is a great song by the American rock band, Talking Heads, called Crosseyed And Painless. Singer David Byrne talks about how facts are simple and facts are straight, how they don’t do what you want them to. Facts can be awkward, even for heads of countries.
We heard some time ago in a different context from the US about ‘alternative facts’. Social media is now awash with so much disinformation, is it any wonder people may feel there is nowhere to go for a modicum of truth. It makes managing this crisis, at this time in world history much more difficult.
People are understandably looking for hope, in terms of possible new treatments, antibody tests and a vaccine. A lot of positive research is underway but at the moment all trials on treatments or vaccines must have the caveats ‘may’ ‘might’ ‘could’ or ‘possibly’ attached to them.
At the extreme end, we saw in the US at the end of last week, talk about having researchers try inserting disinfectant into people’s bodies.
Bad science gets people killed. Scientists have a huge responsibility to speak out at this time, with evidence-based material, when the world needs them more than ever before.
Challenging times for our health system
Our health system is in a strange place now. Emergency Departments are very quiet and GPs say the same about their practices. Where are all the patients gone? It’s a real concern for what may be coming after the worst of this wave of coronavirus is over.
Some early problems over unusuitable personal protective equipment have apparently been replaced by other challenges. Red tape, bureaucracy.
In addition to the health risk fears, there are reporting and oversight requirements for nursing homes in relation to the Health Information & Quality Authority (inspections), the National Treatment Purchase Fund (contracts and payments system for Fair Deal residents) as well as the Department of Health oversight.
These may be difficult to deal with during a crisis when staff want to tend to patients or residents – but they are aspects of the system that are necessary.
Concern and fear among healthcare staff, especially in residential centres, is palpable.
We hear from senior staff that healthcare personnel are testing positive, who are asymptomatic (have no symptoms); some are testing positive with just sniffles, no temperature or cough, while others have just gastric upset as their only symptom.
Some health staff complain of aches and pains – which shows how challenging this virus is to contain and monitor.
Along with the experience of patients, the voice of healthcare staff is vital in this crisis. Staff need to be comfortable with the protections they are given in managing confirmed, or suspected cases.
There is an important role for health unions here in ensuring no employees are put at unnecessary risk. The stakes are too high for everyone.
Concern and fear among healthcare staff, especially in residential centres, is palpable. As one nurse has said to me in a communication: “We are in a pandemic and one step away from a coffin at all times.”
As nursing home employees test positive, they must self-isolate and their close contacts have to be identified quickly. For some nursing home residents who test positive, it may be that they cannot be isolated, for various reasons.
There are restrictions for family members too. In France, family members can visit very ill or dying patients, once the visitors are wearing masks and take the required precautions.
For our health staff, this is a job that at the best of times is a challenge. But in the midst of coronavirus, the physical and emotional strain must be almost unbearable on occasions. As one nurse has said to me in a communication: “We are in a pandemic and one step away from a coffin at all times.”
People just want to help
Since the first confirmed base here on 29 February, I have received several communications from people wishing to source, donate, or coordinate the provision of personal protective equipment, or ventilators and other materials to the services here.
Some have been successful in doing so. In other cases, it has not worked out, for various reasons.
Obviously, all of the materials must meet the required standards. We know from early on from the HSE that some material donated in good faith was not suitable and has not been used.
I was made aware of cases last week where gowns were reportedly too short in length and masks were falling apart. These were not HSE sourced or supplied but came from other sources.
People are genuinely trying to help in any way they can and these things will occur. When a review is conducted of the handling of the Covid-19 emergency, it will be important to establish if any genuine opportunities to provide the health service with vital life-saving equipment, that meets the required standards, were missed. This is an issue that has arisen also in other countries.
Reopening up society will not be easy
Now 5 May has taken on a special status as an expiry date. Pressure is growing for some relaxation of measures, as the weather improves and the early summer looms.
The Government is working on a strategy which may see some gentle reopening of certain aspects of the economy and social life, based on health advice. Getting the phasing of these measures right will be crucial.
There will be a point whereby small businesses will reopen, particularly DIY stores and personal services, but under certain ground rules.
The big step will be in relation to cafes, restaurants and bars. There are measures suggested that could be adopted, to open public houses – for example allowing only limited numbers of known local customers in at a time, for a set period and with social distancing rules operated by customers and staff.
This is all unfamiliar territory and will not be easy. Invariably, things will also fail and there will be unexpected consequences and difficulties.
The hotel and tourism industry looks set for a shocking year, which is very sad, given all the work that has been put into developing this wonderful industry here.
Mass gatherings of over 5,000 are prohibited until the end of August which, for Ireland, is effectively the end of the summer. A year without the Dublin Horse Show, the national ploughing championships, the Galway races, literary and music festivals, concerts and arts events is hard to contemplate.
The challenge for the Government is to get the correct balance of protecting public health, and the economic and societal future of Ireland. It would be no surprise to have tensions between the Department of Health, the Government and the HSE on how exactly to proceed and the capacity to do certain things.
The HSE is an independent agency with its own clear governance and board. The HSE is not the Department of Health, and there are potential challenges there too, as regards decisions.
The HSE is aware of what its capabilities are in relation to delivering on Covid-19 testing and ramping that up. Currently, it is about 18,000 tests a day.
Many of the measures being asked of the HSE, via the National Public Health Emergency Team and ultimately government, also have a cost. That final cost is unclear and there will be questions as to how the full cost of Covid-19 will be covered, in terms of the HSE’s annual budget.
This is an important issue for the HSE Board and the financial governance there because there are a myriad of non-Covid-19 services to be run and how this crisis will affect the overall budget and provision of services into the future will be an issue.
It is already clear that there will be significant waiting lists for non-Covid-19 healthcare, by the time this emergency ends, or at least tapers down. This will represent another wave of health cases the system will be faced with.
It’s made all the more complex, by the impact of the State’s decision to take over private hospitals. The landscape of the health service will be very different for some years to come after this crisis eases.
Much depends on if we were to see a return of the virus returns for further cycles, if it remains more generally in the background, plus the progress in developing general availability of proven antibody tests, developing anti-viral treatments and producinga vaccine.
Key to lifting restrictions will be what is in the public health interest. Officials will want to be certain that the health service has a very efficient system to quickly test all suspected cases, trace close contacts and ensure people are following the isolation rules.
This all has to be closely monitored in real time, too. Then businesses could re-open and be responsible for meeting the social distancing rules. Those that do not, could be shut and would only have themselves to blame, if that was to occur.
Many feel isolated as we contain virus
There are so many stories of the impact of Covid-19 which we do not hear.
Consider the impact on people who are blind or vision impaired. People with sight loss live in a more tactile world and the absence of human contact and adds to feelings of isolation, the National Council for the Blind of Ireland has explained.
It says that through its helpline, callers have been stressing how isolated they feel, being unable to connect with their family and friends.
Ireland has so far managed to keep Covid-19 somewhat contained. The re-infection rate is just below 1 and the spread is under some control.
Our public hospitals have not been overrun and have a large amount of capacity still. The assistance of private hospitals has largely not been needed. But this is a dynamic situation and very delicate.
The facts and figures we currently have on Covid-19 do not tell us the full picture. It is only historians who will tell the complete story, with the benefit of official records, reflection and the full objectivity of time.
Many of those historians may not even be born yet. But as they too, in time, look to the sky to contemplate, what this period in history was truly like here. Let them be inspired that we did our best, to fend off an unwelcome visitor.
Stars they will see, shine on us now too. We are all connected. Another fact of life, here on Earth.