Getting back to a better future

Coronavirus has transformed our lives, in ways that would have been unimaginable at the start of the year.

It is as though we have time-travelled into another world. 

No-one saw this coming, or knows what is still around the corner.

In the next Back to the Future film series installment, Marty McFly never goes back to 2020 – it’s just too scary, too unbelievable. 

Today, people yearn for the old ways, and wonder when they will be able to enjoy life as it was before. We all hope it won’t be too long before we can get back to a better future. For now, we must keep heart in testing times. 

It has been especially tough on older people and children. Today, every minute should matter, because things can change in seconds.

Our outlook on life has been altered. There is a new kind of Bucket List now, of things you must do before you die. 

On that list are amazing things like – shaking someone’s hand, hugging an old friend, or having an impromptu party. Hard to believe, isn’t it? 

We have fallen into an Orwellian future, with some bizarre scenes. 

One of the odd new rules that popped up this week is that pubs that reopen need to have the volume of television sets turned down low, so that people don’t have to shout over each other, resulting in a greater risk of spreading the virus. 

Are people now to watch a rugby, football, or GAA match in a pub, with no sound? Has anyone broken the news to Marty Morrissey? A GAA game without Marty’s voice is like pasta without cheese, or bacon without eggs.

Some things are set in stone, so good luck with that rule. 

Are people to encounter a new band of visitors to the local pub – the Volume Police? 

We have fallen into an Orwellian future, with some bizarre scenes.

It also shows how the mixed messaging still continues with various measures. Almost at the same time as news about keeping the volume down on television sets in pubs was circulating, there were suggestions that live concerts would be able to resume soon. Are the bands also to play with the amplifier turned down to nought? 

It would be like a scene from Spinal Tap and where perhaps someone sneakily turns the amplifier up to 11. Along with our lives, coronavirus has surely messed with joined-up thinking and amid the noise, so much seems out of sync. 

Coronavirus has also brought out some elements of human nature that are unpleasant. Certainly not very Irish.

People calling others out, reporting on neighbours, fighting about restrictions. You should always be careful about pointing a finger at someone, because when you do, there are usually three fingers pointing back at you. 

Early days, but school reopenings ‘reassuring’ 

The reopening of schools was one of the major things that the Government had to get right. 4,000 schools have opened, after the longest extended break from the classroom for pupils. It’s still early days for sure and no-one knows how the weeks ahead will go, as we enter the colder autumn and winter period. 

So far, the HSE says the indications on school re-opening are reassuring. The official figures show that 54 cases of the virus have occurred among school children, but most infections were acquired in the community, not the school. 

Also, there have been no outbreaks in schools and in all but one case, it was a single case of confirmed Covid-19. Good news for children too that the HSE is introducing a less invasive nasal swab, given how unpleasant the existing nasopharyngeal swab can be at times. 

The decisions on who is a close contact of a confirmed case in a school are made by public health staff. Each case is based on the specific circumstances of each school.

Despite what the guidelines from the European Centre for Disease Prevention and Control say about a close contact being defined as someone who was in a closed environment like a classroom with a Covid-19 case for more than 15 minutes, it’s not as cut and dried as it seems.

It will not automatically mean a whole class must be sent home. A lot depends on the layout of the school, the flow of kids and many other factors will determine who is a close contact. 

Test and trace operation comes under pressure 

This week the HSE’s test and trace strategy came under the microscope. The decision to suspend serial testing in meat plants, due to pressure on testing in the community of suspected cases, raised serious questions about its promised ability to deliver 100,000 tests a week, when that pressure comes. 

It’s not just about being able to deliver 100,000 tests a week. Those tests would have to be turned around in an acceptable time-frame too, to help in the fight against the spread of the virus.

For the people that are doing their part in following the public health advice, they want to see the State do its equal part too in tracking and tracing.

The terminology used about pop-up ‘test centres’ has also been unhelpful at times. These are swab centres, not test centres with laboratories. The swab has to go to a laboratory and through a complex process, involving highly-skilled staff and for the results to come back after PCR tests.

Some people may think that when they visit and leave a so-called ‘test centre’ the testing clock has started. It has not. So, language here is important as everyone tries to cope, including the swab, contact tracers and laboratory professionals. 

HSE Winter Plan due to be published 

Questions have been raised about whether the HSE has enough staff to deliver the growing demand on Covid-19 testing.

Michael McNamara, the Independent TD and chairperson of the Special Committee on Covid-19 Response, pointed out during the week that people also expect that the HSE has made best use of the past six months of the crisis to build up hospital capacity, in terms of sufficient beds and staff and facilities.

That will be tested in the weeks and months ahead. If the system fails, and there are massive waiting lists and significant hospital overcrowding, it will likely lead to much anger and calls for accountability.

A HSE Winter Plan is expected to be published, probably next week. It will set out the testing and tracing strategy and the measures to deal with Covid-19, as well as deliver non-Covid-19 care.

The ability of the health service to meet what is coming with coronavirus, will define whether we are truly in this together, or actually – you are on your own. 

The language of lockdown is ‘unhelpful’ 

I detect a change in approach from the National Public Health Emergency Team also. There seems to be no appetite for a return to so-called ‘lockdown’, despite the rise in cases and even more recent deaths.

Whatever about the rationale behind the need for such extreme measures, there is a diminished mood among the public to accept lockdown.

Going back to where we were in March is not the future. 

But it’s more than that. We can see how lockdowns disproportionately affect older people and children too.

This week, acting Chief Medical Officer Dr Ronan Glynn said that the language of lockdown was unhelpful. While NPHET deals with public health, the Government also has to look at where we are in terms of a society, economy and a people.

In a notable change, in future, the NPHET advice will be filtered through a new oversight group of senior Government department officials and others, before it goes to Government and then is released for public consumption.

Will we see the minutes of those deliberations? 

The move may be seen by some as taking the spotlight and some of the power away from NPHET.

For the Government, it may offer the chance to fine-tune any new recommended measures and make them more palatable for the public.

Going back to where we were in March is not the future. 

The medium to long-term plan to deal with Covid-19 is due to be published by Government next week.

For now, there appears to be a hold on deciding on the NPHET recommendations from late last week, about tighter restrictions in Dublin, in terms of visitors to private houses and the reopening of all pubs in Dublin being contingent on what the virus trends are around 21 September. 

Around 30% of all cases occurred in healthcare staff 

All the while through this, the health service has to continue. 

There has been a rise in the number of healthcare staff affected by Covid-19. The latest figures show that 8,691 cases have occurred in healthcare staff. That’s about 30% of all Covid-19 cases. There have been eight deaths among healthcare staff.

If you look at the figures from the Health Protection Surveillance Centre, between 26 July and 1 August there were 286 cases detected among health care staff.

From 23-29 August, there were 803 cases. Most of the infections have been among nurses (2,788), healthcare assistants (2,326), doctors (540) and porters (98).

In terms of locations for these cases, most have occurred in nursing homes (2,131), hospitals (739) and private houses (748).

As autumn/winter approaches, the risks for healthcare staff will rise if we see increase patient cases in hospitals and residential care facilities. 

Every bed will be needed in the weeks ahead. 

While hospital cases overall have remained relatively low, the numbers are trending upwards. This has to be watched closely.

Yesterday, there were 51 patients with confirmed Covid-19 in hospital. Seven of these were in intensive care. The total number of intensive care beds open and staffed in the hospital system is 345.

Before this all started there were about 100 fewer ICU beds. Those beds are needed for Covid-19 and non-Covid-19 cases. Indeed, the majority of ICU beds are occupied by patients who have other conditions, not linked to coronavirus. 

In terms of general beds, yesterday there were 304 vacant beds in the hospital system. New figures show that at the end of August, there were around 290 hospital beds closed in our health system. Of this number, 70 were shut due to staffing shortages. The rest were shut for infection control purposes (140 beds) and for refurbishment (81).

Every bed will be needed in the weeks ahead. 

Do we need daily reports of case numbers? 

There has been some criticism of the daily reporting of Covid-19 cases and how this affects the national mood, as numbers rise and fall each day.

Dr Glynn addressed the issue during the week at one of the press briefings. He emphasised the need for people not to focus on the number on any single day, but on the overall trend.

But he also made the point that the department will not stop releasing daily figures, because this is public information and if it were to stop, officials would no doubt be accused of suppressing the facts. 

Hopefully at this point, people are more familiar with the 14-day incidence for every 100,000 people, and how that rate is important to watch. It is valuable from a country comparison perspective and also on a county by county basis to give a better view of the trends.

At the end of last week, the 14-day incidence for every 100,000 people in Ireland showed that the county with the highest rate was Dublin at 73.2 cases and Limerick at 66.2 cases. Not far behind were Kildare on 61.6 cases and Leitrim on 53.

With coronavirus, the situation is very dynamic and a rise in cases in any county over a few days will mean the picture changes. 

No-one on NPHET wants to be the Grinch that cancelled either Hallowe’en or Christmas

This week was notable because it was first time that Halloween and Christmas were mentioned at one of the Department of Health press briefings.

No-one on NPHET wants to be the Grinch that cancelled either Halloween or Christmas. Having the country’s parents chasing you down the street in anger is one thing, but you don’t want kids close on their heels after you too!

So, the official position is that no-one is cancelling either of these big events, which are usually fun for kids and adults alike. NPHET will be giving specific advice closer to these events. 

The health experts want families to plan now for these moments, so that people can celebrate safely with loved ones. There is no denying that Halloween and Christmas will be very different this year.

At the end of the year, we will all hopefully be saying goodbye to a year to remember, never to be forgotten, but for all the wrong reasons. 

The evenings have started to draw in now. You can already see how the light fades fast at the end of each day.

Remember how those lights in the sky watched over us, when coronavirus first visited these shores, early in the year and especially during lockdown, when the heavens appeared clearest at night. 

And so they will again guide us now through winter, and we hope, into better times. 

We must accept the darkness, because it shows us the stars.