Peadar O’Grady examines the divergent approach of governments North and South in tackling the spread of Covid-19 across Ireland.
North and South of the Irish border, the public response to the Covid-19 outbreak has largely been one of support, solidarity and a desire for an effective scientific approach to containing and delaying the impact of infections.
The message of handwashing, using tissues and social distancing was taken up quickly and the notion of reducing the impact on services has been appreciated universally. While the mainstream media has been quick to report on breaches of social distancing, spreading rumours, and decrying panic-buying while printing full page images of empty shelves which encourage this behaviour, generally people have been quicker to take up restrictions than the government has been to advise them.
Indeed, at government level, the approach has been dogged by foot-dragging and fudging the response to demands for accountability in terms of health service resources to identify, contact trace and treat those who become infected, and clear scientific support for the timing of restrictions on travel and social gatherings and attendance at work.
Failure to Launch
The British government refused to close schools for two weeks, after almost all European countries had, and the Stormont Executive slavishly followed suit. They were slow to advise travel restrictions or restrict public gatherings other than some sports events.They have not put financial support packages in place for workers who have lost their jobs or who have to self isolate. What limited measures have been put in place for businesses by the British government should be available to businesses in the North, but there is little to no advice on how to access it.
Moreover, the lack of testing for patients for coronavirus is shockingly low in the North. The scale of the spread is entirely unknowable because so little testing has been carried out, leaving the impression on many that the situation is far behind that of the South, but without the figures to prove it. It also inevitably means that people who should have been tested but have not gone on to spread the virus, and those who have been in their presence will not be aware of the need to self isolate. The lack of testing, an approach taken by Boris Johnson, has been criticised internationally and is far removed from the measures in places like South Korea, where testing and isolation are largely credited for slowing the spread.
For its part, the acting Irish government has responded more robustly but still ineffectively, given the lessons learned from Italy and China.The government did not publish a ‘National Action Plan in Response to Covid-19’ until March 16th, more than 2 months after the outbreak was reported in China and more than two weeks after the first case was reported in Ireland. The first phase described in the document, the containment phase, was already over by then and the delay phase had begun. There was nothing in the document that wasn’t known in February before the outbreak started in Ireland and there were no scientific references or sources published for the advice in the document.
While it is understandable that any health service has to wait to see how successful their containment measures will be, there is no excuse for not having a plan to meet each level of risk. While the vast majority (about 80%) of those who are infected will suffer only a mild condition and recover with minor support at home, about 1 in 5 will have a more severe condition, requiring hospital admission for several weeks, and about 1 in 30 will require an ICU bed.
As of March 16, when Taoiseach Leo Varadkar said he expected 15,000 cases by the end of March, there was still no clear plan for making hospital beds, ICU beds and equipment like ventilators available, nor how the gap in shortage of facilities would be made. The Department of Health had only identified 22 extra beds to add to the 225 public ICU beds and did not know how many ICU beds there were in the private sector. The Intensive Care Society of Ireland pointed out that while there are 500 ventilators there are not 500 ICU beds to support their use.
North of the border, urgent questions to the Minister for Health about the number of ventilators and ICU beds went unanswered until late last week, when the BBC learned that the number was far too low – as expected. Across the UK there are shortages in hospital beds and ICU beds, and the staff to go with them, compared to other EU countries – fewer than 3 beds per 1000 population compared to 8 per 1000 in Germany while Ireland has fewer than 5 available ICU beds per 100,000 compared to the UK with 7 ICU beds per 100,000 and Germany with 29.
These numbers become much starker when we consider that the largest international producer of ventilators is Ireland based, and one company responsible for exporting testing kits is based outside of Dublin. Questions are rightly being asked about why both governments have not immediately stocked up on both, and moreover, why neither has sought to requisition production of ventilator and tests until after the pandemic.
Similarly, People Before Profit has been calling for the immediate requisition of all facilities within the private healthcare sector which may be required in order to assist with capacity in the HSE and NHS.
The different health advice given in different EU countries might have reflected the divergent approaches in each but generally there has been almost a complete absence of a coordinating role by EU authorities and the complete lack of political will to follow World Health Organisation (WHO) guidance across the board.
The difference between the UK and Ireland, however, has nothing to do with difference in medical opinion across the border or with the EU, and everything to do with how it is being implemented.
In the UK, Tory politicians told the public they would follow the herd immunity theory – allowing the vast majority of the UK to get the virus, and build up ‘immunity’, promising that only those with underlying health issues would face serious health risk or death – as though those people were particularly expendable. Anyone who is aware of the detail of the Tories Welfare Reform cuts (or any aspect of Tory policy) wouldn’t be surprised by this, but nonetheless it generated outrage and disgust. The same public anger was directed at the Stormont Executive parties who followed suit uncritically.
It was that public pressure which has forced any progressive moves to shut schools, or as recently as today, to announce more testing – up to 800 tests per day.
Ireland has obviously responded much more robustly, though that wouldn’t have taken much, and there is still a long way to go. The financial package which has been announced puts people on scales of need, offering some around €200, and others around €300 – rather than offering anyone who is impacted the higher rate to ensure no-one is financially penalised by the impact of the virus.
The caretaker Fine Gael Government have largely hidden behind the National Public Health Emergency Team (NPHET) to camouflage their reticence in advising restrictions in travel and mass gatherings as well as workplace closures.
There are some similarities that are important to draw out when analysing the approach of the British and irish governments to the Coronavirus.
Firstly their refusal to publish the expert advice they are basing their decisions upon has lead to a breakdown in trust, not just among the public, but among scientists and virologists. In the UK a group of scientists have written an open letter to the UK government:
“…We request that the government urgently and openly shares the scientific evidence, data and models it is using to inform its decisions on the Covid-19 public health interventions in the UK. This transparency is essential to retain the scientific community, healthcare community, and the public’s understanding, cooperation and trust.”
Despite repeated questioning by People Before Profit elected representatives on both sides of the border, clarity has not come, and it has allowed them to hide any discrepancy between the scientific health-based advice and the considerations of preventing economic damage to big business.
Lack of transparency
Transparency and openness in communication and coordination is the foundation of trust in the civil and health authorities and needs two urgent reorientations. First we need to ensure pressure is maintained on both governments to clarify the advice given and to ensure the scientific independence of any technical advisory group. The scope of any group coordinating the emergency response should include elected representatives and a range of public service workers with experience of managing emergencies including frontline health workers like ambulance staff, firefighters and builders. Allowing administrative officials and ministers to dominate means more ‘Yes Minister’ type cover-ups and a less effective public service emergency response.
Second, as well as the immediate causes of a failure of trust in civil authorities, poor communication and coordination, we need to address the long-term corrosion of trust caused by inequality and poverty worsened by austerity in the UK and Ireland since 2008 and the running down and privatisation of public services including health services. Already in the Republic 140,000 workers have been laid off and are queing to sign on. Social solidarity is mentioned frequently in the ‘National Action Plan’ but it seems little solidarity from employers to staff is to be expected.
The pandemic requires a huge boost to health and social protection in Ireland North and South and to win it and hold it will require pressure from the left and the trade unions. In Spain the government has just nationalised private hospitals to deal with Covid19. We have to urgently rebuild our public health services during the crisis but when the crisis passes we will have to fight to hold on to any gains and push for an NHS on both sides of the border which is invested in heavily, which sees an end to privatisation, and which is run on the basis of need. Political organisation and strikes will be key to this project.