2021 has started out with Ireland, north and south, being in its worst position since the pandemic began. Eoghan Ó Ceannabháin takes both governments to task for their Covid response, arguing that it has been nothing short of neoliberal catastrophe.
We have entered the year 2021 in total disaster.
Ireland now has the highest rate of Covid cases in the world. In the South, the number of people in hospitals with the virus is more than double what they were back in April. Covid-related deaths in the North have now surpassed 2,000 and continue to rise rapidly. Already hospitals across the island are past capacity, and the worst has yet to come as we haven’t seen the full impact of the January surge in our hospitals. As one doctor, Anthony O’Connor, put it last week, “It’s no exaggeration to say our hospital system is at the gates of hell.”
As we career into catastrophe, there has not been a shred of humility from the government politicians responsible for the situation, nevermind any admission of culpability. Health Minister Stephen Donnelly insists that, “The government has been following health advice from day one”. Taoiseach Mícheál Martin and Tánaiste Leo Varadkar continued to defend the government decisions that have brought us to this point; Martin claiming it would be “unfair” to say the government should be ashamed of its response, and Varadkar saying it was “too simplistic… to say that if one thing had been done differently, everything would be fine”.
The North is further along the trajectory of this catastrophic Covid wave, anticipating that ICU admissions will peak next week, having entered a 6 week lockdown on 26 December. Yet despite the Northern Executive’s incredible unwillingness to respond quickly to the rapid rise in cases in November and early December, they have doubled down refusing responsibility for the mess. First Minister Arlene Foster continues to blame individuals demanding “personal responsibility” from the general public, whilst knowing rightly that it was the Executive that tailed the worst policies of the Tories and reopened all business and hospitality in the weeks leading up to Christmas.
Nobody Saw this Coming?
Meanwhile, sections of the media that cheered the government on as they ignored scientific advice have gone into overdrive as they try to cover for them now. “Nobody saw this coming”, said various ostriches at the Irish Times as they rubbed the sand from their eyes in early January. Business analysts told us that reopening hospitality was reasonable at the time, even if it has backfired on us now. Others claimed without evidence that there was a “public demand” to reopen. For sections of the media and for the government alike, pressure from the business lobby amounts to a “public demand”.
A cursory look at the facts shows us that none of this bears any relation to the reality. Despite Stephen Donnelly’s repeated bare-faced lies about following public health advice “from day one”, it is clear that the government has now ignored public health advice on at least two key occasions, with disastrous consequences.
The first was back in October, when NPHET recommended a move to Level 5 restrictions for 4 weeks. The government refused and Leo Varadkar appeared on Claire Byrne Live to go on a tirade against NPHET. Cases continued to rise and two weeks later the government had to implement Level 5 restrictions – this time for 6 weeks.
The second was at the end of November. A letter from Dr. Tony Holohan laid out the “high risk” associated with indoor settings like bars and restaurants, the fact that they have been associated with “super-spreading events and transmission in social settings”, as well as being “associated with an increased number of secondary cases compared with transmission in family households”.
Dr. Holohan’s recommendation was clear:
“The NPHET therefore recommends that the hospitality sector remain closed (with the exception of take-away and delivery) over the eight-week period… Of note, if some element of hospitality is retained, the NPHET is of the view that the recommended easing of measures with regard to household mixing over the two-week festive period as set out above [earlier in the letter] could not also take place.”
On the 14 December – 12 days before the 6-week lockdown in the north began – Dr. Tom Black, chair of the British Medical Association in Northern Ireland said in response to the rising cases of COVID and the already stretched NHS, that ‘the logical decision’ would be to begin a 4 week lockdown immediately, as the NHS was on course to be completely overrun come January.
The December Debacle
What did the governments do both North and South? In the South, they opened hospitality at the beginning of December. They then allowed household visits later on in the month. In the South, Donnelly has described this as Level “3a and 3b”, in a cynical attempt to mislead people regarding the recommendations, which clearly recommended hospitality be closed for the entire eight-week period, or failing that, to prevent household mixing “over the two-week festive period”.
Even though the level of deterioration might not have been predicted at the beginning of December, it became more predictable as the month progressed. Between 16-19 December, caseloads ranged from 421-576. On the 20th and 21st, caseloads were in the 700s, and on the 22nd and 23rd, they had reached the 900s. It was abundantly clear as the month went on that the growth rate of the virus was dangerously high. NPHET called for the full implementation of Level 5 restrictions on 21 December. On 23 December, they reiterated the call.
As we grew closer to Christmas, the government were faced with a choice: They could admit they had gotten things horribly wrong and humbly ask people not to visit one another’s households in order to avert a catastrophe. Or they could continue their gamble in order to avoid taking responsibility for ruining peoples’ Christmas with their families.
They chose the latter, again rejecting NPHET advice, exacerbating an already deteriorating situation and laying the ground for the explosion of cases we have seen in the last few weeks.
In the North, the on again, off again restrictions have been a total disaster.
A 4 week “circuit breaker” lockdown was implemented in the North on 16 October. It was clear when the period was coming to an end that levels of Covid were still dangerously high. Dr. Tom Black of the British Medical Association warned the reopening at that point would be an “act of vandalism”. Likewise, the Chief Medical Officer also warned against lifting restrictions as it would mean more deaths.
A government whose primary concern was public health and peoples’ lives would heed these warnings without question. Yet the DUP called for the rolling back of all restrictions. Sinn Féin equivocated on what should be done. Michelle O’Neill initially called for a phased reopening that would include a ban on the sale of alcohol, before coming under pressure and rowing in behind the calls to extend restrictions.
In the end, the DUP vetoed proposals to extend the period of restrictions and a ‘compromise’ of a 1-week extension was agreed – Alliance and the DUP voted in favour, Sinn Féin voted against and the SDLP abstained.
The lifting of restrictions lasted a week before new, tighter restrictions had to be put in place once again – another two-week “circuit breaker”. These were not enough to get the virus properly under control. The Executive reopened hospitality and shops on 11 December for the two weeks leading up to Christmas, and allowed holiday bubbles with 3 households and a relaxation of travel restrictions. As Sky News reported it, “just in time for shoppers to hit the high street”. The decision was clearly made precisely for this reason, rather than because it was the right thing from a public health perspective.
But, the writing was on the wall as cases surged and the new strain was detected in many places across the water in Britain. It was reported that Ministers on the Northern Executive were given three possible start dates for a new lockdown: the 19 December, 26 December or 2 January. The 26th was deemed to be the best option – just the right balance between lives and profits.
Moreover, the DUP, Alliance and the UUP in the Executive voted against restricting travel from GB as the new strain picked up speed; and disastrously tailed the Tories – even as the Welsh and Scottish governments acted first, waiting to implement another strict set of restrictions beginning on Boxing Day.
North and South, the December guidelines were implemented in the worst possible way. They allowed people out to shops, pubs and restaurants, ran Fáilte Ireland ads urging people to “Dine Out Safely” over a few weeks in December, and then sent them back into households where many would carry Covid-19 back to their families. Both governments refused to heed advice from the scientific and medical community.
An All-Ireland Response
The unevenness of the Covid crisis across the two jurisdictions on this island has been a feature since the pandemic began. There has been lipservice to the idea of cooperation across the island, but no concrete action has been taken. If anything, until now, partition has suited the Fianna Fáil-Fine Gael-Green Party government in particular; and the DUP in the North. Until recently, cases have been considerably higher in the North, something Leo Varadkar has been quick to use as a cudgel to beat Sinn Féin with, while Mícheál Martin has made use cynical use of the border to write off the possibility of a Zero Covid strategy.
Meanwhile, the DUP politicians have used the tragic COVID toll in the South to bring up issues of hardening the border, stoking sectarian flames rather proposing policies that can contain and eliminate the virus.
It is nothing short of a travesty that Ireland, as an island, has not made use of its geographical advantage to lead the way in Europe in implementing a Zero Covid strategy. The Southern government have had no intention of attempting this and have used partition as their useful excuse. The DUP have sought to tail the Tories at every turn, resisting the kinds of restrictions that might save lives. While Sinn Féin have generally supported public health advice, they have been dismissive of a Zero Covid strategy – “We are not New Zealand”, was the facile response of Michelle O’Neill when asked why Zero Covid couldn’t be attempted in Ireland.
The situation in Ireland now is at its worst since the pandemic began. However, it is not the case that things were being handled well up until this point and that we have suddenly lost control. The danger of something like this happening is inherent in the so-called “Living With Covid” strategy being pursued on both sides of the border, which allows the virus to spread unchecked until it is completely out of control. Lockdowns are then implemented in order to prevent underfunded and understaffed hospitals from becoming overwhelmed. Thus far, each lockdown has been wasted, as the government refuses to implement the measures that could crush the virus entirely. They then open up and allow cases to rise until it is time to lock down again. Rinse and repeat.
The chaos of this approach cannot be understated. Every time community transmission rises uninhibited, we lose control of the virus, as the testing and tracking systems are overwhelmed. We risk massive shortages in hospital staff because of contracting COVID and a threat to the ability to care for patients. With the increase of spread, we risk other factors, such as the evolution of new variants of the virus that are more deadly or more infectious. And, every time lockdowns are implemented, the public becomes frustrated and tired, running the risk of lower rates of compliance. The more we continue to run these risks, the more the crisis deepens.
A Neoliberal Disaster
There is no doubt that governments North and South have displayed a staggering level of incompetence in dealing with Covid-19 and that their actions will cost us many lives over the coming weeks. But incompetence alone is not the primary driver for what has brought us to this point.
Rather an ideology that prioritises private profits over public health has meant that governments North and South have spent the past year gambling with peoples’ lives. There is no question that this has been a key factor – they have told us it is. Mícheál Martin laid out the thinking clearly at the beginning of December: “We took a more conservative approach on the household visits, and then traded that off with visits to hotels and restaurants”.
Slides from a Department of Finance presentation lays out their thinking clearly in terms of a “Health/Economic Trade Off” and a “policy trilemma” that means they must find the “sweet spot” that straddles “economic outcomes”, “health outcomes”, and “societal outcomes”.
Neoliberalism is at the heart of government failure to deal with this pandemic. Temporary testing infrastructure has been dismantled when the virus has been at a low ebb, instead of being put to use to aggressively chase down Covid in the community. Contract tracers have been hired through recruitment companies on hire-and-fire contracts, some of whom are now in dispute with their employers over being asked to take up additional responsibility beyond their pay grade. Our contract tracing system was inadequate when virus levels were low, only tracing back 48 hours and not being used to generate new data on how Covid was spreading. The new surge in cases has meant the system is now being inundated.
Our health services, likewise, are on the brink of overwhelm. The meagre improvements granted to nurses and midwives in the South after their strike in 2018 have not been enough to address the recruitment and retention crisis. The government was gearing up to rely once again on student nurses and midwives on their placements to plug these gaps – a job they would expected to do for a measly sum of €100 a week. With pressure mounting to pay them, the government has now announced that the placements will not take place, ostensibly so that the those who would be training the students can focus on dealing with patients at the front lines.
The reality is that, North and South, student nurses and midwives have been dealing with patients on the front lines since the pandemic began – often without proper remuneration for their efforts. Many students have spoken about how they have cared for Covid patients without supervision because of the lack of staff available. With more and more healthcare staff now out of action, the loss of the students could be a major blow. Once again, the decision seems to have been made not out of concern for their wellbeing, but because the government is stubbornly refusing to pay them for their work.
In the North, before the pandemic, there was a nursing shortage of over 3000 unfilled positions, and a chronic underfunding of the NHS. Currently, the main issue around ICU bed capacity is not the physical bed, but the trained ICU nursing staff to give appropriate patient care. Already, the North has seen the Southeast Health Trust take to social media to encourage off duty HSC staff to report to work because of being completely overwhelmed.
The pandemic has drawn attention to another reality that existed well before Covid-19: The doctors performing 24-hour rotations. These kinds of hours are illegal under EU law, yet they are undertaken by junior doctors and by foreign-trained doctors. In the case of the latter, these are doctors whose qualifications are not given the same recognition as those of EU-trained doctors and are effectively blocked from a path to consultancy. This means they are stuck in rotations for years on end. These doctors make up over one third of all trained doctors in Ireland – without them the system would collapse.
Looming over the ongoing crisis is the spectre of private healthcare. A new deal has been struck which will allow up to 30% of private beds in the South to be made available to deal with the current surge. Once again, this will line the pockets of the likes of Larry Goodman and Denis O’Brien, as the state has agreed to pay the price ordinarily paid by private insurance customers. There is also a distinct possibility that there still will not be enough capacity to deal with what is coming.
The Irish Nurses and Midwives Organisation has demanded that private hospitals be taken into public ownership. This kind of demand would have been unheard of before now – an indication of the severity of the crisis and the hellish scenario facing health workers in our hospitals right now.
Yet Mícheál Martin’s government is determined about one thing: They want to exit this pandemic with their neoliberal tax-haven model unscathed, without having made any major permanent investment into public health, and without rocking the hugely profitable private health sector. This is why the large majority of new jobs in the health service are temporary – to be stripped away again as soon as possible. And while they do public health on the cheap, they are happy to open the coffers and pay out to private hospitals to paper over the cracks.
Will they succeed in doing so without suffering massive political damage? There is huge anger among many health workers and in wider society over the handling of the Covid crisis. The exploitation of student nurses and midwives, the massive payouts to private hospitals, the fact that our ICU capacity is woefully inadequate, the constant cutting of corners, and the outright lies about public health advice – all of this will leave deep scars that will not be easily healed when the worst of the pandemic is over.
And despite their criminal mishandling of the Covid crisis, the government is somewhat protected by it – if it weren’t for the public health effort, it is quite possible that there would be thousands of people on the streets to protest over issues like the sealing of the mother and baby home records. This will not last. The reverberations of this crisis could be felt well into the future and could create major opportunities for those who want to fight for a better, more humane system.