Experts could explain Covid-19 decisions more fully to public

It has been a difficult and somewhat confusing week for people, trying to understand where Ireland is going with Covid-19.

We have hit a roadblock on the way out of the emergency with the pause in the move to Phase 4 for at least three weeks.

We must hold out for hope amidst the Covid-19 gloom.

Weeks and weeks ago, at the height of the emergency and when case numbers were high, few people were wearing masks and the advice was mixed on the benefits.

Now, with case numbers relatively low, masks have become mandatory on public transport and will soon be mandatory in shops. It's a measure already announced in France, Britain, Spain and elsewhere, so we are not alone in these moves. But perhaps we have been slow to get there. 

On the face of it, keeping pubs shut would appear to be counter-intuitive and fuel the trend towards house parties. At least with pubs, numbers can be controlled and it can be realistically policed.

Likewise with travel; the advice is not to undertake unnecessary travel abroad, yet a 'green' list of countries that are acceptable regarding travel and that have a similar or better profile with the virus to Ireland is to be published on Monday.

Some may view it as a "go ... don’t go" message, which is perplexing. People can visit Ireland from countries with high virus rates but Irish people cannot reciprocate.

At this point, there should be precise data available on how many cases have emerged from encounters in pubs, shops, travel and which countries are involved. Much more detail could be provided so people can understand and buy into all the decisions.

People will be asking themselves - if the pause and reverse button has been pressed in relation to Phase 4, after a daily high this month of 34 cases - then what will happen in the autumn when the schools are due to be back?

People in Kerry may not be able to go into a small local pub for a pint and a chat but they will certainly encounter American tourists moving about, who have travelled from a country with staggering coronavirus cases and deaths.

Irish people are advised not to travel to these places but visitors can move about freely, without having to self-isolate. It is a mixed message, which understandably has people scratching their heads.

Mandatory testing of people arriving at airports and ports is not supported by the National Public Health Emergency Team. However, the NPHET has been in favour of mandatory self-isolation.

Overall, Ireland has been doing well. The number of deaths and cases remains low in real terms.

The official position is that we are not seeing a second wave and the current numbers do not represent a surge.

Members of the public feel they have sacrificed a lot, endured much and have been winning the battle through huge efforts.

There are factors behind the cautious approach now being taken. There was a rise in cases this last week, compared with the previous one. The age profile of cases involves more younger people.

But the decisions this week do not quite tally with the praise of the collective effort. That's what is confusing. Perhaps it has not been explained well enough.

While the R number is uncertain, it is believed to be around 1.4. The case numbers which contribute towards the R factor are relatively low. Certainly nowhere near the 1,068 new cases reported on 15 April last.

The situation in hospitals is also stable, with low numbers of confirmed cases and patients in intensive care. Experts say Ireland has among the lowest prevalence of Covid-19 in Europe. This is all positive.

There are factors behind the cautious approach now being taken. There was a rise in cases this last week, compared with the previous one. The age profile of cases involves more younger people.

The number of close contacts of confirmed cases has risen. More clusters or outbreaks have been seen in private homes, linked to house parties.

One private house is reported to have had a congregation of 40 to 50 people linked to an outbreak. Not all private house outbreaks are down to parties. These outbreaks can happen, even when people are trying their best to stay safe in a household.

A group of around 14 scientific and medical experts this week signed a letter calling on the Government to implement a zero Covid island strategy here, to eliminate the virus.

They say this would allow Ireland to open up as much of society and the economy as possible. It would mean local relaxation of restrictions, wherever there is no community transmission, to allow a return to near normal conditions in those areas.

There are parts of Ireland which have very few cases but must follow the 'one size fits all' approach that is currently in place. That must be frustrating for people in those communities. They may feel that what happens in Dublin dictates the national approach.

The worst of worlds would be for Ireland to be performing some kind of Lannigan’s Ball, with the virus moving forward, then moving back again, at regular intervals.

That could be soul-destroying for society, social-cohesion, public support, the economy and health services.

Keeping people in this together has to be much more than a slogan. It must always be based on science, good reasoning and explanation of policies, as well as continuity in the messages.

A change of Government was always going to alter the dynamic in some way. The last Government took its lead from public health advice and this Government says it is doing the same.

Face-to-face consultations for mental health services are resuming where these are necessary. While technology has its place, the one-to-one patient and therapist encounter in a private, calm space is an essential part of mental health support.

During the week, we also heard some heartbreaking evidence about the mental health impact of coronavirus. Experts from mental health organisations were before the Dáil Committee on the Covid-19 response, whose important work is expected to come to a close soon.

We heard how, during the lockdown and beyond, mental health organisations have seen an increase in anxiety, low mood and people feeling overwhelmed.

The virus has caused significant disruption to people’s relationships and their expectations about what life will offer them in the months, and perhaps years ahead, personally and professionally.

In most cases when the virus hit, face-to-face mental health services had to be suspended and care moved to phone calls, video chats and online support.

There has been no one-size fits all approach by mental health organisations and they appear to have adapted well to the shock of the changed environment, all things considered.

Patients with mental health issues reported mixed experiences during the lockdown. Some people trapped at home were surprised at how their family rallied around and bonded, to keep them safe and supported.

Others experienced extreme distress and mental health support organisations have reported that the intensity and duration of calls to them increased.

Face-to-face consultations for mental health services are resuming where these are necessary. While technology has its place, the one-to-one patient and therapist encounter in a private, calm space is an essential part of mental health support.

When the supports collapse, people can turn to alcohol, prescription medicines and street drugs to try and cope.

The personal interaction with a health professional for mental health assessment and care is vital. So there are particular issues for some patients in distress. They need to engage with health staff, who must wear personal protective equipment.

When a patient needs to see the whites of the eyes of a caring professional and have the human touch, in a time of crisis, that may not be possible when they are wearing a mask, and so it’s quite heartbreaking to think about that.

The Covid-19 outbreak has also had a negative impact on the vital fundraising work of mental health organisations. Groups like Mental Health Ireland and Jigsaw have said that while the World Health Organization recommends that at least 12% of health budgets should go towards mental health, in Ireland the figure is about 7%. 

This is public enemy number one and the basic measures remain the key ones – identify likely cases, test and trace for others and treat the illness as best doctors can at this point.

If Covid-19 had been a hurricane, or an earthquake, or some event with a clear start, middle and end, it would still be difficult but easier to cope with. What we are experiencing is not a time-bound event.

We are not totally sure when it actually started and we most certainly have no idea when it may end or at least subside, to being significantly less of a threat. That makes it so difficult to cope with on a human and organisational level.

This is public enemy number one and the basic measures remain the key ones - identify likely cases, test and trace for others and treat the illness as best doctors can at this point.

No-one knows exactly what is coming next. The autumn/winter period is a big concern.

The health service is trying to resume with some form of normality but it's all far from normal. While Covid-19 has dominated the headlines, other illnesses and conditions continue to afflict people.

The national public waiting lists passed 800,000 for the first time at the end of June. The Irish Patients' Association has called for a NPHET style committee to advise on non-Covid-19 care.

It would help oversee, for example, measures to ensure there is no overcrowding in emergency departments this winter and also advise on managing national waiting lists, especially for patients waiting a long time for treatment.

Also, in Britain this week, the Academy of Medical Sciences warned that the UK must prepare for a potential second wave, or risk seeing double the number of deaths that occurred during the first wave.

In a sobering assessment, the Academy suggested that a reasonable worst case scenario there is for the R value to rise to 1.7 from September onwards. Under the projections, there would be a peak of hospital admissions and deaths in January and February 2021, similar or worse to the first wave earlier this year.

According to the British Medical Journal, the experts have warned that a combination of coronavirus, a backlog of patients needing assessment and treatment and the possibility of a flu epidemic, poses a serious risk to health. When you look at those facts, it has the appearance of a perfect storm on the horizon.

If it occurred here, it would put Ireland’s testing, tracing, isolation and treatment services to the absolute challenge. In the last week, Ireland conducted around 50,000 tests - which is some achievement.

This time, hospitals and nursing homes would hopefully be better prepared, with clear protocols and personal protective equipment. But no-one really knows what to expect and many are weary after the first battle.

This autumn will also be an important time to see a big uptake of the flu vaccination by health staff and the public too. Every second lost about deciding whether someone has the flu or Covid-19 would be valuable time that can not afford to be wasted.

Now is the critical window of opportunity, to prepare for what the months ahead will throw at us. 

Most of 2020 has been terrible, physically and mentally. At times, when things look like they are brightening up, storm clouds gather.

It can be desperately lonely, in the midst of everything, surrounded by this strange world. But know this, you do not walk alone.

Hold on.