"We didn't think we would be talking about flattening three curves, and we certainly didn't think that one year on, we would be seeing the worst impacts of the virus, which is where we are now."

The head of the HSE Paul Reid is looking back on the 12 months and three waves that transformed the country and the health service. 

While the first emergency meetings started last January, it was the television coverage from abroad that brought the enormity of what was happening home. 

"The early TV coverage that we were seeing coming from Wuhan, and then as it came across to Bergamo, it began to feel real", Mr Reid said. 

"We were on video calls to medics and clinicians in hospitals in Italy and Spain and it was quite scary what we were hearing," he said, adding that they needed to understand the impacts that this would have for the Irish health service, which is "under significant strain on a normal day in terms of capacity". 

The Italian military transported coffins by convoy in Bergamo in March of last year

Mr Reid said we prepared well for the virus that was spreading across the globe with the early discussions focused on creating an extra 10,000 hospital beds through field hospitals and using private hospitals. 

"What we didn't know was the scale of what we were going into. On PPE, we were spending €15ma year. We were saying would we need to double that or spend €50m? In essence, we spent €1.1bn. So, it was the scale that was overwhelming at that stage", he said. 

"We all have to put our hand on our heart and take reflections on what hasn't worked and what we could have done better."

Similarly, the number of ventilators had to be doubled. 

Regrets

Mr Reid said there are a number of things to be proud of in terms of how Ireland handled the pandemic, such as the responsiveness of the health service.

"I have never seen so much change implemented so quickly by so many with such a great impact. I think it's a tremendous reflection of the health service," he said.

On building testing capacity, at the beginning we had just one laboratory - the National Virus Reference Laboratory - with the capacity for 600 tests per day.

"We had labs in our hospitals but they weren't used to dealing with anything like this scale. So, it was a huge challenge to mobilise what is now up to 40 labs," he added.

"I look back and think what could we have done differently at a different point in time?"

Equally though, Mr Reid readily admits that some mistakes were made too and many lessons learned. 

"We all have to put our hand on our heart and take reflections on what hasn't worked and what we could have done better," he said.

One of the areas for reflection is how nursing homes were supported.

"I look back and think what could we have done differently at a different point in time?"

He said the HSE was not usually in charge of private nursing homes and that the question "who was responsible for what" was one of the things they were not very clear on at the time. 

"There might have been a bit of second guessing around who was doing what, to be frank, and I think that's just something that probably didn't have the same coherent response as we had in our hospital system," he said. 

"There's a few things we know now in terms of preparation, congregated settings, especially for vulnerable and older people, they're not built for pandemics, they're not fit for pandemics," he added.

On a personal level, the head of the health service said he regrets the loss of healthcare workers to Covid-19.

"Right now to date, we have lost 15 healthcare workers to Covid. Every death has been sad throughout all of this. It's particularly really sad when you have lost someone who has come to work to protect us, to protect the public," he said.

"I have spoken to many of the families, the one thing they always say is their loved one 'just wanted to come to work and save patients and save peoples lives', that's one thing I feel really sad about," he added.

The risk of failure

Looking back on the year, Mr Reid said the pandemic highlighted a need within the public service for fast decisive action.

"I had always said we will get 70% of our decisions, at best, right, and we will most likely get 30% of decisions that didn't work or that were wrong, but the worst thing we could do was not make decisions."

He said this is the environment needed in the public service. 

"For too long public servants have been constrained by the risk of failure and that won't work in a pandemic," he said. 

"I'm very optimistic about the kind of society we will get back to but I do think it will be different."

What is clear though is the need to future-proof for further events such as the pandemic we are currently experiencing. 

"We have to build a national pandemic workforce and capability. It's something that has to be a public service that we build on for the future. Our testing, tracing, laboratory capacities and public health workforce all has to be built at a much stronger base than we were ever able to have it," he said. 

Mr Reid said we need to have capacity on our infrastructure to scale up when needed. 

"That may be a combination of fully employed public service employees and something we can contract in at the appropriate time as well, but from a public health perspective we have to have a really fixed expertise," he added. 

He said we are in a much stronger position with a permanent workforce already built up for swabbing and contact tracing but the biggest challenge is hiring more public health experts. 

Mr Reid said these challenges include the "relentless level of work involved", as well as industrial relations issues around pay.

"We are going through those processes now. We do need to resolve that and it will help to recruit and retain further employees in this area," he added.

He said it is hoped they can double the workforce in public health by recruiting 255 additional public health experts and that recruitment progress commenced last October. 

Hope for the future

After living through 12 months of the pandemic, what kind of situation does the head of the health service see us being in this time next year?

"I'm very optimistic about the kind of society we will get back to but I do think it will be different," he said.

"I think we are going to be stronger as we come through it after the vaccination programme, but I do think we will take huge learnings about how we interact with each other and how we protect each other, not just in pandemics but maybe even in flu seasons."