By the time the National Public Health Emergency Team (NPHET) met on Sunday, one thing was clear: the measures in Dublin to curb the spread of Covid-19 weren't working quickly enough.

The capital has been on Level 3 – with some added restrictions – for more than two weeks. Acting chief medical officer Dr Ronan Glynn told the Oireachtas Covid-19 committee last week that meaningful change needed to be seen in the coming days. The capital, he said on Wednesday, needed a "significant improvement".

That was the hope when NPHET wrote to Minister for Health Stephen Donnelly on Thursday, that Level 3 measures were not required countrywide, at which point data on the disease's progression was based on the first half of last week.

Hospital Report

However, as the data from the latter part of the week came in – and was poured over by NPHET – a view formed that the progress in Dublin wasn’t significant enough. The rate of growth in the capital was slowing, but not going into reverse. Elsewhere in the country, the virus was growing more quickly.

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In addition to this, as the chief medical officer Dr Tony Holohan’s letter to Government outlines, there were concerns over the spread of the virus in the over 65s, the growing number of deaths and hospitalisations, and the testing positivity rate, which now stands at 3.6 per cent for the last seven days – higher than the average of 3.4 per cent for the entire pandemic. All of these metrics indicated that the virus was gaining a foothold again.

Some participants in the meeting also formed the view that the failure to control the virus in the capital was an indication that Level 3 could not be relied on to suppress the virus at its current level.

As Holohan wrote to Minister for Health Stephen Donnelly on Sunday night: “The measures currently in place are not sufficiently controlling the disease as evidenced by a high volume of community transmission and sustained increases across key indicators.”

The concern was such that two key aspects of the approach to controlling the virus – local measures and a graded response – were to be abandoned. According to well-placed sources, the view was that the strategy of local lockdowns or control measures works, but not in every circumstance. In Laois, Offaly and Kildare, they were effective when there was a clear "ground zero" of infection, namely meat plants.

In Tipperary, an outbreak in a mushroom farm was contained without resorting to an official lockdown. But in Dublin, the virus wasn't present in one setting – it was present in every setting. As the Covid committee were told last week, that means no big clusters but it also "makes it more difficult to control because there is not one obvious target".

The virus was also growing nationally. The average number of daily reported infections was now well in excess of 400. While some counties are not as badly affected, sources said that after a certain point, it becomes a problem that has to be addressed on a system-wide basis, as the pressure on the healthcare system is felt nationally, not locally.

Scale

NPHET ultimately decided – and members still believe – that moving through the different levels would ultimately lead to the same destination: the harshest restrictions being put in place. Holohan warned in his letter to Donnelly: “[A] graduated approach will not have sufficient or timely impact on the trajectory and scale of the disease and will not protect the core priorities.”

The idea, sources say, was for a short, sharp break that would allow the country get the virus under control again before the Christmas break, and before the impact of winter truly hits health services, which can be as late as December or even January. The simplicity of a lockdown appealed both in practice and from a communications point of view. There are ongoing concerns about the capacity of the Government and the health service to adequately convey clear messages about what activities are allowed, but it’s easy to understand a lockdown.

In the absence of going to Level 5, and if measures announced by Government do not work, the view from NPHET is clear. Cases will rise significantly, as will hospitalisations. Modelling, Holohan told Donnelly, shows that “if current trends continue, 1,600-2,300 cases will be notified per day by November 7th. The modelling also shows 43 people with Covid-19 being admitted to hospital per day by that date”.

Whatever comes to pass, the past week – and the decisions taken – will doubtlessly resurface.