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The Debate: What should Ireland’s long-awaited Covid inquiry examine?

Decisions relating to nursing homes, schools and the ‘meaningful Christmas’ of 2020 will need to be evaluated so lessons can be learned for the next time

Private nursing homes have raised ‘very serious concerns’ with Nphet about the withdrawal of State funding for Covid-19 infection controls. Photograph: AP Photo/Emilio Morenatti

Pat Leahy
Tomás Ryan
Tue Jan 9 2024 - 06:00

Pat Leahy: Just because some people may be a bit discommoded by its evidence and conclusions is no reason to delay

The long-awaited Covid inquiry is shortly expected to be approved by Cabinet and set up in the coming months, running until the second half of next year.

The lengthy delay is perhaps understandable given the spectacle of the British inquiry that has unfolded in recent months, with both politicians and senior officials reluctant to have their decisions during the pandemic, taken under the most extreme duress and frequently with a minimum of reliable information, examined and interrogated in the cold light of day. But that is no excuse really.

It is hardly beyond the wit of man to design an inquiry that is not an exercise in finger-pointing, but rather an honest attempt to learn lessons and better prepare us for the next pandemic. And just because some people may be a bit discommoded by its evidence and conclusions is no reason not to do it. It should have been done before now.

So what should the inquiry do? Well, it should certainly investigate a number of individual decisions taken by the Government and senior public health officials over the course of the crisis. For example, in the first phase of the crisis in early 2020, as the world looked on in horror at the situation in northern Italy where hospitals were completely overwhelmed by Covid cases, Irish hospitals were basically cleared out of long-stay and elective patients in preparation for a huge wave of infections. But many of these ended up in nursing homes with insufficient testing capacity and poor infection controls, and a wave of deaths ensued.

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Another decision that should be examined is the decision to lift many restrictions in advance of the “meaningful Christmas” later that year. The coincidence of that reopening with the advent of the highly infectious Delta variant led to a massive wave of infections and a sudden lockdown in the days after Christmas.

That lockdown lasted for months – but was it too long? In general, Ireland locked down longer and harder than most countries. The inquiry should also investigate the costs of the lockdowns – not just economic (though that is part of the picture) but also the social costs: in increased domestic violence; in schooling lost, especially for children in vulnerable situations; in isolation for older people, some of whom never fully recovered from the lockdowns. The inquiry should find a way of evaluating all of this. And let’s not forget other consequences – at a time of an acute housing shortage, housebuilding stopped. The lockdowns were not cost free, and some effort should be made to count the costs.

[ Shape of Covid-19 inquiry begins to emerge – but will it satisfy Opposition and public? ]

It might be interesting, too, to hear from those who advocated for zero-Covid and called for longer and tougher lockdowns, and that a Covid-free Ireland should shut itself off from the world. How might that have played out as the rest of the world reopened?

It would also be useful to look at some things that worked well – the rollout of the vaccine and the wide buy-in from the public into the programme. The financial supports that preserved a functioning economy and enabled the astonishing bounceback in economic activity – and therefore, the public finances – after reopening.

The inquiry should also concentrate on not just the decisions that were made but how they were made. The truth is that the relationship between the political decision-makers in Government and the public health advisers was unbalanced and then dysfunctional. As Jack Horgan-Jones and Hugh O’Connell put it in their indispensable account, Pandemonium, “Some of the most drastic, expensive and cruel policies ever imposed by the State were arrived at within a system that was ad hoc and could be haphazard.”

All this, it should be reiterated, is not intended to put people in the dock – but rather to learn lessons. The findings by the Organisation for Economic Co-operation and Development that Ireland experienced no excess deaths in the period adds weight to previous assessments that Ireland got more right than wrong. But we did not, for sure, get everything right. We need to figure out the lessons of all that. “Do not weep, do not wax indignant,” Spinoza said. “Understand.”

Pat Leahy is political editor of The Irish Times

Prof Tomás Ryan: Our major weakness was the lack of a coherent pandemic strategy

What is at stake in Ireland’s Covid inquiry? The way we approach this inquiry will influence how we prepare for, and respond to, future pandemics. We can choose to be ready for the next time, or we can again find ourselves running around in circles.

Preparedness means minimising death and disability, while also avoiding the use of invasive social restrictions. We need to assess how the policies and actions of our Covid responses measured up in delivering positive outcomes.

Ireland has so far experienced 9,466 Covid deaths and suffered a relatively long period of time under social and economic restrictions during the first two years of the pandemic. Despite recent headlines, the pandemic resulted in a clear rise in excess mortality from 2020.

Ireland got a lot of things right: vaccine distribution and take-up, financial support, communication with the public and social cohesion. We had one of the best economic performances during the worse parts of the pandemic and in the aftermath. Had the Government followed the response of the UK, Ireland would have suffered an extra 4,000 Covid deaths in 2020/21.

On the other hand, if we had not made certain tactical errors (such as nursing home management in the first wave, and Black Christmas 2020), we could have prevented thousands of unnecessary deaths. But these mistakes are now so obvious that an inquiry is hardly necessary to ensure those lessons are learned.

Our major weakness was the lack of a coherent pandemic strategy. Countries such as Norway, Finland, Denmark, Canada, Japan, South Korea, Australia and New Zealand performed much better in terms of both death rate and time spent in restrictions. A future pandemic strategy should take into account what worked for successful countries, and identify practical ways for implementing appropriate measures here.

[ Hide nothing, avoid ‘tittle tattle’ and focus on substance: what can Ireland learn from the UK’s ‘farcical’ Covid inquiry? ]

The Government did not take on board scientific advice from a sufficiently broad range of experts. We need a novel system for feeding in current scientific knowledge into the response – incorporating diverse scientists, psychologists, human rights experts and economists, with clear terms of reference.

A crucial issue is that no risk assessments seem to have been conducted by the National Public Health Emergency Team or other bodies before implementing many Covid policy decisions. Schools contributed to Covid spread in the population, and we turned a blind eye to this at many stages of the pandemic. Long-Covid risks to children were not sufficiently communicated. Why did it take so long for recognition that Covid is airborne? Accepting the role of air hygiene will be a crucial component of any future strategy.

There are also political questions for the inquiry. As we learned from foot-and-mouth, we cannot effectively manage a pathogen unless we can control our borders. A major failing of the Covid response was the lack of political effort in engaging with Stormont and Westminster for coherent North/South Covid policies.

Why were the State’s Strategic Emergency Management structures and framework (developed in 2017) not implemented in March 2020? Why was our public health infrastructure so underdeveloped and what is being done to improve it for the future? We need a clear review of the data systems used to track infections and implement contact tracing.

The inquiry should be composed of independent, international experts from here and abroad who were not involved in responding to the Covid pandemic or commenting on it. Its focus must be on future preparedness rather than assigning blame. There should no barrier to the rigour of the difficult questions asked.

A 12- to 18-month inquiry is only a first step. Covid is now a major cause of death and a leading cause of disability in our lives. The true costs of long-Covid are yet to be borne out. How we deal with future pandemics will depend on how much we as citizens insist on effective preparedness from the State.

Tomás Ryan is associate professor in the School of Biochemistry and Immunology and Trinity College Institute of Neuroscience at Trinity College Dublin

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