Jennifer O’Connell: Covid has taught our health system nothing

Thirty three days. That’s how long we lasted – barely enough time to relax our “very high standards of behaviour”, hold a ritual mask-burning and hug a granny before it was announced that the National Public Health Emergency Team is coming back. Or a scaled-down version of it.

On Wednesday – the day after the World Health Organisation's Europe director Hans Kluge accused Ireland of lifting restrictions too "brutally", which was presumably nothing more than a weird coincidence – Tánaiste Leo Varadkar announced that a new team was being formed to advise the Government.

It probably won’t be a Nphet Nua. It is hard to imagine that the Government wouldn’t use this opportunity to appoint more people with scientific backgrounds to the team, and fewer civil servants. Still the idea that an expert group is once again being rapidly assembled to help manage our response does not feel like progress.

How manageable a part depends on the state of the health system. And there, for Ireland, is the rub

Many people were annoyed by Kluge’s remarks; loudly indignant that Ireland is being denied its gold star for being the best little country in the world for managing pandemics. After all, our response delivered one of the lowest mortality rates from Covid in Europe. But there is no denying the current data either. Over roughly two weeks in March, more cases were detected on antigen tests than in the first two waves of the pandemic, as Jack Horgan-Jones has reported. We’re back to cancelled elective hospital procedures, calls for the reintroduction of masks, and closures of hospital wards and beds.

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Where did it all go wrong? Or did it actually go wrong? Maybe, instead, it has gone entirely as we should have been able to predict. Pandemics, as history has shown, don’t end neatly. They wax, wane and eventually become a more manageable part of the fabric of our lives. How manageable a part depends on the state of the health system. And there, for Ireland, is the rub.

There are three factors driving the current crisis. The first is that the relatively mild, but highly transmissible, BA.2 variant is coursing through society. The second is that personal responsibility is proving to be a busted flush. Nphet and the mask mandate disappeared and left a vacuum, and that vacuum was not filled by people’s innate good judgment. I suspect this was less to do with the way restrictions were lifted, and more to do with the disempowering manner in which our behaviour was micro-managed over the last two years. This was exacerbated by a communications failure at what was supposed to be the end, to explain that “no longer mandatory” did not mean a mandatory end to mask-wearing.

Covid was like a mass experiment to see what happens if you infantilise five million people for two years and then one day tell them to do as they like. What happens, it turns out, is that they will do as they like – they’ll crowd into pubs, shops and onto buses and generally behave as though the words “airborne transmission” had never entered their vocabulary.

Irish people have a lot of good qualities, including compassion. We’re capable of rising to an urgent challenge if there’s a clear cost/benefit return, such as “wear a mask to protect your grandparents”. We are not so good at seeing our individual actions as part of a bigger picture with a less immediate pay-off. This is particularly true after a prolonged period when we were barely encouraged to think for ourselves at all.

I got the train from Waterford to Dublin this week. In my carriage, I was the only person in a mask. At one point, a packed train pulled in opposite, full of students returning to college. In the carriage across from mine, I again counted one mask.

I disembarked, walked up the hill to St James’s Hospital and arrived straight into a different world, where I was writing a story on cancer services. This alternate world is in the grip of another wave – the fourth? The fifth? Is anyone still counting? On the haematology-oncology day ward, Norma O’Riordan, an assistant director of nursing, was back doing the Covid arithmetic. If you have 171 patients due in, 91 of whom need treatment, and you subtract four staff nurses to Covid, how many people can you safely treat? “On every ward I’ve been on this morning, there are at least four to five people out,” she told me.

And that brings us to the third reason. We’re back exactly where we started – being asked to moderate our behaviour to save the health system. But is it really being overwhelmed by Covid, or is Covid the excuse for a system whose permanent state is overwhelmed? Over 2020 and 2021, the Health Service Executive hired an additional 13,500 staff. Its budget is €6 billion higher than in 2018, not including Covid-specific funding. There are 800 more hospital beds. So where have those staff and that money and those beds gone?

We need a health system that can withstand more surges, more waves, more deadly variants and new viruses

The problem we now face is much bigger than another wave in this relentless pandemic, which some experts are hopeful will peter out in the next two or three weeks. Hospitalisation rates are dipping across Europe. The real question now is what the strategy after that might be, beyond lurching along until the next crisis. We need a health system that can withstand more surges, more waves, more deadly variants and new viruses.

We need hospitals which function fully during evenings and weekends, so that staff can access non-urgent diagnostics, patients can be discharged as soon as they’re ready, and people are only admitted through emergency departments if they actually need to be there, and not because there’s no one senior enough around to make a decision to send them home. As one consultant pointed out to me, this is not the last pandemic we’ll face. And if this one taught us anything, it’s that we can’t keep doing the same thing over and over and expecting a different result.