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Dublin: 10°C Wednesday 21 October 2020
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Opinion: Covid-19 has changed everything, so it's time for rational planning and national unity

Irish health professionals need leadership from our politicians, writes Dr Anthony O’Connor.

Dr Anthony O'Connor Consultant Gastroenterologist

IN THIS DECADE of centenaries, one echo of the past that we would all wish not to have to revisit was the great flu epidemic of 1919, in which 20,000 Irishmen and women lost their lives.

Historian Ida Milne’s 2019 book, ‘Stacking the Coffins: Influenza, War and Revolution in Ireland, 1918-19′, explored the many ways in which the pandemic profoundly changed the course of Irish history and describes a Dr McNamara of Dublin’s Mater hospital who prescribed “whiskey, in heroic doses” as the treatment of choice – for his patients, one can only presume.

Fast-forward a century and we find ourselves in peril again. COVID-19 is frightening. It is a novel condition against which we have neither natural immunity nor a vaccine.

While less infectious than conditions like measles it moves with stealth and speed, leaving destruction in its wake. It has caused a great deal of human suffering around the world, and there is every chance it will do the same here, but to what extent we cannot know.

The vast majority infected will have mild or no symptoms but a significant minority will require hospitalisation and intensive care. Some people will die.

As a male, and a frontline medical doctor with Asthma, I have a lot to fear from this both personally and professionally and no reason to downplay it. 18 doctors, 16 nurses and four healthcare workers gave their lives during the SARS outbreak in 2003. At least eight doctors died in Wuhan, including Li Wenliang, the initial whistleblower who noticed the illness we now recognise as COVID-19 who for his troubles was visited by the police and told to pipe down.

In Ireland, the public health authorities, with Deputy Chief Medical Officer Dr Ronan Glynn to the fore ought to be commended for functioning with calm, clear-eyed competence in response to an unpredictable and rapidly evolving situation, resolutely putting patients first.

8762 Coronavirus Briefing Coronavirus Briefing. Pictured (L to R) Director of the Health Protection Surveillance Centre Dr John Cuddihy, Chief Medical Office Dr Tony Holohan, and Deputy Chief Medical Officer Dr Ronan Glynn at a press briefing. They have been provided daily by the Department of Health and the HSE. Source: Leah Farrell

Irish medical professionals deserve praise

They have focussed their efforts on meticulous contact tracing and directed their messaging at encouraging potential cases to come forward and dealing with them as they do. In this task, they have been successful, with clear guidance to professionals, good teamwork and a canny utilisation of the ambulance service. No transmission has been confirmed within the state yet. This work will be proven to have without doubt saved lives. It should not be taken for granted.

And many lives are most definitely at risk, although the quoted ‘global mortality rate’ of 3.5% that many have quoted is somewhat misleading, as mortality falls to 0.9% when Iran and China are excluded. The assumption many seem to make that a flu outbreak will automatically behave in the same manner in a Northern European spring/summer with health systems that have had a chance to prepare for it as it did in a Chinese winter with an unprepared system is a shaky one.

Some have called for immediate, stringent curtailment of regular daily activities in the state such as work, education, public gatherings and air travel, pointing to the success of countries such as China in mitigating the effects of the outbreak at its height.

This is understandable and appeals to us as a neat, sweeping decision befitting a complex challenge. By contrast, no one ever dreams of redeploying and training vast numbers of civil servants to do painstaking contact tracing of large numbers of very mildly unwell people or large-scale public information campaigns about handwashing. Yet this is the type of unfashionable grind likely to have the most impact.

As anyone who has lived through a severe weather event in Dublin will bear testament to, even the most disciplined of societies can only tolerate such restrictions for a certain amount of time.

It’s time for rational thinking

This virus is going nowhere any time soon and we need to prepare for how we might organise life here around the infection for a long haul of six to 12 months. We have no evidence that current early containment measures in operation are not working. Bringing the country to a standstill right now with aggressive quarantining and expecting to keep that up for a year as the virus rages around us the world over is neither feasible nor viable.

The resultant falloff in productivity and output deprives us of the money needed to pay for public health measures and the care of the sick, risking a situation whereby the time where draconian measures are most needed the country may not have the resources of revenue, labour and spirit to withstand further hardship.

We must be mindful of the trap of thinking: “something must be done: this is something, therefore this must be done”.

tree lights 719 The lads time party leaders were united was at a carol service at Christmas. Here, Fianna Fail Micheal Martin TD, Finian McGrath TD, President of Sinn Fein Mary Lou McDonald TD, Taoiseach and Fine Gael leader Leo Varadkar and Leas-Cheann Comhairle Pat with Social Democrats TD Roisin Shortall at the switching on of the Christmas tree lights outside Leinster House. Photo: Sam Boal/Rollingnews.ie Source: sam boal

Politicians must take responsibility

As the week has passed I have noticed on news bulletins the juxtaposition of stories about the outbreak with stories of the ongoing efforts to form a government. I hear talk about policy exchanges, bilateral discussions, and meetings about meetings with no apparent urgency in forming an administration.

I see little political consensus that whoever assumes the reins of power may have to immediately face some of the greatest peacetime challenges in the history of the state, at least the equal of those posed in the 2008 financial crash, which may at some point involve massive disruption to the quality of life and civil liberties of the people.

A major outbreak could overwhelm our already creaking health infrastructure, as pressure on beds, particularly in Intensive and Critical Care units becomes unbearable and elective work grinds to a halt.

Our agriculture and food security will be stress-tested. Huge decisions in transport, education, justice, finance and even state security may be needed, that will be anathema to many on both the left and right.

Those on the left would for example under normal circumstances baulk at some of the measures China took to control its outbreak, including monitoring GPS data from people’s phones and forced redeployment of public workers. People on the right of the political spectrum may struggle to countenance measures such as the state guaranteeing the jobs and income of persons being asked to self-isolate, and the commandeering of private hospital intensive care facilities.

Yet it is no exaggeration to say that since the general election was called, COVID-19 has changed the world. Therefore pre-election promises and post-election rhetoric about who will work with whom must now be considered null and void. Party loyalties and biases aside, I expect that privately, 90% or more of the population would acknowledge that any of the four candidates for Taoiseach: Ms McDonald, Mr Martin, Mr Varadkar or Mr Ryan would have the patriotism, pragmatism and executive competence to steer the ship of state through these turbulent times.

It’s time for national unity

If politicians cannot form a stable administration in the coming few days then a temporary government of national unity involving all parties must be considered, possibly with a technocratic independent cabinet minister appointed via the Seanad to help deal with the outbreak, such as Professor Sam McConkey.

In conclusion, we have moved long past 1919 in both politics and healthcare and this time we face a virus posing the greatest danger to the old and infirm rather than the young and vigorous, as was the case then.

A ward in the hospital in which I work a century later bears the name of Dr Kathleen Lynn, a doctor, rebel politician and former TD who in 1919 was released from jail in order to help fight the epidemic.

Lynn went from there to Liberty Hall, where she inoculated 200 members of the Citizen Army with an experimental vaccine, not one of whom according to her account developed ‘flu. We’re not asking that from her successors, just that they merely get on with the task entrusted to them four short weeks ago.

Dr Anthony O’Connor MD, MRCPI is a Consultant Gastroenterologist at Tallaght Hospital.

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Dr Anthony O'Connor  / Consultant Gastroenterologist

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