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Notes from a GP: Covid cases in millennials are now showing in their grandparents

Our GP argues that while it’s understandable the government didn’t want to rush to Level 5 this week, the numbers now mean this is inevitable.

Anonymous GP

TOUGH CALLS DRIVEN by hard data. Leaks sprung on the frightened public by unknowns playing games.

Senior Politicians with hurt feelings. A Cabinet grappling with life versus economic death choices. The last few days, while not quite Game Of Thrones, certainly had a feel of House of Cards to it. 

Sadly, unlike in the shows, the deaths from this drama will be real, the disabilities longer lasting and the businesses ruined either way may never come back. What is going on and how did we get there? 

We are going to have another Level 5 ‘lockdown’. That is the only certainty from this last week. As any politician at an election count will tell you, numbers don’t lie. While you can read them in whatever way your Count Day feelings need you to, they always end up reflecting the reality of what is happening on the ground. 

Unravelling

In our local communities and hospitals and healthcare settings, things are starting to go wrong. Fast. The Government knows this. 24 hours after publicly laying the boot into NPHET for recommending Level 5 restrictions, the Tánaiste Leo Varadkar privately admitted to his Fine Gael Parliamentary Party that such a move could still happen.  Numbers have a habit of being right.

The numbers are going up. There were 69 cases on 6 August. On 6 September, we saw 138 cases. Tuesday, 6 October had 424 cases. The initial rise was largely confined to younger, healthier, people. Thus, the deaths and hospitalisations were low.

The rapid case rises in those over 65s is the trend that scares. Having seen no Covid cases for most of the summer, many GPs are reporting daily cases in their Practices. What was initially affecting party-going millennials is now presenting in family-event-celebrating parents and grandparents. 

The problem spirals out of control as the age of cases rise. Older people aren’t as healthy as their younger adult children. While they might not die from Covid, older people have a higher chance of needing prolonged hospital care.

The death of somebody is a personal and family tragedy, but it doesn’t really affect unconnected people. The filling of hospital beds with sick Covid cases does. 

Somebody occupying a hospital bed for 30 days means that 10 other 3-day cases can’t get in. That’s angiograms for heart disease, mastectomies for breast cancer. It’s the emergency hip surgery or the pregnant lady with pneumonia. 

A Covid bed drains nursing and medical staff away from outpatient clinics or A+E departments. Waiting times spiral deeper. A floor of Covid wards neutralises half the hospital. It takes out more than the 40 beds involved.

Blood tests, CT scans, ICU capacities all get slashed. Covid cases take longer to gown up for while doing medicine at a social distance reduces accuracy, productivity and staff energy.  

What impact on society?

The higher the number of community cases of Covid, even in younger people, the more the impact on society. Businesses leak employees who either isolate with Covid or are restricting due to family members with Covid.

Schools send children home as Covid gets into corridors and staff rooms. Small enterprises wholly shut as a single staff member affects and infects several others. 

Community services like home help, meals on wheels, physiotherapy and dentistry will contract when Covid numbers rise higher. GPs are diverted to acute Covid Care and take longer to see routine cases in need of a Doctor’s input.

All of this is happening daily in our localities albeit not always visible to those busily sitting in seats of power or posturing in the blare of TV camera light.

So, was the Government right to overrule NPHET?  Should we have self-inflicted a gunshot wound to our collective economic hearts by triggering a Level 5 ‘lockdown’? Ireland is not alone in seeing rising youth cases leading to rising older cases. It would have been alone in activating such drastic measures as NPHET proposed.

If you believed the Minister for Finance’s fantastical claim, as leaked by his party colleagues, such a move would have locked us out of ECB funding. Should Michéal Martin have cogged a Bad Boys movie quote to rival Leo’s Mean Girls quips? 

Whatever the answer, the fact is the Government opted to stick with Level 3. It had every right to do so. NPHET’s role is simply to advise, while Government’s job is to understand that advice, integrate it into its thinking and act accordingly.

In rebuffing NPHET the FF/FG/Green coalition was simply weighing up NPHET’s plan against its own alternative plan. What that plan is, however, has not been told to us citizens. We have no idea at all what steps the Government is taking to stem cases.

We are aware of the finely balanced judgement it took to protect business and livelihoods by sticking to a ‘Level 3 – done better’ policy. That legitimate step will only work if it is coupled to measures to protect against the collapse of Ireland’s healthcare system. 

NPHET’s plan understood, and tried to account for the indisputable fact, that Ireland has a chronically weak and mal-funded healthcare system. Its failure was in not sufficiently weighing the value of a functioning working economy. Livelihoods depend on economic activity. 

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The Government has correctly weighted the value of jobs. However, its ‘Level 3- done better’ plan has fatally misunderstood the health system that lives depend on. It failed to beef up critical hospital capacities over summer when Covid was waning. The HSE plans to run services at 80% capacity this winter.

It should be double that. This missed opportunity will force choices in hospitals between Covid sick patients and ‘normal’ sick patients. The first avoidable deaths due to this miscalculation by our Government in exerting their right to ignore NPHET will trigger their panic and a Level 5 type imposition. 

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Anonymous GP

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