Taking Stock April 21

What are we to make of it, less than six weeks after the first Irish death on 11 March, particularly as the first tentative moves to re-open Europe’s economies are beginning?

We now have 687 dead in the Republic and 207 in the North – almost 900 dead on the island in forty days, the real total certainly higher since the Northern figure, as in England and Wales, includes only deaths in hospitals. 900 is more than have died on the Republic’s roads since December 2015, more than the worst year of the Troubles; indeed, 1972 excepted, worse than any two years of Conflict deaths combined. All in under six weeks.

The dead were people, who did not ask to be taken so cruelly and precipitately from their lives and from their families and loved ones, very often without a chance for a last goodbye. Each death a tragedy and they should not be forgotten. Think how we respond to terrorist atrocities, like Nine Eleven, or Bataclan,  or  air atrocities, like Teheran or the Western Ukraine, or domestically a disastrous fire, like the Stardust. The virus deaths are not dissimilar, sudden – when the virus takes hold there is isolation, and  death comes in a matter of days – and cataclysmic. The anger, the indignation, the frustration, the loss, of the bereaved expressed eloquently in a poem “My Sister is Not a Statistic,” written by Mayo born Dorothy Duffy about her sister, Rose Mitchell, and broadcast on RTE during the last week; it is impossible to listen to it without being moved.

Yet even as the first hints are appearing that we in Ireland are starting to get on top of the Virus (the “good news” is that the number of new cases appears to be stabilising), a sense of fatalism and acceptance seems to be creeping in. The victims are being categorised and compartmentalised:  90% of those who died were over sixty five; the daily median age of the dead has been over eighty; most suffered “an underlying medical condition;” over half the dead (54%) have been in nursing or retirement homes. And we measure daily whether the death totals have changed over previous days, and compare Ireland’s “deaths per million” ratio with those of other countries. All understandable – we are, after all, caught up in this and anxious for a solution that will bring normality back rapidly (some hope!); plus the information is useful and helpful. Still, the net effect is to reduce the immediate dead to mere statistics.

The magical concept now is the R0 symbol– the measure of how contagious a disease is; less than one is good, indicating that each person will infect less than one other, so eventually the infection will peter out. For Ireland the RO now appears to be below one; last month’s dire forecasts of  thousands dead and tens of thousands hospitalised were based on models using a much higher R0. It may well be that when the major ravaging effects of the Virus have subsided the dead will be much less than feared, perhaps 2000 or 2500 tops; and we will count ourselves lucky. Lucky?  That is a monstrous figure, not one to rejoice but rather to mourn over.

How has Ireland done? A dedicated team of health officials have earned the respect and admiration of the public for providing transparent and comprehensive information on the situation at daily press briefings and have advised the government on how to proceed, advice that the politicians have followed. All standing in favourable contrast to what has happened across the water in Britain. It did no harm that the Taoiseach is a doctor who grasped early on the potential seriousness of the situation. The public, well informed, have responded, taking to heart what was said and asked of them in terms of altering behaviour, social distancing and the lockdown. The compliance rate has been extremely high and the net effect after several weeks has been cautious optimism at official level that the curve has been flattened and that the situation is now stabilised. The lockdown is set for review on 5 May and though few expect it to be lifted, provided the situation holds or improves there is some optimism that it may be loosened or tweaked.

There have been issues, including the shared international ones. Like all other Western countries we were caught unawares and, in the main, unprepared – prosperous societies with health systems predicated (and resourced) on the assumption that most of the population was healthy. Any emergency planning, here and elsewhere, had been to cater for a localised disaster rather than a national pandemic. And, like others, we were and are bedevilled by basic shortages in essential equipment of all sorts including protective gear for front line health workers and the ingredients to process testing – the recognised key component for combatting the virus. This initially hampered the official response and made for insufficient testing early on; indeed, as I write, we have only now disposed of a backlog of tests.

But testing HAS been ramped up and has become focussed on where problems have been identified particularly now on the staff in all Ireland’s nursing and care homes including those where clusters of infected have been identified and where many residents have died. This will not bring back those who have died but it should protect the large majority of untouched homes and residents. And, again as I write, the numbers hospitalised requiring intensive care seem to be declining. The good and bad in the Irish health system are well known: excellent care once in the system but delays and long waits for those relying on the underfunded, under resourced public health system which has been under continual pressure with a steadily rising (and aging) population, the whole bedevilled by a two tier system under which those with private insurance jumped the queue. There were fears that the system would be overwhelmed and buckle over the Virus. This has not happened, with public self-discipline helping greatly.

Arguably there were a couple of Irish “own goals” early on. There was a failure to impose an early ban on flights and visitors from outside and especially Italy as the extent of the crisis there became known; an international Rugby match with Italy was cancelled but the supporters came anyway. Thousands of Irish on vacation in Italy and Spain flew home. The Common Travel Area with Britain remains, with the Ferries still operating – and there is the open Border with the North. There was also the usual heavy attendance (thousands) of the Irish at the Cheltenham horse racing festival and also the usual weekly attendance by Irish fans at soccer matches in England, all before St Patrick’s Day. Ireland has many contacts at all levels with Britain and does not have the luxury of New Zealand’s remoteness and ability to seal its borders.

There are now questions being asked about the slowness of reactions on this and to the developing horror story in retirement and care homes. Here a factor to bear in mind. Ireland had a general election on 8 February, with a surprising outcome (Sinn Fein getting the most votes) and an ensuing and ongoing political stalemate.  The current government is the former one continuing in a caretaker capacity.  Few would question its performance and measures taken to combat the virus (indeed a refrain heard often is that it’s a pity it hadn’t governed the country as well before the election and virus crisis!)

Measured internationally Ireland is not doing too badly. Looking at the mortality rate, Ireland is currently placed ninth (the feast is very moveable) in terms of deaths per million, with 139, and behind all the major Western European nations except Germany (56) Austria (52) and Portugal (72). We are well behind Belgium (503) Spain (446), Italy (399) France (310), the Netherlands (219) and Switzerland (165) The UK figure, currently 16,509 dead, or  243 per million, is too low by a margin since it includes only hospital deaths.  We are, however, ahead of the USA, which already has over 780,000 cases and 42,000 dead and rising but which is averaging currently  127 per million  because of its enormous population.

We are ahead also of most of the Nordics, several of which have roughly similar populations, Norway at 33, Denmark at 63 and Finland at 18. Sweden however has 1580 deaths, or 156 per million, having postponed effective action and now paying the price.  The key here, and for Germany and Austria was to take effective measures very early on. The Central Europeans have currently significantly fewer cases and very much fewer deaths. Is it too simplistic to link the heaviest incidences of European cases, deaths and locations to the more prosperous populations of the pre-Enlargement EU countries, who can afford winter holidays and their preferred destinations?

The situation is still very uncertain. Ireland has not dodged the bullet but we seem to have dodged the artillery shell.



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