As we approach the end of October, we are entering the kind of grim situation that many public healthcare experts have been warning could happen since the beginning of the COVID-19 pandemic. Ireland, with one of the lowest hospital and ICU capacity in Europe, risks being overwhelmed by a second wave of the coronavirus.
The last few months have felt like a slow-motion car crash. Back in June, we were on the verge of reaching elimination levels in the South, with just over 300 active cases. Yet Leo Varadkar, with business lobbyists in his ear and a political interest in reopening before stepping down as Taoiseach, tore up his own roadmap and began prematurely lifting restrictions, urging people to go out and spend. Shortly afterwards, the latest spate of cases in meat plants and direct provision emerged, seeding what now looks like a second wave. A few weeks of slow, steady increase, as the government repeatedly delayed the opening of the pubs, but refused to take the kind of action that would reverse the trends and bring the R rate below 1.
The North followed a similar pattern, albeit slightly later. With the virus at its lowest ebb in the 6 counties at the end of July, the Tories introduced the “Eat Out To Help Out” scheme that would give people 50% off a meal between Monday and Wednesday in August–as long as people sat in to eat. This meant large numbers of people congregating inside on a regular basis throughout the month of August. Cases once again began to rise, and picked up further in September as they did in the South with the reopening of the schools. Yet the Northern Executive’s loyalty to business interests prevented them from taking action, and we saw the farcical situation where new restrictions on domestic gatherings were introduced just hours before the reopening of the “wet” pubs.
Hospitalisations and critical cases are now growing rapidly across the island and there is a genuine fear that hospitals could be overwhelmed. Only weeks ago, the establishment were flying kites about the possibility of a Swedish style strategy that would seek to allow the virus to spread freely among the under 60s. This idea is looking increasingly ridiculous as outbreaks in nursing homes are on the rise once again.
“Living With Covid”
The strategy of “living with Covid” that has been promoted for the last number of weeks is looking increasingly dangerous. It is clear that control is being lost of COVID-19, yet Mícheál Martin’s government chose to delay the inevitable and to avoid taking the advice of NPHET to implement Level 5 restrictions. In the North, restrictions that have focused on households have done little to stop cases sky-rocketing–clearly, if people are still going to work or being crammed into crowded classrooms, preventing them from visiting their friends will do little to stop the spread.
Yet the establishment North and South have set out their stall that this is how they wish to proceed for the foreseeable future–a “living with Covid” strategy that will see us move in and out of rolling lockdowns until a safe vaccine is developed. This could be well into 2022 or even beyond.
The effect of this strategy is clear: it will add to bubbling frustrations, fatigue and the already dire mental health crisis. It will mean thousands of deaths, spread out over the course of a few years. There will be many more people who will suffer the effects of what is now being called “Long Covid”–where patients may suffer long term damage to the heart, lungs, kidneys and brain, and symptoms such as fatigue, a racing heartbeat, shortness of breath, aching joints and “brain fog”.
There will also be the constant risk, particularly as the fight against Covid goes on, that confidence in public health measures will be eroded and that people may be less likely to follow restrictions. There will also be increasing pressure from business to throw caution to the wind and to open up entirely. The strategy of governments North and South is akin to forming a human chain and running along the edge of the cliff–we will certainly lose some people along the way, and we run a constant risk of the whole chain getting dragged over the edge.
But what’s the alternative? We are increasingly being presented with the option of continuing with the current strategy, or adopting a Swedish style approach that would be devastating, particularly with our health services as stretched as they are. But there is a third strategy that could chart a path out of this crisis and save many lives: a Zero Covid strategy.
Zero Covid does not mean absolute zero. It means reducing the virus to such low levels that any new cases can be swiftly tracked, isolated and contained. This would prevent many deaths in the long run and it would mean that once the virus was under control, restrictions could be mostly lifted, with travel into Ireland limited to test capacity at airports.
The current moment in Ireland requires decisive action, but the kinds of measures being introduced by governments North and South are unlikely to bring the virus under control. A “circuit breaker”–a short, sharp lockdown–was announced last week by the Northern Executive.
Will this do the job? It amounts to the closure of restaurants and pubs, and little else. Given that these measures have been insufficient in the South, we can expect cases to continue to rise in the North. Last week Mícheál Martin’s government announced increased restrictions forbidding people to visit different households as they desperately tried to avoid moving to Level 4 or 5, which would mean the closure of some non-essential businesses. In reality, all that amounts to is putting more Gardaí on the streets and to threatening people with greater fines and arrests.
This will not turn things around, as people continue to have to go to work, where the virus can easily spread. Moreover, evidence from a recent NUIG study shows that repressive measures such as fines and arrests do not function to change peoples’ behaviour.
It’s clear that for most ordinary people, “Living With Covid” isn’t about living at all–it’s about working, getting business profits moving, and risking your health doing it.
A circuit breaker would therefore have to be genuine to be effective. Unlike the way it’s been implemented in the North, all non-essential workplaces would have to be closed down.
But whereas the establishment would hope for a brief period of restrictions before opening up again and setting us back months once again, a Zero Covid strategy would require restrictions to be kept in place and gradually lifted only as levels of Covid in the community are being reduced.
Modelling from September predicted that if we followed this strategy now we could have been down to 10 cases a day by December, or even 1 case a day if we regularly tested frontline workers. This could have meant effective elimination by January–a relatively short period of time, when it looks increasingly likely that we will see rolling lockdowns under the current strategy for the next 2-3 years. It is likely that this would now take a bit longer–the longer we allow the exponential rise of the second wave to continue, the longer the lockdown will have to be when it is finally implemented.
An Economic Circuit Breaker
There are a number of things that would need to happen to make this strategy viable. The first is to ensure that workers should be supported through this period with adequate financial supports. These efforts must include restored Pandemic Unemployment Payments and furlough schemes, extending them to everyone and not allowing certain groups to fall through the cracks as happened before. Moratoriums on rents, mortgages and evictions are also critical.
If a “circuit breaker” is required, it ought to be accompanied by an economic circuit breaker. Give people the appropriate financial means to put their own, and the public’s, health first.
Once this is in place, perhaps the most important requirement is the building of a permanent mass testing infrastructure and the reduction of test turnaround times to less than 24 hours. Testing in Ireland has been a debacle. The system was overwhelmed early on, with wait times of 7-14 days in the South and tens of thousands of tests being sent to Germany. The sensible thing to do would have been to invest in infrastructure when cases were at a low level, but it appears the Southern government actually dismantled some of its temporary infrastructure.
Some of this appears to be down to cost and an over-reliance on the private sector; an Oireachtas Special Committee report put the marginal cost for tests carried out in private labs at €140, while those carried out in public hospitals were around €90.
Similarly in the North, the testing system was completely unequipped to deal with the first wave of COVID-19, with Chief Medical Officer Michael McBride warning in March that thousands of cases were going undetected. Capacity has been increased, but nowhere near enough. The Public Health Agency states that wait times for test results are up to 72 hours–this simply is not fast enough for an effective test and trace system.
A public system that was set up for mass testing would reduce these costs considerably. This would mean that it would be possible to quickly trace contacts to stop further spread of the disease.
Other testing methods such as pooled testing could also be used in order to aggressively chase the virus. Pooled testing involves combining samples from multiple people in order to carry out one test on the entire group. If a positive result is found, it is not possible to know at this point who has contracted the virus. Then comes a second phase of testing to break the pool into smaller samples in order to identify the infected person or people.
Pooled testing is not a new method. It was used to test for syphilis and other STIs in U.S. soldiers during the Korean War and subsequent wars, for example. It has the advantage of being able to exclude large numbers of people from having to get an individual test. It would also help to discover asymptomatic people and prevent further spread of the disease. It is also far less time-consuming than getting a sample from an individual.
Invest in Health
In addition to an aggressive testing regime, we urgently need investment in our chronically underfunded health services–on both sides of the border. In the South, the private hospitals must be brought under public control, but this time without lining the pockets of the likes of Larry Goodman, Denis O’Brien, Bon Secours, and various multinational investors. Moreover, the extra capacity should be put to use to clear our waiting lists if it is not required to tackle COVID-19.
It is estimated that €115 million a month was paid to the private hospitals during the first wave of the virus, despite the fact the extra beds were largely unused because the public hospitals did not reach full capacity. We must insist that this unprecedented health emergency that has compounded the already existing health crisis is not something that anyone should profit from, and that all the stops must be pulled out to deal with it.
In addition, there is a dire shortage of staff. During the first wave of the virus, Varadkar’s government made a poor, neoliberal attempt to deal with this shortage by launching Be On Call For Ireland. People were urged to register for new positions in the HSE. The bulk of the 73,000 who applied did so as administrators, supporters or volunteers. However, of the 3,000 healthcare workers who applied, only 209 of them were hired. And even then, the bulk of these were hired on temporary contracts–to be discarded once again as soon as possible.
In the North, Tory cuts to the NHS have been devastating. In 2019, there was an 11.6% registered nurse vacancy in the North, equating to over 2,000 posts–one of the major reasons for the historic nurses strike in December last year. Disgracefully, despite the gargantuan efforts of healthcare workers over the past few months, Stormont has still to implement parts of the settlement owed to the strikers.
It is clear that the neoliberal model is totally unequipped for dealing with this kind of health crisis. Tory cuts in the North and FEMPI cuts in the South must be reversed and we must swiftly move towards an integrated 32-county NHS.
A third vital aspect of a successful Zero Covid strategy is the need to protect workers. Failure to take the measures that would protect meat plant workers seeded the second wave initially, yet factory workers continue to work in unsafe conditions.
The double standards throughout the duration of the pandemic have been stark. The Dáil was shut down completely while Minister for Health Stephen Donnelly waited for test results, yet teachers who have been in schools where cases have been found are not considered to be close contacts.
Heavy investment is required to ensure workplaces can be as safe as possible. Frequent unannounced inspections of workplaces is also necessary, along with sanctions on any workplace that puts workers at risk. Mandatory sick pay is no less essential; the current situation still forces many workers to choose between staying at home and being unable to pay the bills, or going to work and risking infecting their colleagues.
There can be no hope of implementing a Zero Covid strategy with schools operating in the way they are across the island. The preparation done in the 6 months where schools were closed has been totally inadequate. Instead of doing what is necessary, governments North and South have sought to play the right to education against the right of teachers and children to a safe environment and in doing so have also endangered the wider community.
Schools remain unsafe, and teachers seeking to take action to protect their safety at work should be unconditionally supported. There have already been cases in hundreds of schools–reported by parents and teachers despite underreporting in the media.
Schools will need to close for a period and this time used to make them safe for teachers and students alike. Massive investment is required to build extra classrooms, to install ventilation and to hire more teachers in order to reduce classroom sizes. Teachers and students must be supported during this period with increased resources for blended learning. If action is taken now, a phased reopening that could initially see students go to school for 2-3 days a week could be possible before Christmas.
This is no substitute for learning in the classroom, however. A Zero Covid strategy now is vital to ensure that schools can reopen and stay open safely in 2021.
If COVID-19 can be brought down to elimination levels, it will be necessary to ensure that it cannot be brought back into the country and spread again. At the present moment, a ban on all non-essential travel would seem necessary. Further down the line, it may be possible to allow more travel into the country–limited to the number of people that can be tested upon arrival.
For Ireland, implementing such measures will require genuine cooperation across the 32 counties. The Memorandum of Understanding signed by the Northern Executive and Varadkar’s government back in April amounted to nothing more than words on paper. Instead, partition was used as a political tool to present Fine Gael as doing “better” than the North and the rest of the UK. A disjointed response resulted in high numbers of cases in border counties during the first wave. Rather than playing political football with the border, we need an integrated test and trace system and a unified health service that serves everyone across the island.
Those who oppose a Zero Covid strategy claim it is not feasible from a scientific perspective, but this is not the case–it is rather a lack of political will. At this point, it is not only relatively isolated countries like New Zealand and Australia that have successfully managed to reduce COVID-19 to elimination levels. China, Taiwan, Thailand and Vietnam have all done the same, whether by preventing the spread in the first place or by successfully bringing Covid under control after the initial first wave.
As an island, Ireland could formulate a coherent, 32-county strategy that would bring COVID-19 to elimination levels. Rather than using other countries as a measuring stick with which to justify the current failings, we could become an example for the rest of Europe and lead the way in eliminating the disease.
However, both the Northern Executive and the Southern Government seem determined to continue with the “living with Covid” strategy. This will mean workers and their families will continue to be put at risk over a prolonged period of time, and they will not be protected unless they themselves take action.
They are also increasingly using partition as an ideological buffer to justify their inaction. It was reported in the wake of the NPHET recommendations that Mícheál Martin spoke to Boris Johnson, who urged him not to implement Level 5 restrictions as to do so would create a disparity with the North. Martin had no intention of implementing Level 5, of course, but for a while the border has functioned as a ready-made excuse not to act.
From a Left perspective, therefore, it is not enough merely to call for a Zero Covid strategy from the sidelines and hope the establishment will see the sense of it. With hospitalisations and deaths likely to increase significantly in the coming weeks, and not nearly enough being done to stop rising cases, we must organise now in defense of public health. We must urge people to take action if they feel unsafe–to join a union, organise their workplace and refuse to work if they are not protected.
The prospect of industrial action by the Association of Secondary Teachers, Ireland (ASTI) is therefore very significant. The establishment will attempt to demonise teachers and play them against health workers at the front lines. The counter to this is that Ireland has one of the highest rates of COVID-19 among healthcare workers in the world. They only matter to the establishment insofar as they can be used as a stick to beat teachers with. But if teachers can organise to protect their safety at work, they will also be helping to protect the community at large, by preventing further spread of COVID-19.
As this crisis continues, it is crucial that the Left can argue for a way out. The far-right’s calls for throwing caution to the wind is an argument for mass death. The current strategy will fatigue people and cause increasing desperation. Only a Zero Covid strategy provides light at the end of the tunnel–we have to fight for it.