There are no easy solutions or answers. So said Doctor Michael McBride, Northern Ireland’s Chief Medical Officer, when announcing the return to lockdown. There were hard and difficult choices, all with bad outcomes, but what was good for health was also good for the economy, poverty does kill people.
Just before this the Health Minister, Robin Swann, announced that the new restrictions were required in order to protect the NHS. We could not turn away Covid patients he said – ‘who would suggest such a thing’ – suggesting instead that other patients be turned away, without being so dramatic is saying so of course. McBride said that we needed to ‘help protect the non-Covid health service’, not long after one hundred planned operations in the Belfast Trust had been cancelled.
The announcement involved a presentation that included graphs of new cases, number of tests and numbers of hospital in-patients, but no graph on the number of deaths. The Northern Ireland Statistics Research Agency latest weekly report recorded that in the week ending 9 October the total number of deaths in Northern Ireland was 348, of which 89 were due to respiratory causes. The number of deaths where COVID-19 was mentioned on the death certificate, whether or not COVID-19 was the primary underlying cause of death, was reported as 11, which was just over 3 % of all deaths during the period.
To those who thought Covid was exaggerated Doctor McBride said that they needed to ‘wake up’ to the number of cases, number of in-patients and number of deaths.
Two questions were then asked repeatedly by the journalists invited to speak at the presentation. What was the evidence that the new measures were required and what happens if it doesn’t work?
The question on evidence wasn’t answered; one journalist was referred to the minutes of the UK experts group SAGE and to unspecified peer reviewed articles. No one asked whether the members of the Executive were limited to this, or were offered this as an answer if they had asked the question. ‘It worked before’ was one further response to the question.
To the second question – what happens if it doesn’t work? – the answer was that the public must follow the guidelines, so implicitly it’s your fault if it doesn’t. Only near the end of the press conference did the Chief Scientific Advisor Ian Young state that people’s behaviour would have to change after the end of lockdown. Elsewhere it was reported in one newspaper that the document informing the decision on a new lockdown had stated that further interventions will be required “early in 2021 at the latest.”
It would also seem that relaxation of restrictions at Christmas with the “likelihood of increased population mixing” in the run up to it is a significant consideration. (No, I don’t understand the rationale behind this either.)
The document apparently reports concern that Covid hospital admissions will rise to 450 to 600 at the peak; while the average number of NHS Acute services beds available in Northern Ireland was reported as 3,891 for 2019/20 and 3,882 in the previous year. The average number of occupied beds was identical in both years at 3,239. The forecast peak of Covid-19 patients of 600 would therefore occupy a forecasted maximum of 18.5% of the average number of occupied beds at the peak or 15.4% of available beds, before any plans for temporary expansion.
This includes all Acute beds and it would appear that the document has the aim of having a total of no more than 20% of general medical beds, around 320, being occupied by Covid patients. Of course, it is more complicated than this and lots of uncertainty surrounds the ability to create additional capacity, and especially how much will actually be needed. There is no explanation reported on the inconsistency between a target of 320 beds and expectation of up to 600 being required.
Given the lack of transparency, avoidance of answering questions, finger-pointing and general arrogant condescension of the Health Minister and experts it is no surprise they didn’t provide the level of information provided in a short newspaper article. Non-sequiturs, plain contradiction and pontification are regarded as the currency that is required to get the population to do as it’s told. And the population in the main accepts the argument, such as it is, and gets on with generally keeping to the rules except when it doesn’t suit them.
The latest Department of Health figures for 16 October show 3,711 beds available, 180 less than the average last year, with 211 taken up by Covid patients and 615 unoccupied. The figures also show that of 104 ICU beds available 26 are taken up by Covid patients with 21 unoccupied. No doubt the number of beds occupied will increase as it always does in the winter with the onset of influenza infections.
The effect of winter pressures is already being felt in Care Homes with 301 respiratory outbreaks being reported and 72 being classified as Covid related, with a further 10 suspected to be Covid. Around three quarters of ICU and Care home outbreaks are therefore not Covid related. The increased pressure on beds will also most likely reflect the same pattern. If the NHS is overwhelmed by Covid it will not be because Covid in itself is overwhelming.
The figures for the growth of Covid outbreaks in Care Homes is a cause for concern while ‘protect the NHS’ may again be interpreted as a need to get elderly patients out of hospital and into Care homes in order to free up beds – regardless of testing beforehand. It was remarkable that in the press conference the appalling death toll in Care Homes was not referenced or any pledge made to protect their residents.
If the Health Minister and his experts therefore have an argument justifying their approach, it is not that Coivid-19 is an especially lethal threat but that the health service cannot cope with the additional work. So the focus becomes one of reducing the work on non-Covid patients by creating Nightingale Hospitals that use existing facilities and existing staff and involve relatively little activity, while the capacity of the rest of the Service is massively reduced. The overall efficiency of the NHS therefore plummets just when it needs to increase. And this is called ‘success’, and we are all asked to applaud it.
Rather than address this issue as the primary problem, which might raise the question how we got into this position, we have instead the enormous task of shutting the rest of society down (in so far as this is possible). While those most vulnerable are, or can be, identified the message is given that everyone is more or less threatened, when this is not the case. And because it’s not the case the population more and more ignores the rules when it suits, which allows the politicians and bureaucrats to sermonise and talk nonsense, such as the head of the British Medical Association in Northern Ireland telling us that “success leads to complacency, complacency leads to failure.” You might think that if a successful strategy leads to failure you’ve got the wrong strategy.
The approach of the politicians and health service bureaucracy has the comfortable effect (for them) of making the population the problem, requiring that it accept the shutting down of much of its normal everyday activity. Much of the services provided by the NHS is also cut because the NHS is already, how shall we put it, not up to the job. The politicians and bureaucracy responsible for this situation then demand of the population that it support and approve of this, garnering its sympathy because many of the staff who work in the NHS are now exhausted.
Which, brings us once again to the question of what is the right strategy. While the North once gain goes into a level of lockdown the Southern Government is discussing going to Level 5, the most severe level of restrictions in its five-level menu. The prospect now looms of repeated expensive lockdowns that lead only to a higher number of cases when they end.
In ‘The Irish Times’ someone took out a full-page advertisement opposing the current approach and supporting the Barrington Declaration. This has led to objections and claims by some that they will no longer buy the paper. The facts quoted in the advert are nevertheless true: that current life expectancy in Ireland is 81.5, the median age of death from Covid-19 is 83, a total of 20 people under 44 have died from Covid-19, and the record of Covid-19 deaths is one that includes those who died with Covid and not from it.
Controversy around the declaration has involved arguments that have little to do with what the Declaration says or what its argument is, but concentrate on the dubious political character of some of its supporters, its supposed nefarious objective of mass murder and criticism of what it does not say, as opposed to what it does. A number of letters to ‘The Irish Times’ illustrate this.
It is claimed that the facts quoted are intended to mean that the deaths of older people are of less significance, although the point of the declaration is to make protection of the vulnerable the priority, while it has been the current strategy adopted that has demonstratively failed in this regard.
This fact is also construed to imply that these older people lived longer than they should have expected. In any case it is life-expectancy at 83 that matters, not at birth, which is six years for men and eight for women. But the first claim is without support from what the advertisement says and the second fact, while absolutely true, would require more information to demonstrate that at age 83 Covid-19 reduces the remaining life span of six or eight years from everyone who dies from it.
Another line of criticism is that sheltering will not work when there is widespread community transmission. But we have widespread community transmission now after lockdown and there is no reason why measures that are supposed to socially isolate everyone cannot be strengthened for those most at risk. From some on the left especially, the argument is simultaneously put that lockdowns should be more restrictive and would not work for a targeted minority.
The new lockdown in the North is an admission that the previous one failed. That there is the expectation of another one of some sort later is further evidence. That the population is treated as too ignorant to discuss these issues is a repeat on a massive scale of ‘trust me I’m a doctor.’ The modern notion of an ‘expert patient’ is gone.
If the failure of the current policy is unrecognised it is hard to have any confidence that the costs of the lockdown in future deaths will be acknowledged and accounted for. The only thing that will save the current policy from ignominy is if its central claim is untrue – that we face a massive death toll if some sort of society-wide lockdown is not the major plank of State policy.