A year of Covid-19 (2) – following doctor’s orders

The view that there is a single scientific approach to the Covid-19 pandemic has had a number of consequences.

Firstly, it became simply a scientific question; at most politicians had some discretion to accept or reject the extent of the measures proposed by the scientists and doctors, but no wider political questions were involved despite the dramatic effect on people’s everyday lives, their employment and their freedoms.  Any regard to these was argued to be putting ‘the economy’ before lives and particularly denounced by some on the Left.  The Government could pay for any of the economic consequences and let the science-led effort to control the virus take effect.  Anything else was letting politics interfere and was by definition unjustified.

Secondly, because there was a single science, whatever scientific approach was adopted was the right one, again with only a difference of degree acceptable, so that whoever was appointed the scientific leadership was by definition the single scientific authority.  Others could comment, but as we saw in the links in the last post, the scientists themselves were under pressure to accept that there was a single scientific approach, resulting in censorship and self-censorship of critical views.

One example of this was the criticism of the voluntary approach adopted by Sweden, pointing at certain times to its relatively high death toll, while failing to highlight that this had resulted from the failure to protect the elderly in care homes.  Yet exactly this same failure was held up to excuse the record of the Irish state, which pointed to the failure of other countries to protect its elderly population as some sort of exoneration.  In April the Health Service Executive national clinical advisor was pointing to the failure in Ireland not being unique and that many countries were struggling with outbreaks of infection in homes.

At this stage between 45 and 60 per cent of all Covid-related deaths in the UK, Belgium, France, Spain and Italy had been of residents of nursing homes.  Yet rather than this being a series of warnings, of wake-up calls that something was wrong with the prevailing approach, it was accepted.  The chief medical officer Tony Holohan later stating that it was “not realistic to think we could keep it out of homes”.

In 2017 the Irish State had adopted a management plan to deal with emergencies, which it then ignored when the pandemic threatened.  Instead, it made the top leadership of the Health Service Executive the scientific leadership, which almost immediately appeared to have so much authority devolved to it that it also appeared to have almost total control.

This in itself was pretty extraordinary since the HSE (and the Health Service in the North) was widely regarded as being something of a disaster, while the bureaucrats with medical qualifications that had presided over the failing health systems, along with the various governments, were for that reason considered responsible.

In the North, the extent of the failure was brought home when it was reported that Poles living there travelled home for treatment rather than wait years on a waiting list; and that one GP had disclosed that some of his patients who had fled the war in Syria were in ‘disbelief’ at the state of the North’s health system.  The same one sometimes held up as a model for the two-tier service in the South.

Such was the moral panic induced, the responsibility for the ability of the health services to do its job, to protect the health of the population, instead became the responsibility of the population to ‘protect the health service’.  In this, the situation in Ireland North and South was the same as in Britain, the architects and executive of the failing system made their failure the responsibility of the people they had failed.

Since the health services could not protect the people and had already failed, it was clear from the start that the people would fail to protect the health service. Simple and routine daily activity became the occasion for berating the public that they were letting the health service down, or as the Health Minister in the North put it, was equivalent of going into a hospital and ‘slapping a nurse.’

The blinkered approach that considered there was a single scientific approach, and the domination of this approach by a medical bureaucracy, meant that wider considerations were ignored.  It became a situation I have described before as one in which those with only a hammer perceive every problem as a nail. This was obvious when the strategy adopted became subject to the inadequate resources of the acute health systems North and South.

It is important to recognise the domination of health services by the acute sector, the hospitals, which always downgraded social and community services and public health; the price of which in the pandemic has been paid in lost lives.  It is not as if the problems with this have never been acknowledged.  In the North the necessity of greater emphasis on community services has been repeated in reports as often as it has been disregarded following their publication.  Public Health has always been the Cinderella service, although at least she got to go to the ball; in the health service she would have got to go to the laundry in the outhouse.

The National Public Health Emergency Team (NPHET) married the erroneous view that there was a single scientific approach with the acute services bias common to many health systems.  This common bias helps explain the similar failed approach adopted by so many countries that ironically justified each other’s failure by their own.  Yet the nature of the threat has been obvious from the start.

In the last week of December, it was reported that a majority of the 2,150 deaths in the Irish State were accounted for in nursing homes and that in this, and in infections among hospital staff, it was among the worst in the world.  In the North it was reported that 39.2 per cent of all Covid-19 related deaths in 2020 were of care home residents in hospital.  In effect, the gathering of the vulnerable in enclosed locations became not protection but helpless confinement, and the mechanism to provide treatment the instrument of infection.

The common approach of generalised lockdown was justified by the need to protect an inadequately resourced health service that precluded targeted protection of the vulnerable in homes and outside.  Yet it is admitted in NPHET minutes reported over a week ago that “the majority of the excess hospitalisations, intensive care admissions and deaths would be amongst those aged 60 – 79 Years”.  The policy of precisely targeted measures and resources to protect these people was rejected on the grounds that this would lead to unsupportable demands on the heath service.  Was it not taken into consideration that targeted protection would act to reduce potential demands on the health service?

Despite all this, the authority of the medical leadership has withstood the outcome of the failed approach adopted, in Ireland and in other countries.  Instead, the measure of success is not avoiding failure, but failing better.  That is, not being so bad that the country comes out looking worse than others.  The performance of the Boris Johnson government has therefore been a bit of a get out of jail free card, and the Irish is not the only political leadership on these islands that has relied on nationalism for political protection, not excepting the Johnson government itself.

Forward to part 3

Back to part 1

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