Cassandra Voices

Tag: NPHET

  • Covid-19: ‘The North Began’ Part II

    Northern Ireland has already conducted a statutory inquiry into how Covid was managed. In contrast, the Republic is set to have a ‘review’ without statutory powers to compel witnesses to attend. This despite the Republic having had both a relatively high fatality rate and punitive restrictions that don’t appear to have worked. Maybe there is something to be learned from the Orangemen?

    In a seminal 1913 article entitled ‘The North Began’, the renowned scholar Eoin MacNeill opined that the rest of the island of Ireland could learn from the approach then adopted by Ulster Unionists in setting up the Ulster Volunteer Force. Ultimately, this led to the creation of the Irish Volunteers, ostensibly to protect Home Rule, then supposedly imminent, but which also contributed to the emergence of the Irish Republican Army after the Easter Rising of 1916.

    MacNeill’s argument comes to mind with the recent announcement of a limited ‘Review’ into how Covid-19 was managed in the Southern Irish state – and also regarding how the experience of life during Covid differed from the North, especially for Dubliners, who were significantly disadvantaged.

    Who can forget – amid frenzied reports of hospitals being overrun in Italy and China by a new infection – this state going into lockdown as a ‘temporary’ precaution? A mantra quickly adopted was to ‘flatten the curve’ referring to the Rate of Infection, with every citizen encouraged to adhere to ‘social distancing’ rules until the health system was ready to absorb the expected surge.

    Having cut ICU beds after the Crash, the twenty-six county state was poorly placed by comparison with most of its E.U. counterparts to deal with expected surges.

    The Irish ‘Plan’

    Yet, for once, the Irish state did have a properly planned response (‘Ireland’s National Action Plan in response to COVID-19 (Coronavirus) Update 16th March 2020’) – having previously modelled responses to pandemic scenarios. Essentially, it was envisaged that third level institutes would be closed – as occurred – with field hospitals opened in these large, idle facilities. It was, on paper at least, a great plan.

    With any ‘Irish Plan’, there were two distinct pathways to follow. The first involved attempting to follow the ‘Zero Covid’ approach adopted by New Zealand, which sought to keep Covid off their islands altogether by requiring international passengers to remains for a specified period in quarantine facilities prior to any stay in the country. Then there was the so-called ‘Swedish Model’, which emphasized protection of the vulnerable, while minimising restrictions on personal liberties.

    Neither of those models were pursued in Ireland. Instead, we developed a strange hybrid with an emphasis on ‘a top-down, command-and-control approach.’

    Once an estimated 10,000 Irish racegoers took a round trip to the UK to witness J.P. McManus’s horse run in the Cheltenham Races whatever slim chance the ‘Zero’ option had of success evaporated. Incidentally, this large migration occurred with the approval of the Chief Medical Officer, Tony Holohan, who also ordered care homes to re-open in March, 2020.

    Instructively the Irish plan was based on an assumption that ‘6% of people may become more seriously infected and will require hospital care.’

    It is now clear that this figure was much exaggerated, based on flawed Chinese data, and generated undue fear. Moreover, early statistics on Covid hospital admissions seem to have included patients who tested positive for the virus, but were admitted for something else, as well as those who caught the virus while in hospital being treated for another condition.

    Many of those hospitalised ‘with Covid’ may have been asymptomatic, due to the sensitivity of the PCR test. As an important article in the New York Times from August 2020 put it: ‘Your Coronavirus Test Is Positive. Maybe It Shouldn’t Be.’

    Sweden

    In these circumstances, the Swedish Model was harshly criticized as uncaring, and it was said that the disease would spread like wildfire. Yet, in hindsight, it seems to have been the lesser of evils.

    Alas, there is still no consensus as to the cumulative total of fatalities that occurred in the different European states. Nonetheless, even sources that seem less favourable to the Swedish approach, such as the ‘Worldometer’ table on Wikipedia, rate their death toll as lower than Ireland’s per capita, despite a significantly older population. There were 1,860 Reported Deaths per million happening there, as opposed to the 1,980 here. (Original source: https://www.worldometers.info/ coronavirus/?utm_campaign= homeAdvegas1. See Wikipedia table, ‘Statistics by country and territory’: https://en.wikipedia.org/wiki/ COVID-19_pandemic_in_Europe).

    Another metric provided by the Organisation for Economic Co-operation and Development, ranks the Scandinavian nation lowest for overall cumulative excess deaths among a number of countries studied from 2020-22, at 6.8 per cent. By comparison Australia had 18 per cent, the U.K. 24.5 per cent, and the U.S.A. a rate of 54.1 per cent.

    In retrospect, it is plausible that the ‘Irish Plan’ might have co-existed with either the Zero or Swedish approaches. Based on what was known at the time, it may have been worth trying a Zero approach initially. It probably would not have worked – not just because of a porous border with the North or membership of the European Union – but also because it seems that Covid-19 was already circulating in Europe as early as March, 2019.

    Normalisation of House-Arrest

    Intelligent leadership adapts to changing circumstance, and so, with the likely failure of the Zero-Covid approach, the Swedish model could – and should – have been adopted by the autumn of 2020. Had the Irish authorities adhered to their own plan, by that time, the universities would have been functioning as field hospitals. Yet that’s not what happened.

    Instead, ‘temporary’ lockdowns, introduced in March 2020, were gradually normalised into a weird form of house arrest. Rather than lasting a few weeks, these ‘temporary’ measures would dominate our lives for almost two years. It was an unprecedented, draconian suppression of civil liberties, which became more tyrannical and absurd as time passed by.

    The ‘new normal’ was to live within two kilometres of home, later extended to some five kilometres. All social activities were banned, bar a clap in one’s garden to thank ‘front-line’ staff. Meanwhile, Irish care homes – where air is often stuffy and poor quality – were left to fester with full occupancy, as sick elderly patients were released from hospitals. Consequently, the level of mortality that occurred in these institutions was second only to that of Canada during the first wave.

    That the Taoiseach at the time of outbreak, Leo Varadkar, had previously been a medical doctor, was an initial source of hope that we would be guided by competent leadership.

    Empty hospitals, however, such as Baggot Street and St. Bricin’s in Dublin, continued to lie idle. Elected representatives, including Varadkar, effectively devolved leadership to NPHET (the National Public Health Emergency Team for Covid-19). which was composed almost entirely of career civil servants – arguably with little ‘skin in the game’ if businesses were shut down – but whose pronouncements came to be treated with the same reverence as was once accorded to the Catholic hierarchy. Throughout that period their evaluations decided our destinies in ways that often seemed ridiculous.

    Image: Daniele Idini

    Science becomes religion

    Holohan’s decision to appoint Professor Philip Nolan – ‘The pair had known each other for years’ – to oversee disease modelling ought to have prompted concern. Nolan was then President of Maynooth University, his ‘research was in physiology – specifically the control of breathing and the cardiovascular system during sleep.’

    With limited apparent research background or expertise in infectious diseases, Nolan’s wayward models – and bizarre commentary on antigen testing – informed Irish government decisions throughout the pandemic.

    According to the authors of Pandemonium: Power, Politics and Ireland’s Pandemic (2022), ‘almost everyone who attended NPHET meetings agreed on one thing above all others: this was a Tony Holohan production.’ An unnamed source in that publication described his style as ‘very dictatorial and autocratic,’ and ‘intolerant of alternative views.’

    Science became the new religion. Yet the measures often seemed scientifically questionable. Thus, in line with WHO guidance a positive PCR test within twenty-eight days of someone dying was listed as a Covid fatality – even if that poor individual had died in a car crash!

    Meanwhile, ‘stay safe’ became ‘stay sane’ for many of us who watched scarce resources dwindle, as the normal conduct of business was prevented. Sadly, little adaption to challenging circumstance occurred in line with ‘the science’.

    Who can forget the moral panic that ensued in the summer of 2020? Thus, tabloid photographers cunningly used long range lenses to foreshorten the view of people at beaches. Despite people sitting apart, it looked as if they were on top of one another. Subsequently, in January 2021 it emerged that not one case of transmission could be traced to the beach ‘outrages’ when assessed by the U.K. authorities.

    ‘The Republic guarantees religious and civil liberty’?

    The Irish state was set-up a century ago to prevent the coercion of Irish citizens. Notably, the fourth paragraph of the 1916 Proclamation asserts:

    The Irish Republic is entitled to, and hereby claims, the allegiance of every Irishman and Irishwoman. The Republic guarantees religious and civil liberty, equal rights and equal opportunities to all its citizens, and declares its resolve to pursue the happiness and prosperity of the whole nation and of all its parts, cherishing all of the children of the nation equally, and oblivious of the differences carefully fostered by an alien Government, which have divided a minority from the majority in the past.

    Ergo the social contract on which this Republic is based ought to protect personal freedoms, within bounds. Yet, instead we had unprecedented and clearly disproportionate restrictions imposed on us by our own government. It seems that being ‘the best in the class’ mattered most of all to Irish politicians in terms of accepting dictates from European masters.

    EU leadership?

    Meanwhile, disastrously, leadership at the European level was sorely lacking: Rather than providing positive guidance to adapt to the reality that Covid was effectively endemic by the winter of 2020, the European Union supported lockdowns, a milder model of that first trialled in that great bastion of liberal democracy: the People’s Republic of China.

    Hence the Germans banned outdoor markets – even though outdoor trade should have been encouraged. Meanwhile, only at the last minute did the Austrian government abandon the idea of forcing injections on recalcitrant civilians. Thus, it seems logical that there should be a proper inquiry into how Covid was handled at the E.U. level, as well as in each member state.

    The unwillingness of the President of the European Commission Ursula von der Leyen to release communications with vaccine manufacturers, including text messages with Pfizer boss Albert Bourla, also raises serious questions regarding transparency.

    In Ireland, the utter incompetence of Boris Johnson in the U.K. provided lasting cover. He was memorably, if somewhat bizarrely, compared to a rogue shopping trolley creating chaos about the place.

    A regular refrain on Irish media, and in private conversations, was that ‘at least we’re not as bad as the Brits’. Thus, instead of finding ways to enable the maximum amount of people to live their lives as normally as possible, officialdom largely adopted a ‘no can do’ approach. At times, it almost seemed as if the state broadcaster was intent on terrorising the population into submission.

    Irish Constitution

    In such a challenging period, thoughts of God might may have come to mind. In line with the sentiments expressed in the 1916 Proclamation, Article 44 of the Irish Constitution of 1937 protects practice of faith from obstruction.

    Unlike care homes, churches and temples are typically tall spacious venues with plenty of fresh air. There was little scientific basis for banning people from attending such places, provided certain measures were adopted – including ensuring adequate ventilation, personal space, and adapting rituals pertaining to communion and hand shaking.

    In my view, the state was obliged to vindicate these rights. After all, what is the point of a constitutional right if serious efforts are not made to adhere to it in challenging circumstances?

    Instead, essential freedoms were extinguished at the stroke of a pen. Thus, by early 2021, twelve months into the pandemic, what were effectively inmates of the twenty-six counties were being subjected to the most stringent restrictions on personal freedoms in Europe.

    Lockdown gains?

    It may be recalled that during Covid, there was talk about ‘building back better’; that society would become more compassionate; that we would have a notably better health system afterwards Today, little of that seems evident.

    Indeed, under questioning in September 2020 from Michael McNamara TD in the Dáil, Taoiseach Micheál Martin revealed that just twenty-three ICU beds had been added since the start of the pandemic.

    The impact of shutting down the construction trade for long periods should also not be overlooked. Homeless figures are now at an all-time high – amid huge levels of emigration, much of this in response to the state’s desultory attitude towards housing. All of this despite Ireland being the least densely populated state in the E.U., and supposedly among the richest.

    Nonetheless, in both Cork city and Dún Laoghaire, earnest efforts were made during Covid to adapt and advance neighbourhoods by way of enhancing their public domains – thus facilitating local trade and improving amenities.

    What then was the experience of Dublin City? As the main place of work for the country’s civil servants, the city centre was all the more quiet for their absence. While the country was undergoing the most severe of lockdowns in Europe, Dubliners were, to all intents and purposes, singled out for the most repressive regime of all.

    Along with ‘front-line workers’, anyone involved in agriculture or food production during Covid was effectively exempt from restrictions on movement. Hence, it was the urban populations who were particularly hampered in the course of their normal lives – while many of their rural counterparts experienced much less difference, apart, obviously, from children being kept at home from school.

    Despite it being well-established by 2021 that it was safe for people to socialise outside, March that year saw ordinary decent Dubliners being harassed by police for drinking outside in parks by the River Dodder – instead of gathering inside, where infection would more likely occur.

    A few stretches of cycleways were added along Werburgh and Nassau Streets – with unsightly plastic bollards inserted there and elsewhere. Public toilets were provided in an ugly kiosk outside the Stephen’s Green Shopping Centre – despite purpose-built public toilets being sited only sixty metres away inside Stephen’s Green, that the Office of Public Works keeps locked-up.

    The only serious civic gain during that time was the pedestrianisation of Capel Street, and a small amount of pedestrian pavement being widened elsewhere.

    Decline of Dublin

    Otherwise, Dublin’s city centre clearly stagnated. A small vignette: throughout the entirety of Dublin 1, there is only one public glass recycling bank sited at Shamrock Street in Ballybough. That is obviously disastrous in terms of under-provision for such a densely populated area.

    Coincidentally, every year, the Irish Times reports on the IBAL Litter Survey which repeatedly finds Dublin’s north inner city to be the worst in the state. Yet, during the ‘Covid Years’, City Council management actually moved to close down this one glass recycling facility! Fortunately it was saved in September 2022 – but only after intervention by councillors, (Alas, no reports in the Irish Times about any of that.)

    Meanwhile, cops on the beat became far less visible around the inner city. There were regular reports of gang fights occurring around the quays as a thuggish culture festered, culminating in the notorious Dublin Riots of October 2023.

    A lasting perception of inadequate personal safety has eroded public confidence, which has resulted in people avoiding town – further undermining the commercial viability of many of the businesses based therein.

    Thus, the city centre is clearly now in crisis; once bedrock establishments of the city’s premier core around Stephen’s Green, such as Shanahan’s on the Green and Café en Seine, have either closed down or have seen profits halved.

    The commissioning of a report last year by the government regarding O’Connell Street – while doing little else obvious otherwise – does not inspire confidence.

    The prospect of an accountable elected City Mayor with powers has long been held out by central government as a logical solution for the city’s management. Yet just like the airport railway that has been repeatedly promised since the early 1970s, I’ll believe it when I see it.

    Failure to adapt

    Ultimately, the initial response by responsible citizens to adhere to extraordinary state rules in a time of crisis was abused beyond belief. On this, the neoliberal economist Milton Friedman was proven right: nothing becomes so permanent as a ‘temporary’ government programme.

    Any hopes of the state responding to Covid in a progressive manner gradually evaporated. Official guidance regarding mandatory facemasks was never properly updated – despite clear evidence that the effectiveness of basic blue ‘surgical’ masks was minimal, at best. Had people been made aware of the efficacy of different mask types – albeit a secondary consideration to good ventilation – it would have enabled citizens to better manage their risk exposure.

    Meanwhile, the arrival of low-cost, antigen Covid tests for home use offered an obvious way forward. People would have a quick way of identifying whether they would pass on the virus – and could act accordingly. Remarkably, however, NPHET’s Philip Nolan pronounced on Twitter that these were being offered by ‘snake-oil salesmen’!

    Fortunately, outside eyes were watching. Harvard epidemiologist, Professor Michael Mina, brought some sense to proceedings by tweeting back at Nolan ‘For an advisor to your government – you don’t appear to know what you are talking about’, adding, ‘The comment adds nothing of benefit and further sows confusion. You should be ashamed of your demeanour here.’

    Regime Media

    So much media space was bought by the state by way of advertisements, it was Herculean. Unsurprisingly, counter-arguments were not encouraged, as few outlets were prepared to question the official line.

    In hindsight, it is remarkable to consider the emphasis placed on encouraging individuals to take – and indeed coercing them into taking through passports – vaccines. The miraculous benefits of Pfizer, Moderna, and Astra-Zenica were all widely publicized at the time. Yet, the vaccine trials were not actually set up to prove they would either prevent transmission or serious illness.

    When Astra Zenica was taken off the market entirely early last year, arising from ‘rare but serious’ side-effects, media coverage was muted. Meanwhile, the Johnson and Johnson vaccine has also been withdrawn from the market in the United States – but yet again, there seems to have been little reportage here on the magic shot being discontinued.

    So, where were the brave journalists questioning what was happening at the time, or now for that matter? Aside from photos of naughty social occasions that leaked onto the internet, commercial media organs essentially competed with one other to be the first to publicize official edicts. There is little reason to suspect any difference in future. Other than a few honourable exceptions, it seems what we have in this country is a propaganda apparatus, as opposed to a free media.

    The pronouncements of NPHET were all that mattered. Nine euros was sanctioned as the minimal spend when eating out – presumably because Covid was waiting for an eight euro offer?

    All the time, people delayed necessary health checks and procedures – initially ‘to flatten the curve’ – and so critical conditions may have gone untreated. Others put on weight through inactivity.

    There was also the undoubted impact on many people’s mental health, as after a few months, the grim reality of forced isolation, without-end-in-sight, pushed many towards the edge. At least in part, such factors may explain Ireland’s highly elevated mortality in the wake of Covid. All this underlines the need for a robust inquiry into the state’s management of that period.

    Any Accountability?

    It seems to me that the cumulative effects of Ireland’s Covid response surely did more harm than good. Now, if this state is to do its job properly in future – if we are to learn anything from that dystopian time – it is essential to conduct a transparent and rigorous assessment of the response.

    The effects of that period were pronounced and are, to some extent, ongoing. For example, it is notable that the number of recipients of sick benefit in England and Wales has increased by 38% since Covid. How does that tally with the experience here? Lacking powers to compel witnesses and documents, how can the state’s Covid ‘Review’ properly assess impacts of its response during that time?

    I fear nothing will be learned from this Review, as it lacks the necessary powers. Yet where are the elected representatives who should be demanding the proper statutory inquiry that is necessary?

    Without such a process, if we ever encounter a similar challenge, it is worrying that the state’s agents – ‘the permanent government’ of civil servants – may fail to have due regard to fundamental constitutional rights.

    Game On (for some)

    Memorably, with restrictions on sports, almost all facilities were shut down – despite most activities being held outdoor. Notably, golf and hill-walking were prohibited – even though these presented the least threat of exposure to an airborne virus.

    As time went on, some allowances were made for certain sporting bodies – such as the GAA. Again, Dublin benefited least, as that body’s membership is disproportionately rural.

    By year two, the emergence of a two-tier state seemed fairly clear, with the GAA allowed to have over 40,000 spectators from Mayo and Tyrone attend the All-Ireland Football final in Croke Park on September 11, 2021 – at a time when many businesses in that part of Dublin were closed down.

    The decision-making process that allowed the match to take place was notable, as the ‘new’ freedoms were only announced retrospectively – with a press statement issued on September 9th stating: ‘From 6 September, indoor events can take place with 60% of the venue’s maximum capacity, provided all the people attending are fully vaccinated or have recovered from COVID-19 in the past 6 months’. Did the GAA know something that the rest of us didn’t when arranging the fixture?

    Party On

    Only later did it emerge that as early as June 2020, the Department of Foreign Affairs on Stephen’s Green were hosting soirées in spite of the rules – well before Boris’s notorious Christmas Downing Street parties later that same year.

    Meanwhile, a retirement gathering in RTE featuring some of the best known presenters on the station, was found to have involved five breaches in relation to Covid 19 advice, protocols and regulations.

    Memorably, an apparent sense of entitlement also extended to then E.U. Commissioner Phil Hogan, who was forced to resign in August 2020 after being caught breaking the rules by playing golf and having supper afterwards. And with that, went the best opportunity Ireland had to influence E.U. affairs at its most senior level.

    Even a year later, little seemed to have been learned, when it emerged that the former Minister for Children, Katherine Zappone, had held a party on July 21 for around fifty attendees in the garden of the Merrion Hotel. But that was all happily resolved when the Government Press Office released a statement a fortnight later stating that the Attorney General was of the view that it was permissible for outdoor gatherings of up to 200 people.

    How can such carry-on occur in a proper democracy? It seems that rules could be retrospectively interpreted differently if required.

    Justice for the Plebs

    Yet the leniency shown to ‘the few’ sharply contrasts with the dogged pursuit of ‘the many’. For the outrageous crime of spreading the Lord’s Word, in December 2022 three Evangelical Christian street preachers were prosecuted for holding an outdoor event beyond five kilometres of their homes the previous year. Consequently, those three men each now have criminal records – having never had them before.

    As of August 2023, it was reported that there had been a staggering 13,000 prosecutions under the Health Acts against Covid offenders – and yet even today, this madness has seemingly not stopped!

    Only this week, in February 2025, the trial date has been set in April for the prosecution of the so-called ‘Dubai Two’ who allegedly broke quarantine rules during that period. Thus. two young mothers face the prospect of a month in jail and a €2,000 fine.

    Where is the Republic that ‘guarantees religious and civil liberty, equal rights and equal opportunities to all its citizens’ as per the 1916 Proclamation?

    Vaccine vs Liberty?

    Based on that experience, it is impossible to ever again trust the state to ‘suspend’ civil liberties. What reward was there for compliance?

    Let’s not forget that only the day before the 2021 GAA football final, it was reported that 90% of Irish adults were fully vaccinated. Yet, a mere four days later, Holohan was out again warning that further lockdowns were on the agenda – as indeed occurred, with restrictions only ending fully in February 2022.

    So then, if the vaccines were so effective, why then were we again subjected to lockdowns after much of the population had been vaccinated? Either the vaccines worked, and subsequent lockdowns should not have occurred – or else the vaccines were not so effective, and the emphasis put on mass inoculation was incorrect. This argument needs to be addressed.

    Even with the high rates of vaccination and diminished threat, as late as January 2022, members of NPHET were contemplating force injecting the small minority outstanding.

    All of this points to the need for public confidence to be restored – by way of a robust evaluation as to how matters were managed. It is now five years since Covid began, and three since it ended; people’s memories will be getting hazy.

    RTÉ: Rewarding Failure?

    And what of the media apparatus that helped ensure compliance in the population? The year after Covid ended, the wheels came off the wagon of RTÉ, when it emerged that there had been serious problems with the finances and management at the state-owned company.

    Memorably the then Director General Dee Forbes resigned in June, 2023. Around the same time, Ryan Tubridy’s ‘secret’ payments subsequently came to light.

    Problems in that organisation were evident for some time, as was previously raised in this publication, well before it exploded onto the national consciousness.

    Nonetheless, it appears that the Covid period provided cover for questionable practices, both within that organisation and in other state agencies.

    But this was small beer compared to the €725 million fixed upon the Exchequer only last year by the government to ensure RTÉ’s continued operation until 2028. That cash could be used to build up to 1,500 houses, potentially reducing the state’s homeless population by almost a third. Instead, it is being shovelled into an economic albatross that loyally served the government, when the people required rigorous journalism.

    How can we expect accountability at the state broadcaster when cash is shoveled in so easily?

    So then, whatever happened to the assertion in the 1916 Proclamation about ‘cherishing all of the children of the nation equally’?

    Looking North

    Thus, it is interesting to look North, as they took a somewhat different approach. It’s a different jurisdiction, but with a broadly similar social make-up.

    In the main, similar restrictions were adopted, with schools and pubs closed for much of the period. It was far from perfect in terms of coping with the crisis, with criticisms at the time, and since, as stated in evidence. Restrictions on social assemblies were clearly detested in some quarters, most memorably by a vocal Van Morrison.

    Yet, over time, a different approach gradually emerged. For example, in the first year, as occurred with crowd events in the south, the Orangemen called off their summer marches to prevent contagion. This was a sensible approach, given the knowledge at that time – and arguably more notable given that body has not always been associated with responsible approaches.

    But by the second summer, however, the Orangemen allowed outdoor, localised events to go on. Again, this was consistent with an evidence-based response. Simply put, the Orangemen got it right in terms of their Covid response!

    Last summer a suitably robust Inquiry was conducted in the North into how the state there had responded – with the BBC reporting that it had heard ‘devastating evidence with multiple failings across several departments.’ Hardly a ringing endorsement for that state’s response, which made for uncomfortable listening for many of those involved. Yet, the process may prove cathartic if mistakes are not to be repeated.

    As part of that inquiry, elected representatives were asked to turn over all text and WhatsApp messages from the period. Unfortunately, Sinn Féin politicians had apparently deleted the most relevant ones. In contrast, the Democratic Unionist Party (DUP) disclosed their texts. One member, Edwin Poots, appeared to have regarded Covid as a ‘Catholic’ disease – but, in fairness, he seems to have been an outlier.

    More encouraging were the texts from the current Joint First Minister, Emma Little-Pengelly, who voiced concern for children from poorer areas who were dependent on free school meals, which were to be suspended during school closures. This was a thoughtful and compassionate approach.

    Obvious need for a statutory Covid Inquiry in the ‘Republic’

    What could be learned from a comparable Covid inquiry in the South? Certainly, it would be very useful to gauge how the state implemented its emergency plan; how it adapted to new data; and how it will respond should a similar scenario ever again arise. MacNeill’s 1913 article resonates yet again; much can be learned from the approach adopted in Ulster.

    Instead, a culture of non-transparency that developed during Covid seems to have been normalised throughout the Southern government. Rather than a statutory Covid inquiry with accountability prioritised, it appears the so-called Republic are now to be governed according to secret pacts made with elected independent representatives.

    To borrow a description from Theobald Wolfe Tone, the last regime was ‘execrable’; and yet, there is every reason to fear the new administration may be even worse.

    Alas, it is hard to see how a non-statutory ‘review’ without powers to compel witnesses or documents will find much that is not already part of the establishment’s narrative.

    Without adequate explanations, as an inquiry could allow, my faith in this state has been shattered. Simply put, once entrusted with special powers, the government made a bad situation bloody awful.

    God forbid, if a proper inquiry was to occur, perhaps we might learn that at most crucial junctures, this state and at least some of its agents see themselves as beyond accountability – and are happy to force citizens to carry the cost of demented policies.

    Should this state ever again try to enforce measures such as those during Covid, I for one will be looking North to see how the Orange brethren respond. In the absence of accountable government here, I have learned to respect those who at least seem to prize their own civil liberties.

    Renowned musician Ronan O’Snodaigh (brother of Sinn Fein T.D. Aengus) playing bodhran on the walls of Derry/Londonderry with proud Orangeman Richard Campbell in 2021.

  • Vaccine Passports “Inherently Illiberal”

    On October 5th of this year, Minister for Health Stephen Donnelly spoke before the Dáil during a debate to extend the legal framework for restrictions in the State – the sunset clause of the Health Amendments (Covid-19) Act 2021 – for three months. He stated that there was no intention to extend the restrictions beyond October 22nd, but that they wished to keep the legal framework in place in case of the need for further restrictions or lockdowns.

    This was clearly a lie, or ignorance on an unforgiveable scale. It cannot be both.

    In the interim, hospitalisations related to COVID-19 have steadily climbed, and the wheel of fear and dread has begun to turn again, quickly gathering pace.

    Thankfully, the government are attempting to turn the tide by extending the need for the Covid certification pass to theatre and cinemagoers, as well as banning nativity plays and playdates, thus surely halting the inevitable pressure that is being mounted on our health system.

    Inherently Illiberal

    I must state from the outset that I am vehemently against the concept of a vaccine passport or vaccine mandates. I believe them to be inherently illiberal and it pains me to see the willingness with which we have adopted them into our society.

    I acknowledge that when an issue produces such a visceral response, there is an increased likelihood that my reasoning may be faulty. Having read Daniel Kahnemann’s Thinking, Fast and Slow , I recognise that instinct and emotion can often cloud clear judgement. Hence, I have attempted to examine the principal arguments for and against vaccine passports in the context of the coronavirus pandemic to see if I can or will come to a different conclusion.

    I take COVID-19 extremely seriously and witness the impact of the pandemic on the patients that I meet every day. This relates not just to actual illness but to the myriad other issues, both medical and non-medical that the past twenty-two months have created for them.

    I support vaccination but not forced inoculation in the same way that I support appropriate medical treatment, not forced care. I worry that unnecessary interventions will create long-term sequalae that cannot be predicted, in the same way that inappropriate prescribing of medications does.

    Preventing the Spread?

    The most obvious argument in favour of vaccine certification is that it should prevent the spread of disease in an enclosed area. The certificate will work to protect both vaccinated and unvaccinated from contracting and spreading the disease and reducing the burden on the hospital system.

    Unfortunately, there is absolutely no evidence that this is the case. Vaccinated citizens have been readily demonstrated to be able to contract and transmit the virus in the exact same manner as an unvaccinated person.

    A recent Lancet study demonstrated that vaccination reduced the risk of Delta variant infection and accelerated viral clearance. This is great news, demonstrating that vaccines are effective. However, fully vaccinated individuals with breakthrough infections had peak viral load similar to unvaccinated cases, and could efficiently transmit infection in household settings, including to fully vaccinated contacts.[i]

    If vaccinated and unvaccinated persons are equally capable of transmitting a virus, why do we insist on segregation and marginalisation of a significant minority of our population?

    Pandemic of the Unvaccinated?

    The second argument commonly encountered is that it is the segment of the population who are unvaccinated by choice who are creating the ICU and hospital bed capacity issues.

    As of November 17th 52% of patients are unvaccinated, with a significant percentage of this population also immunocompromised. According to Minister Donnelly, 98% of the vaccinated ICU patients are immunocompromised. On this basis, there is a strong likelihood that a significant proportion of the unvaccinated cohort are not unvaccinated by choice but because they are too unwell to receive the vaccine.

    This is speculative on my part but is worth considering, and requires refutation.

    Another argument advanced is that full participation in society is not free and requires solidarity on the part of the individual citizen: Thus, “Play your part. Protect yourself. Protect others” is a common slogan.

    David Robert Grimes wrote an essay recently for The Guardian, comparing smallpox vaccine mandates in the early 1900’s to today’s issues. Of course, he neglected to mention that there was no vaccine passports in use at the time for participating in normal life, and provides no justification for them other than that they represent a mark of ‘solidarity.’

    He also states that participation in society is not free, and that freedom comes at a cost, which is somewhat paradoxical. There is an expectation of brotherhood in society. However, if brotherhood is coerced against someone’s will, it is difficult to define it so.

    I have not seen any evidence that prominent politicians during the smallpox era demanded that unvaccinated people should be banned from supermarkets and public transport. Does this evoke the spirit of fraternité?

    Finally, although never explicitly stated in Ireland, vaccine certification is certainly an effective measure to improve uptake of a vaccine.

    Whether one defines this as a nudge, gentle encouragement or coercion is a different argument. When I asked the Irish College of General Practitioners their position on the implementation of this system, they replied that ‘these people (the unvaccinated) may particularly benefit from national interventions to promote vaccination and limit the spread of COVID-19’.

    This statement is certainly open to interpretation. Undoubtedly, it has been effective in ensuring increased take-up of the vaccine in young adults – young people who may not have bothered otherwise with brother- and sisterhood.

    In a Machiavellian sense, this is the only true and potentially justifiable reason for a vaccine passport to be introduced in a civilised society. I cannot see another. Unfortunately, even 100% vaccination uptake, as in Gibraltar, has not resulted in the resolution of pandemic issues, with rising case numbers among the vaccinated causing all large Christmas activities to be cancelled.

    At this point in the pandemic, the above justification in Ireland no longer holds water. Ireland has one of the highest vaccination rates in the world, with 93% of the eligible adult population fully vaccinated.

    One should therefore assume that the remaining 7% of the ‘non-cooperating’ population are much more likely to consider a certification system coercive and will exacerbate their own fears of over-intervention by the State and unwelcome intrusion into their private lives.

    Someone who argues that this is for the benefit of the unvaccinated in protecting them from society does not do so in good faith. If someone does not wish to be inoculated at this point, there is more than a strong possibility that they do not wish to take up the kind offer of a jab.

    A certification system hence is more likely to have the inverse effect of its presumed benign intention. It is more likely to convince them further that the State wishes to harm and to segregate them against their wishes from a society that has already, by and large, shunned them.

    State of Distrust

    There has been no attempt to understand any of the multiple reasons why people do not wish to receive this vaccine. Distrust of the State, distrust of the pharmaceutical industry, distrust of the healthcare industry, anecdotal reports of adverse effects and concerns regarding under-reporting, the list is varied. The consistent link between all these issues/concerns is that of distrust.

    Many papers have been written on the subject of discussing vaccine hesitancy as a doctor with a patient. All suggest addressing hesitancy with compassion and understanding as decision-making around vaccination entails a complex mix of cultural, psychosocial, spiritual, political, and cognitive factors.[ii]

    Reasons for vaccine hesitancy fit into three categories: lack of confidence (in effectiveness, safety, the system, or policy makers), complacency (perceived low risk of acquiring VPDs), and lack of convenience (in the availability, accessibility, and appeal of immunization services, including time, place, language, and cultural contexts).

    All suggest addressing the patient’s concerns carefully, discussing with openness and honesty any potential side-effects as well as advocating the benefits, such as they are.

    Has any of this been done at any point during the pandemic with the vaccine hesitant? Vaccine passports are not a tool to advocate for immunisation in a humane and empathic manner and it is equally certain that the most effective way of fomenting further distrust is to patronise people for their ‘stupidity’ in doubting the effectiveness of a medical intervention, while downplaying the potential for any side-effects and then to mandate the intervention as a necessity for full participation in normal society, such as it is.

    Scapegoating

    Instead of focusing on and congratulating the 94% of the eligible adult population who have been vaccinated, we have decided to scapegoat and segregate the dirty few who have not complied with government directives.

    As a reminder, segregation has never been an attractive or effective feature of a functioning society. I make no lazy comparison to Nazi Germany, but rather suggest that people consider the State’s recent attitudes to same-sex relationships.

    It should not be forgotten that homosexuality was only decriminalised in Ireland in 1993. That was a horrible and unjust law, horridly intruding into the lives of normal people. Same-sex marriage was legalised six short years ago in 2015.

    Can any sane person reasonably make the case that it was legitimate or more importantly, healthy for a society to deny that two private citizens who love each other should be allowed to spend their lives together in a loving, equal relationship? That it was reasonable that same-sex marriage was such a danger to society that it had to remain illegal in the twenty-first century?

    By this logic, are the unvaccinated so lethally unclean that it is worth intentionally re-dividing society? That it is worth every citizen who wishes to eat in a restaurant having to demonstrate by law a private medical decision to a waiter that has no interest and no business in knowing same?

    The State is not a benign entity and is capable of dreadful, discriminatory decisions that have long-lasting impacts of the fabric of the country that we live in. Our long history of governmental corruption, cronyism and cover-ups at the cost to its people did not magically disappeared at the onset of a pandemic to be replaced by a wonderful, altruistic body guided by love and the rights of the individual.

    Marginalisation

    We should also consider the demographics of some of the people who do not wish to be vaccinated. People with lower levels of household income and those living in disadvantaged areas are demonstrably associated with increased likelihood of vaccine resistance and hesitancy.

    A recent survey also demonstrated that BAME people are a minimum of 25% less likely to take up the offer of the Covid vaccine.

    It is regularly reported that lockdowns and prolonged periods of state-imposed restrictions have had the most demonstrably negative effects on the exact population groups who are also hesitant to receive the vaccine.

    Therefore, we have managed to punish and further marginalise the very people who have suffered the most throughout this pandemic and will likely suffer the most in the years of anticipated turmoil ahead.

    This is not to denigrate the many wonderful, intelligent people who quite rightly question the manner in which they feel their country is being governed and directed but to highlight the unnecessary dual suffering that many people will encounter in the months and years ahead.

    In any other time, scepticism and resistance to dictates targeting minorities would be celebrated, not scorned. We should hold our leaders to a high standard at all times, not allow them easy opportunities for deflection from their own failings and label almost everything that does not agree with State narrative as “misinformation.”

    Again, instead of trying to understand why people do not wish to be injected with a treatment that they consider dangerous and unproven, and to try to convince in a humane and empathic manner, we have instead chosen to demonise and make them the culprits for the current issues that the hospital system faces in Ireland.

    Do we wish to follow the example of Singapore and begin charging patients who become ill and are unvaccinated by choice? Do we wish to follow the lead of Australia and send our citizens to quarantine camps against their wishes? Do we wish to follow the lead of Austria and lockdown the unvaccinated, and now mandate vaccines for the whole population?

    Why are these questions not being asked and answer by the opposition political parties in Ireland? Liberalism is defined as a political and social philosophy that promotes individual rights, civil liberties, democracy, and free enterprise and is supposed to be the cornerstone of left-wing politics.

    The presumed left, including Sinn Fein, Labour, the Social Democrats, People before Profit, have been pathetic in their lack of any attempt to hold the State to account. A strong opposition is the cornerstone of democracy, and it is not present currently in Ireland.

    Image (c) Daniele Idini.

    Public Health Department

    I have discussed vaccine certification with the local public health department in relation to the management of this pandemic. The doctor that I spoke to readily admitted that there is no medical indication for the use of vaccine certification and was shocked at the extension of the recent legislation in October.

    Hence, my surprise at the recent declarations by Colm Henry and Ina Kelly, president of the IMO, that the public should walk out of pubs or restaurants that are not asking for Covid 19 digital certificates.

    There remains no evidence whatsoever that vaccine certification has made any improvement to the management of the COVID-19 pandemic in any country that it has been used.

    An Israeli paper examining the effects of their ‘Green Pass’ concluded that apart from the coercive effects of increasing vaccine uptake[iii], there is no evidence that the use of a passport system reduces morbidity loads on a population.

    To repeat, there is no public health evidence for the intentional segregation of society. None. Zero. Nada. Zilch.

    Anyone who argues that there is should be immediately dismissed as a fool. However, if you wish to look at the data, the HSPC have kindly provided information on COVID-19 outbreaks in the Republic of Ireland.

    In May of 2021, there had been a grand total of two outbreaks attributed to hairdressers/personal grooming services. By November, there are now twenty-two recorded. In May, there were ten outbreaks attributed to public houses. By November, there have been forty more.

    Does anyone truly believe that presenting a piece of paper at the door achieves anything when the holder continues to have the potential to be highly infectious? There is no evidence that it improves either your safety or the safety of others.

    Image (c) Daniele Idini

    Misdirected Indication

    There has also been a recent effort to blame the unvaccinated for various sad occurrences that have occurred because of the lack of capacity in the HSE. Thus, it was reported that a transplant operation was cancelled because unvaccinated patients occupied ICU beds and the procedure was unable to go ahead.

    Blaming the unvaccinated for this is completely disingenuous and abdicates responsibility for decades of poor management. The reader should know that Ireland does not have a good reputation in the transplant world. We are currently 18th out of 24 countries in Europe, below Lithuania and Estonia in terms of organ transplantation per million people.

    In 2015, Dr David Hickey, the transplant surgeon described in the Irish Independent that he was the only pancreatic transplant surgeon in the State. Despite multiple offers to the HSE to mentor two people to take over his role, nothing was done. The pancreatic transplant program was then moved to another hospital setting, against advice and without consultation. At the time, no transplants, despite their life-saving nature, took place over a nine-month period.

    To consider that the people ‘clogging up the ICU’s’ are responsible for historically well-recognised governmental and state body failures is malicious.

    The 2019 Euro Health Consumer Index places Ireland in last position, below Albania, North Macedonia, Latvia and Romania, countries all with their own issues, in terms of outpatient hospital waiting lists.

    Ireland has the lowest rate of hospital consultants in the EU18, a fact heavily bemoaned by the Irish Medical Organisation. Shortages of GPs, shortages of nursing and allied health professionals, overcrowded emergency departments and public health failures have been reliable sources of outrage and headlines over the course of the past twenty years.

    Fortunately, there is now a perfect fall guy in the shape of an unvaccinated person to take the ire of the populace.

    The unvaccinated are at fault for five-year orthopaedic waiting lists, the unvaccinated are responsible for spiralling chronic diseases in an increasingly obese and unhealthy society. The unvaccinated are responsible for the lack of clinical staff living and working in this country.

    It would be laughable were it not for the real human cost of such misdirected indignation and hatred.

    If we are to blame the individual for the failings of the system, we should apply this logic to the others who place a heavier burden on the health system. The obese, the alcoholics, the smokers, the poor should all feel our wrath at the impact they place upon our hospitals. Perhaps an obesity cert would be an incentive for them to lose weight or keep them out of restaurants? That can only have positive results.

    Chaotic Interference

    Continuing along this path of chaotic interference in people’s lives will have iatrogenic consequences. Professor Helen Townsend, director of the Self-Harm Research Group in the University of Nottingham, has described the likely severe long-term consequences of lockdowns and that these have never been accounted for in policy making19.

    Has any consideration been given to the societal impacts of intentionally separating the ‘dirty dissenters’ from the rest of the country? If there is no public health evidence for overwhelming benefit, how can we justify such an enormous departure from normality?

    The ethical implications of these decisions have clearly not been fully considered, if at all. It should be noted that the National Public Health Emergency Team does not have any bioethical or legal representation, an amazing fact considering the enormous decisions that have been made on the basis of their recommendations over the course of the past twenty months.

    The Irish Council for Civil Liberties has repeatedly requested that such a representative should join NPHET, but this has been ignored. The ICCL, for what it is worth, has also stated their strong opposition to a domestic vaccine passport, stating that the system is discriminatory and has been developed without any meaningful consideration of human rights.

    And yet still we persist and tolerate further encroachment into both our and our children’s lives. 50,000 people can go to a football match in the Aviva stadium, the CEO of the HSE can drink and rub shoulders with sporting royalty indoors without a mask, yet we think it is appropriate that nine-year-old children should be masked and instructed not to attend nativity plays.

    190,000 children are currently living in poverty in Ireland, yet this is not a crisis worth addressing in the mainstream media. Instead, it is recommended to avoid playdates and sleepovers while Gary Barlow croons to thousands in the 3 Arena. It is preposterous and the antithesis of public health. It causes me great shame as a doctor that these measures are being carried out in the name of my profession.

    I am unable to convince myself that a system of vaccine certification is a reasonable or ethical idea in an essentially fully vaccinated adult population for a virus that is transmissible regardless of your vaccination status.

    Image (c) Daniele Idini.

    A Thought Experiment

    If you remain convinced that it is, I would like to propose a final thought experiment. Consider a politician or government that you dislike or fear. Consider your reaction if they were to have introduced a vaccine passport over the course of the past six months.

    Would you agree with segregation of society if Donal Trump suggested it? Would you clap wholeheartedly if Vladimir Putin encouraged marginalisation of a minority of people who have not broken any laws? Would you dismiss civil rights concerns if Bolsanaro was championing minority-blaming and hatred?

    If you would agree to all these questions, I would congratulate you on your single-minded conviction and realise that I will never convince you – as is assumed to be the case with all ‘anti-vaxxers’, a derogatory term that I despise.

    Coercion and essentially forced vaccination signifies a complete failure of scientific and public health messaging. My sympathies lie with the people who are not currently welcome to participate in society on the basis of one personal decision which has not broken any law.

    They have been stripped of their constitutional rights without seemingly without any recourse to due process. That should give anyone reason to pause and reflect. Without acknowledging it, we have become a country that has slipped, almost overnight, into an enduring state of fear and intolerance. I worry for the future and the country that my children will inhabit.

    [i] Anika Singanayagam, PhD et al, ‘Community transmission and viral load kinetics of the SARS-CoV-2 delta (B.1.617.2) variant in vaccinated and unvaccinated individuals in the UK: a prospective, longitudinal, cohort study’, The Lancet, October 29, 2021,  https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(21)00648-4/fulltext

    [ii] Shixin (Cindy) Shen and Vinita Dubey, ‘Addressing vaccine hesitancy: Clinical guidance for primary care physicians working with parents’, The College of Family Physicians of Canada, 2019 Mar; 65(3): 175–181. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6515949/

    [iii] Ruth Waitzburg, ‘The Israeli Experience with the “Green Pass” Policy Highlights Issues to Be Considered by Policymakers in Other Countries,’ November 2021, International Journal of Environmental Research and Public Health, 18(21):11212. https://www.researchgate.net/publication/355819969_The_Israeli_Experience_with_the_Green_Pass_Policy_Highlights_Issues_to_Be_Considered_by_Policymakers_in_Other_Countries

  • Pandemic Considerations

    As an immediate disclaimer, I am a doctor training to be a general practitioner in Ireland and am a member of the Royal College of Physicians of Ireland. I have worked in the local hospital emergency department and Covid assessment hubs as well as a general practice surgery during the pandemic and have seen very unwell patients suffering with Covid-19 and the after-effects of same. I have friends who have lost parents and grandparents and understand the devastating effect that the virus has had on their lives. I absolutely do not underestimate the seriousness of this disease. I am fully vaccinated and recommend that patients are vaccinated should they so wish. I am vehemently against the concept of vaccine mandating and passports. I fully support the right to protest and detest the concept of censorship by large technology companies. I feel that in the current climate of extreme opinions on this topic, I must state all the above. I have no expertise in infectious diseases, public health or epidemiology. Like most doctors, regardless of whether they choose to admit it or not, my understanding of statistics is limited. Hence, I do not offer any opinion in this regard.

    The Doctor in Society

    The Covid-19 pandemic has been an ever-present part of our daily lives for over a year. There is little left to say that has not already been said in relation to the correct management of the virus on a national and international level. It appears – from the approaches of different countries around the globe – that it is impossible to reach anything approaching universal agreement on the best manner of protecting vulnerable people from the disease, while simultaneously protecting vulnerable people who also have suffered terribly because of the restrictive measures that governments have felt it necessary to enact in our societies. Hence, the purpose of this essay is not to provide an opinion as to the approaches adopted, but to discuss and examine some ethical considerations and the implications of our decisions.

    We should first consider the role of a doctor in society. John Berger wrote in A Fortunate Man, a seminal book on the life and work of a dedicated general practitioner in rural England, that ‘like an artist, or like anybody else who believes that his work justifies his life, Sassall – by our society’s miserable standards – is a fortunate man.’[i]

    Certainly, as a vocation, medicine is endlessly interesting and the care of people when they are unwell is incredibly rewarding, despite its demands. There is an intimacy between a doctor and his patient that is intangible and key to a successful therapeutic relationship. We occupy a privileged position in people’s lives as we often meet them when they are at their most vulnerable and most in need of help.

    Note the deliberate use of help as opposed to treatment. I use this word purposely because treatment in the general sense is not always appropriate when trying to improve a patient’s condition. Berger continues that a good doctor can be recognised as someone who ‘meets the deep but unformulated expectation of the sick for a sense of fraternity. He recognises them’. You’ll notice that the recognition does not include intelligence, curiosity or diligence, although these are all welcome attributes.

    Ethical Pillars

    Another important aspect of being a decent doctor in the true sense of the word is to regularly consider the four ethical pillars of medical practice. These are autonomy, justice, beneficence and non-maleficence. Acknowledging and adhering to these principles allows us to help and treat patients in a humane manner and should allow doctors to recognise the limits of our ability to protect people. This is an important point to emphasise. As physicians, we often see ourselves as lifesavers or life-preservers, but this is often not the case and creates unrealistic expectations for both the doctor and patient.

    Our primary function is to prevent unnecessary suffering and death where possible and to try to consider the effects of our treatments not just on the patient, but on the patient’s family and wider community. Beyond the above, we are capable of little else, which is in of itself, no mean feat.

    A significant risk in the practice of medicine is that in the search for ‘progress’, our hubris means that we are trying to cheat death on behalf of the patient with ever-increasing numbers of interventions, with often dubious effects on patients’ quality and quantity of life.

    This is often apparent in the field of oncology. For example, a recent paper published in JAMA in November 2020 examined the clinical trial data available on treatment outcomes of all novel cancer drugs approved for the first time between 2000 and 2016.[ii] 92 novel cancer drugs were approved by the FDA for 100 indications based on data from 127 clinical trials. Despite the enormous cost of both developing and treating patients with these drugs, the median absolute survival benefit was 2.4 months.

    This requires emphasis. 2.4 MONTHS of median survival.

    This is simply staggering and reflects that we may have lost our way in the medical community, approving medications for use without fully appreciating the implications of this decision i.e., if this person receives x drug at x cost, what effect will this have on the healthcare system as a whole? Does treating patients in this manner, with often experimental medications, benefit society as a whole or the pharmaceutical industry? This may require a ‘hard heart’ as described by Jim Stockdale in Thoughts of a Philosophical Fighter Pilot. The correct decision for the many is often the hardest on the few.

    Progress in Medical Science

    It goes without saying that it is essential to strive for progress in science and medicine. This should not require stating as I am in awe of the advances made every day in medical science. It is, however, equally essential to recognise the fundamentals of health and the requirements for same. The UN defines health as not just the absence of disease, it is a state of complete physical, mental and social well-being. Can we say, as doctors, whose role it is to help restore and maintain health, that any of our patients are healthy in the context of the events of past year? Are we striving to help our patients to be healthy or are we only treating their diseases as they develop? There is a subtle but significant difference.

    Ivan Illich, the philosopher, wrote extensively about the effects, both good and bad of doctors and medicine on not just the individual but on society in general.[iii]3 He recognised the amazing large-scale innovations in public health that have given us access to good food, safe water, sewage disposal etc, but he also recognised the potential for medicine and the medical profession to cause significant harm. The focus of his arguments relate to the adverse impact of medicine on society. His principal argument being that the medical profession was eroding the individual’s capacity to accept suffering and more importantly, the capacity to die one’s own death.

    As previously mentioned, our duty is to ameliorate suffering where possible and allow patients to suffer and die with dignity when this is appropriate. Our attempts to do more has the potential to lead to catastrophe, both physically and psychologically, because it can permanently remove a patient’s perception of control over their own being. Prominent examples include the current opioid epidemic in the US and benzodiazepine addiction issues here in Ireland. All developed under the guise of attempting to alleviate suffering, but instead mutating to continue to cause devastation to this day.

    Overdose deaths involving opioids, including prescription opioids, heroin, and synthetic opioids (like fentanyl), have increased over six times since 1999.[iv] Most of these deaths are attributable, unintentionally or not, to the medical profession. This is a sad reality. Simply because a treatment decision is well-intentioned does not protect the doctor or the patient from unintended circumstances.

    Hence, I would advocate where at all possible, conservative or ‘light touch’ medicine, promoting patient empowerment and autonomy. Where possible, I suggest promoting the ideal of health provided by William Landen: ‘To ensure good health; eat lightly, breathe deeply, live moderately, cultivate cheerfulness and maintain an interest in life’.

    Latter-day Clergy

    Physicians should be an occasional addendum to life; instead, we have increasingly assumed the role previously held by the clergy. This is not a positive development. Although the medical profession has not asked for this endowment, it has accepted it without significant resistance or understanding of the spiritual nature of the role. Many physicians are not consciously aware of the transference, creating further patient dependence and maladaptive behaviour patterns, creating the class of people known to doctors as ‘heart-sink’ patients. Medicalisation of existential angst manifesting as vague abdominal pain serves neither the doctor, the patient, nor society in general.

    Public health is an extension of medicine that is remarkably important but often ignored at a societal level. It has been defined simply as the science and art of preventing disease and is tasked with the promotion and protection of the health of entire populations. This is a gargantuan task and is arguably much more important than the other, more visible fields of medicine. While the aims of public health medicine are admirable, it would be easy to deduce that multiple aspects of modern public health, beyond the basics mentioned previously, had been failing miserably up to the onset of the pandemic.

    Levels of both child and adult obesity as well as type 2 diabetes are increasing year on year, chronic disease continues to over-burden every western healthcare system and smoking rates remain stubbornly high globally. All these issues, created by the cultures of excess and consumption that we inhabit, are likely to worsen in the years ahead, with multiplicative effects on successive generations in Ireland to the point where it is expected that our life expectancy and more importantly, healthspan, will decrease in the years ahead.[v]

    I mention this to illustrate the point that people rarely behave in a rational manner. This is especially evident at a population level. Therefore, one could logically decide in a public health capacity, to intervene in increasingly intrusive ways to ultimately improve the health of the population, through restriction of access to unhealthy pastimes and products. This would presumably entail banning cigarettes, alcohol, highly processed junk food and all other manners of potentially unhealthy choices. This would reduce the burden on our hospitals in both the short and long-term and allow improved access to care for a happier, healthier population.

    For example, the government of Bhutan has banned all sales of cigarettes in their country, with excellent health effects to date. The Prime Minister of Bhutan took the decision because he stated that it was the right thing to do for the health of the country’s citizens.[vi]

    However, it would be argued vociferously that any such decrees would impinge on an individual’s rights to individual choice, not to mention the enormous loss in tax revenue to the State from the sale of such items. The Irish government is estimated to generate two billion euro a year in tax revenue from the sale of cigarettes alone. Interestingly, it is estimated that we spend the same amount on the management of smoking-related diseases in our healthcare system, thus negating this as an argument against banning cigarettes.

    If this were indeed implemented in Ireland, and more particularly in the case of alcohol, there would be immediate cries of excessive intervention in the private lives of the citizens of the State. This would be a perfectly reasonable argument in the absence of a state of emergency, such as we find ourselves in over the course of the past fifteen months.

    It must be stated that the effects of cigarettes and alcohol are not limited to the individual. Anyone who argues this has not had to wait for an outpatient appointment in an overcrowded cardiology or respiratory clinic for three years. One should remember though, that there has been a healthcare and trolley ‘emergency’ in Ireland since Mary Harney announced one twenty years ago and there has been no improvement whatsoever in the annual crisis figures, with increasing amounts of the State budget allocated to the attempted provision of healthcare. In 2018, the Irish state spent €22.5 billion on the healthcare system, which equates to 11.4% of Gross National Income (GNI).[vii] People blame the healthcare system but the system, while dysfunctional, may not truly be to blame. Perhaps, as a society, should we shoulder some of the responsibility?

    State Interventions in Pandemics

    Thus, after thinking about some of the arguments that could be made for state intervention in the lives of its citizens, I think it is important to consider the various ethical approaches that could underpin our ongoing approach to the pandemic.

    A utilitarian approach was initially adopted by the UK government, aiming for the concept of achieving herd immunity to maximise the collective interest. As is commonly known, this was quickly abandoned as the healthcare system came under increasing strain. This approach is not without precedent, and I do not refer to the management plan decided upon by the Swedish government.

    In 1968, the world was struck by an influenza pandemic known as the ‘Hong Kong flu’, killing approximately 4 million people globally, according to the Encyclopaedia Britannica. A paper published in The Lancet examined the response to the 1968 pandemic and noted that the British government was extremely passive in its approach.[viii]

    Fearing that the press would have a field day if it issued a prominent warning about the pandemic, it left it to local medical officers of health to decide on the most appropriate course of action. Interestingly, publishers were also reluctant to risk stoking public fears, ‘a reflection perhaps of heightened anxieties due to the Cold War and the launch of Sputnik, as well as greater respect for medical experts and deference to authority’. This approach undoubtedly led to many deaths and interestingly, affected people under the age of 65 more than the elderly.

    It can certainly be argued that the fabric of British society was maintained at the time, possibly for the greater good in terms of long-term ramifications. Contrast this with the media response to the pandemic today. The Guardian newspaper is one of many which has a live ‘coronavirus update’ section on its website for the past year. Does the information provided serve the individual or the advertisers paying for space?

    Ireland’s Kantian Approach

    By way of comparison, Ireland seems to have adopted a Kantian approach to the management of the pandemic. It is unclear whether this is by accident or by design. In an interesting paper by Gerard Delanty, he quotes the philosopher Jurgen Habernass, the world’s leading political philosopher.[ix]11 He stated that ‘the efforts of the State to save every single human life must have absolute priority over a utilitarian offsetting of the undesirable economic costs’. This equates to, in layman’s terms, ‘lockdown first, ask human rights questions later.’

    While Kantian ideals are superficially attractive, I worry that the implications of following such an approach will have long-term repercussions. One can argue that that the degree of government overreach into the lives of its citizens is deontologically unacceptable and that multiple human rights violations have occurred in this country and may occur again in the near future.

    A report commissioned by the Irish Human Rights and Equality Commission in 2020 stated that ‘not only is Covid-19 more than a public health crisis, but it is also arguably the most significant set of human rights and equality challenges that Ireland has ever faced’[x]12 The report highlights multiple areas of concern regarding the State’s and NPHET’s issuing and maintenance of emergency powers. Principally, these included the blurring of the boundaries between legal requirements and public health guidance, the potential for emergency measures and their enforcement to disproportionately affect certain disadvantaged and more vulnerable groups and the lack of human rights and equality expertise in the decision-making structure put in place to tackle the pandemic, or in the systems that implement and scrutinise these decisions.

    These are significant issues that have not been acknowledged or addressed by the Government or NPHET. This should be of significant concern as it belies the seriousness of the situation. I must stress that I do not suggest that NPHET or the government are made up of morally ambiguous people. They are not the real issue. I honestly believe that they are decent people working hard in the most extraordinary circumstances that we have witnessed in most of our lifetimes. It is in this ‘state of exception’ however, that we must be at our most fierce in the assiduous monitoring and protection of our civil liberties.

    Overreach?

    Giorgio Agamben, the Italian philosopher, has warned repeatedly against the implementation and continuation of emergency powers as a normal paradigm of government.[xi] He questions the imposed limitation of freedom in a desire for perceived safety and security and has previously discussed this issue in his examination of the surveillance powers afforded to the US government after the events of 9/11. He warns against fear and stresses the importance of society guarding itself against any form of extreme government, regardless of perceived benevolence.

    Matthew Crawford, the philosopher cum motorcycle mechanic, also warns against the culture of ‘safetyism’, describing a cycle whereby ‘the safer we become, the more intolerable any further risk becomes’ and that ‘once emergency powers are passed, they are seldom relinquished.[xii]’

    Do we genuinely believe in Ireland that we are immune to benevolent autocracy? Has the question even been asked in the public domain here? Does the absence of questioning and discussion not demonstrate the lack of any public intellectual discourse that might be useful to allow individuals to consider their own ethical responsibilities in a pandemic?

    By corralling people in their homes, the State has acted as a helicopter parent, pacifying us with off-licences and pandemic unemployment payments. The decision was made that people were not trustworthy enough to consider their fellow man and behave accordingly.

    Anti-lockdown campaigners have repeatedly pointed to the relative ‘success story’ of Sweden in its approach to the pandemic. Perhaps, it has nothing to do with the manner of the imposition of the restrictions but to do with how seriously the population took the virus and were satisfied to adhere to advice from the public health authorities. There was reciprocal trust between the State and its’ people. Because essentially, that is the difference between the population groups.

    I would ask people to ignore the behaviour of the virus and instead to consider how people in different countries behave on an individual basis. In Japan, lockdowns have not occurred as they are deemed illegal. However, anecdotally, they take virus very seriously and take what could be regarded as excessive personal risk avoidance i.e., wearing hazmat suits in airports when travelling (this was witnessed recently in Charles de Gaulle Airport in Paris).

    Again, I must re-state that I do not believe that lockdown decisions in Ireland were made with ill-intention. They were made to ostensibly protect the vulnerable in society i.e., the elderly. By and large, despite some nursing home and hospital scandals, this has been effective and a healthcare system, bloated and over-burdened for decades, has avoided a presumed disaster. These are the benefits of the most prolonged and nominally if not practically, the most stringent lockdown measures in Europe.

    The Law of Unintended Consequences

    However, one should also consider and cite the law of unintended consequences i.e., that the actions of governments always have effects that are not anticipated. Hence, it would be unrealistic to assume that our seventeen months of restrictions will have no harmful side-effects. Unfortunately, the vulnerable in society are still those who have and will suffer the most.

    Elderly patients, the focus of our concern, have deconditioned before my eyes over the course of the three lockdowns enacted here and many of my colleagues are reporting similar experiences. Loss of muscle and bone strength has a direct impact on the morbidity and mortality of an elderly population.[xiii]

    Physically active older adults (≥60 years) are at a reduced risk of all-cause and cardiovascular mortality, breast and prostate cancer, fractures, recurrent falls, ADL disability and functional limitation and cognitive decline, dementia, Alzheimer’s disease, and depression. They also experience healthier ageing trajectories, better quality of life and improved cognitive functioning. Inactivity over the past seventeen months will have dreadful ramifications for a significant proportion of the people that we have sought to protect.

    They spend their time with their families in a state of anxiety, fearful of becoming unwell but also guilty at the burden placed on their families. Loneliness and social isolation have increased dramatically. This will have multiplicative effects in the years to come as there is a strong body of evidence to demonstrate that cognitive decline and mortality rates are doubled among people who suffer because of isolation and loneliness.[xiv]

    The ESRI now predicts that tens of thousands of people will permanently lose their jobs, and that up to 250,000 will remain unemployed at the end of 2021[xv]17. Perhaps many of these jobs would have been lost because of the pandemic and not the restrictions, but the negative societal impact of such job losses on people in lower socioeconomic groups cannot be overstated, further worsening inequality and poverty.

    In Ireland, the lockdown has been an inconvenience for the middle class, but I state without hesitation, that the longer this persists, the more devastating the blow will be to the vulnerable in society and the more difficult it will be to recover.

    Socioeconomic Status

    Socioeconomic status has a much more significant impact on health status than medicine and medical care. To provide a stark example, In England, the gap in life expectancy (LE) at birth between the least and most deprived areas was 9.4 years for males and 7.4 years for females in 2015 to 2017; for healthy life expectancy (HLE) it was 19.1 years and 18.8 years respectively.[xvi] This is in one of the richest countries in the world, with a socialised healthcare system lauded and envied globally. It is essential that we remember this fact if we wish to strive for a decent society. I stress again that lockdowns and continued restrictions will affect the most deprived in our own society and further widen the gap of income inequality.

    Finally, the effect of state intervention must be considered on the most vulnerable cohort in society, our children. Lockdowns have been demonstrated to have increased the number of adverse childhood experiences suffered by vulnerable children.[xvii]

    The common argument in favour of lockdowns is that their adverse effects are not multiplicative. I would argue the opposite. The longer these measures remain in place, the larger the long-term effects on children. A study in Oxford demonstrated that children had essentially learned nothing over the course of the pandemic year through Zoom.[xviii]. It is estimated that 100,000 children did not return to school in the UK after the most recent lockdown or were defined as ‘severely absent.’[xix] When will disadvantaged children regain the educational ground that they have lost and what will be the effect of this life on their adult lives?

    The government tells us to stay safe and hold firm, slogans that signify nothing except a lack of imagination. They asked that the citizens of the State protect the health service by adhering to stay at home guidelines, which were enforceable by law. The question must be asked why the State has not applied the same urgency to the trolley and hospital bed crisis, which has been present annually for at least twenty years?

    How many poor people have died unnecessarily because of over-crowding or inequitable access to healthcare services? Why was the Cervical check scandal allowed to unfold? Why the Mother and Baby Home scandal? Why are we building a behemoth Children’s Hospital that is arguably not suitable for purpose and will be by its’ finish, the most expensive hospital in the world? Why does this occur while there are 193,600 children living in poverty in Ireland,[xx] considering the wealth that this country currently generates. One should ask is the state truly worried about its citizens or its systems of ‘care’? There is a significant difference.

    Viktor Frankl

    Finally, we should consider the role of the individual in this pandemic. Victor Frankl, the famous neurologist and founder of logotherapy, wrote about the nature of life and its meaning in the context of his experiences as a prisoner in Auschwitz and his subsequent return to society.

    In Man’s Search for Meaning and Yes to Life, he explores the themes of meaning and his own treatment of patients with severe mental illness. In summary, his own severe despair, which often afflicted him, only served to convince him further of its meaning and the importance of finding meaning in life.

    This does not necessarily mean happiness as this is a more modern obsession. We have no right to happiness in the modern sense. Life does not expect you to be happy or sad or any other emotional state. Life simply is. Within these confines, which are as limited or limitless as you choose, what you emotionally feel during this period is your interpretation of the experience, nothing more or less.

    Tragedy constantly stalks us and will visit at various points during our lives, regardless of external environmental factors. As a result, negative visualisation is a concept that the Stoics advocate. Marcus Aurelius wrote of putting his children to bed at night and imagining them dying. This was not done in a sociopathic sense, but to remind him of the precious time that he had with his children, to value this time and to appreciate that they may be taken from him at any point.

    Perhaps, societally, we could improve our lot by engaging in this thought process more often, not to upset us but to improve our appreciation of what we have now and to steel ourselves against the difficulties that we may face in the future. It encourages difficult thinking and bravery. It may often be easier to retreat to the arms of someone/something else to make decisions for you but is this the correct decision? This pandemic is an external, unfair devastation but I believe that our society, as imperfect and flawed as it is, can adjust and limp forward. I trust in people to make the correct decisions for themselves at this point in the pandemic.

    In Summary

    I repeat my claim to no expertise on the management of a pandemic. As a doctor, I am asked to assess people’s problems, both medical and otherwise on multiple occasions throughout my daily work. While I am required to make my decision with relative confidence where possible, key to being a decent physician is to constantly consider that I may be wrong in my treatment decision and that my differential diagnosis remains broad.

    I believe that at this point, ongoing and future mandated restrictions are likely to be more harmful than beneficial to society and that we should carefully consider the course that we plot and what we value in life. Safety should not be valued above all else and iatrogenesis has terrible implications for health. I write this on a day when NPHET has recommended to government that indoor dining should be restricted to people who are fully vaccinated only. Is this what we have become?

    All images © Daniele Idini

    [i] Berger J. A Fortunate Man: the story of a country doctor. London: RCGP; 2005

    [ii] Ladanie A, Schmitt AM, Speich B, et al. Clinical Trial Evidence Supporting US Food and Drug Administration Approval of Novel Cancer Therapies Between 2000 and 2016. JAMA Netw Open. 2020;3(11):e2024406. doi:10.1001/jamanetworkopen.2020.24406

    [iii] Illich, I. (1975). Medical nemesis: The expropriation of health. London: Calder & Boyars.

    [iv] Wide-ranging online data for epidemiologic research (WONDER). Atlanta, GA: CDC, National Center for Health Statistics; 2020.

    [v] Woolf SH, Schoomaker H. Life Expectancy and Mortality Rates in the United States, 1959-2017. JAMA. 2019;322(20):1996–2016. doi:10.1001/jama.2019.16932

    [vi] Ugen S Bhutan: the world’s most advanced tobacco control nation? Tobacco Control 2003;12:431-433.

    [vii] CSO https://www.cso.ie/en/releasesandpublications/ep/p-syi/statisticalyearbookofireland2020/soc/health/

    [viii] Honigsbaum M: Revisiting the 1957 and 1968 influenza pandemics The Lancet 13–19 June 2020 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7247790/

    [ix] Delanty, Gerard (2020) Six political philosophies in search of a virus: critical perspectives on the coronavirus pandemic. Discussion Paper. London School of Economics, London https://www.lse.ac.uk/european-institute/Assets/Documents/LEQS-Discussion-Papers/LEQSPaper156.pdf

    [x] Irish Humans Rights and Equality Commission, https://www.ihrec.ie/documents/irelands-emergency-powers-during-the-covid-19-pandemic/

    [xi] Stephen Humphreys, Legalizing Lawlessness: On Giorgio Agamben’s State of Exception, European Journal of International Law, Volume 17, Issue 3, 1 June 2006, Pages 677–687, https://academic.oup.com/ejil/article/17/3/677/2756274

    [xii] Matthew Crawford, ‘The Hypocrisy of Safetyism’, Unherd, May 15th, 2020, https://unherd.com/2020/05/the-hypocrisy-of-safetyism/

    [xiii] Hwang, T., Rabheru, K., Peisah, C., Reichman, W., & Ikeda, M. (2020). Loneliness and social isolation during the COVID-19 pandemic. International Psychogeriatrics, 32(10), 1217-1220. doi:10.1017/S1041610220000988 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7306546/

    [xiv] Hwang, T., Rabheru, K., Peisah, C., Reichman, W., & Ikeda, M. (2020). Loneliness and social isolation during the COVID-19 pandemic. International Psychogeriatrics, 32(10), 1217-1220. doi:10.1017/S1041610220000988

    [xv] Quarterly Economic Commentary, Spring, 2021, ESRI, https://www.esri.ie/system/files/publications/QEC2021SPR_0.pdf

    [xvi] Office of National Statistics, https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthinequalities/bulletins/healthstatelifeexpectanciesbyindexofmultipledeprivationimd/2015to2017/

    [xvii] Per Engzell, Arun Frey, Mark D. Verhagen  Learning loss due to school closures during the COVID-19 pandemic Proceedings of the National Academy of Sciences Apr 2021, 118 (17) e2022376118; DOI: 10.1073/pnas.2022376118 https://www.pnas.org/content/118/17/e2022376118

    [xviii] ‘Kids can’t catch up if they don’t show up’ The Centre for Social Justice,  https://www.centreforsocialjustice.org.uk/library/kids-cant-catch-up-if-they-dont-show-up?utm_medium=email&utm_source=CampaignMonitor_Editorial&utm_campaign=LNCH%20%2020210628%20%20House%20ads%20%20JO+CID_c144dc407b002e4fa6548baa2389bf59

    [xix] Ibid https://www.centreforsocialjustice.org.uk/library/kids-cant-catch-up-if-they-dont-show-up?utm_medium=email&utm_source=CampaignMonitor_Editorial&utm_campaign=LNCH%20%2020210628%20%20House%20ads%20%20JO+CID_c144dc407b002e4fa6548baa2389bf59

    [xx] Social Justice Ireland, https://www.socialjustice.ie/content/policy-issues/more-637000-people-are-still-living-poverty-ireland-despite-modest

     

  • Covid-19: Unanswered Questions

    Confusion and fear are to be expected in novel situations where experience is limited; this should fade as understanding grows. Such is the natural cycle. When governments employ behavioural psychologists to induce fears in order to control and coerce the population, however, we have to question their motives and methods.

    Initially we were advised that a zoonotic virus crossed species: horseshoe bat to pangolin and then to humans, via the food chain. Ghastly images were shown nightly of a range of exotic creatures that Chinese people – portrayed in somewhat xenophobic terms because of their, to us, foreign tastes – supposedly enjoy consuming. This outbreak witnessed sagacious, and wealthy, heads knowingly saying ‘I told you so.’

    And apparently we can expect much more, and worse, in the future because of the ways in which we live and eat. Last year any question of whether it could have come from any other source was shot down as absurd by dubious fact checkers, and freighted with conspiracy theory fairy dust.

    This despite Wuhan containing a level 4 BSL laboratory, and three members of its staff being hospitalised in November 2019 with coronavirus-like respiratory symptoms. Furthermore, this same laboratory was conducting gain of function research into coronaviruses, through a grant form EcoHealth Alliance, an organisation funded by U.S. National Institutes for Health. This type of research using viruses was banned by the Obama administration as being too risky.

    Weaponising

    This same research is not far removed from the process of weaponising a pathogenic organism. So why did NIH fund this laboratory to carry out this type of research, and who else knew of the potential risks, and incentives, for finding a novel infective agent and researching possible treatments and vaccines?

    The first we in the West learnt about any of this came from the videos on TV and social media of people dropping dead in the street – in hindsight clearly not coronavirus cases – and the Chinese locking down it citizens. Next there was Italy, with coffins being carted away by military trucks.

    These were all carefully orchestrated publicity stunts, but who was responsible? Who decided to broadcast uncritically these sensational images? The world took note, a pandemic was declared and governments around the world, almost uniformly, imposed harsh and unprecedented restrictive measures on their citizens.

    In Britain the initial plan was to protect the vulnerable, through cocooning, whilst awaiting herd immunity in the young. But there followed a swift turnaround in the face of public outcry. In Europe only Sweden resisted the clamour to lockdown and was pilloried in the international media. ‘Sweden has become the World’s Cautionary Tale’ declared The New York Times in July, 2020.

    The British government’s approach was strongly influenced by the epidemiological modelling of Imperial College’s Professor Neil Ferguson, of previous forecasting fiascos. For example, he predicted three to four million deaths from Swine Flu in 2009, which ultimately resulted in less than 300,000 global fatalities.

    Ferguson’s Imperial paper predicted 500,000 deaths in the U.K. in an unmitigated scenario, and on March 20th, told the New York Times that the ‘best case outcome’ for the U.S. was a death toll of 1.1 million, rising to 2.2 million in a worst case scenario. As of June, the U.S. has seen just over 600,000 deaths, and the U.K. 127,945, in circumstances where the attribution of death to Covid-19 is often deceptive.

    Further doom and gloom laden scenarios was provided by Professor Christian Drosten, head of the institute of virology, Charite university hospital, Berlin, while alternate modelling provided by Professor Michael Levitt, Stanford University and Nobel laureate was ignored.

    PCR Testing

    Dorsten’s main contribution to this story is his paper ‘Detection of 2019 novel corona virus by real time RT-PCR’ outlining the basis for the widely used Drosten-PCR test that has been criticised for multiple errors, and the haste with which it was published. This test is now the most widely used diagnostic test for Sars-CoV2.

    This is despite its invenor Kary Mullis’s – Nobel laureate for chemistry for his work with PCR – stating unequivocally ‘it doesn’t tell you if you are sick’.

    https://twitter.com/zaidzamanhamid/status/1384873889591873536

    There are a number of criticisms of the Drosten method in that he reportedly developed it using partial genetic sequences provided by the Chinese, in conjunction with sequences from other corona viruses. Furthermore, the test which according to Kary Mullis is a quantitative test, is not reported to clinicians this way.

    Instead a qualitative result ‘detected’ or ’not detected’ is reported without giving the cycle threshold, even after the WHO suggested physicians should be given this figure. The significance of the cycle threshold harks back to Kary Mullis’s ‘it doesn’t tell you if you are sick.’ Even Dr Anthony Fauci of the NIAID (National Institute of Allergy and Infectious Diseases) has stated that at ct values of greater than 35 it is unlikely that any live virus is present in the patient.

    https://twitter.com/jimgris/status/1326518250386063361?lang=en

    Why then did Irish laboratories use ct values as high as 45? And why did we go from testing inpatients with PCR, knowing the false positive rate, to the community setting and especially the asymptomatic, given asymptomatics are often ‘false positives’, leading to an inflated ‘case’ count.

    One has to wonder if the state’s spending of an estimated €400 million on PCR testing has been a case of noses in the trough not wanting to avoid the public smelling the coffee. Who were the people with vested or conflicted interests in this issue?

    Churchillian Speeches

    Most Western governments, including Australia and New Zealand, paraded their respective Prime Ministers before the cameras to make speeches of Churchillian gravity, implicitly likening the threat of Sars-CoV2 to World War II. Leo Varadkar even paraphrased Churchill in his first speech to the nation -’never will so many ask so much of so few,’ before imposing unprecedented draconian lockdown measures, based on fear.

    Along the way we have heard words of caution from notable academics including Stanford Professors John Ioannidis and Jay Bhattacharya, as well as Professor Sunetra Gupta of Oxford University. But these voices were hardly ever heard on Irish mainstream media.

    These authorities cautioned that measures would disproportionately hurt the poor and vulnerable; that severe illness was mainly confined to a recognisable cohort, and that there was no evidence for the efficacy of lockdown measures.

    Nobody listened. Instead the government closed schools, prevented people from earning a living, stopped all cultural and sporting activity, prohibited religious worship and confined travel to within five kilometres of home.

    For months elderly people languished alone in nursing homes and hospitals, some dying alone; women gave birth without their partners; funeral rites were severely curtailed, as basic civil rights were completely ignored in response to an illness with an estimated infection fatality rate of 0.05% for anyone under the age of seventy years.

    Every night the state broadcaster became the government’s harbinger of doom with the recitation of nightly death tolls. What purpose other than ratcheting up of fear did this serve?

    Through the diligent questioning of Michael McNamara TD, however, we know that the reported mortality figures included anyone testing positive in the previous twenty-eight days with a PCR test, no matter what their underlying condition. Deaths unassociated with Sars-CoV2 were obviously irrelevant.

    They turned out to be very relevant as the CSO annual death figures of 6.4 per 1000, which were little different to previous years, and even less than 2013. Why then, when death figures dropped, did reporting switch to the spurious concept of ‘cases’, defined by a positive PCR test? Why did the Irish government shamefully enlist the services of RTE in terrifying the nation, and why did the state broadcaster acquiesce? Answers on the back of a postcard…

    Disproportionately Affected

    The message ‘we are all in this together’ was a big lie. The disease disproportionately killed people over the age of eighty, especially those in nursing homes, many of whom were needlessly infected after being transferred to hospitals with testing withdrawn at the height of the pandemic in spring 2020. The obese, those with diabetes, chronic heart and lung diseases are also disproportionately affected.

    These pre-existing morbidities are more prevalent among lower socioeconomic groups in society. So we were clearly never all in this together.

    Civil servants, including politicians and the medical profession, those working in IT and for media corporations, could easily work from home, but nearly half a million people had to stop work for the duration, especially those in the tourism and hospitality sectors. These are mainly young people, and like children, most would only have been mildly effected by the virus. So why were they forced to suffer unnecessarily?

    Moreover, why did small retail outlets have to close for months on end, while off licenses and fast food chains were deemed essential services?!

    States of Fear

    The kind of Propaganda devised by Sigmund Freud’s grandson Edward Bernays who infamously made it fashionable for women to smoke, was evident in the government’s manipulation of the figures, and the media’s delivery. Bernays wrote in Propaganda (1928) ‘The conscious and intelligent manipulation of the organised habits and opinions of the masses is an important element in democratic society.’

    A host of celebrity scientists appeared, many with Conor McGregor levels of empathy, only better elocution, a gentler demeanour and less tattoos. Trite experiments were undertaken on popular TV shows, where we found dour funereal forecasts from infectious disease experts, who were invariably wrong in their predictions, and inane squeaking from a misplaced neuroscience.

    All of these ‘experts’ sang in unison. Dissenting voices were heard briefly and infrequently. Some lost their jobs merely for disagreeing with the bull-in-a-china shop approach taken by the HSE/NPHET/government.

    In her new book States of Fear Laura Dodsworth outlines how the UK government used behavioural psychologists, probably via their Nudge unit, to control the population through the deployment of carefully selected ‘experts’ and repetitive messaging on news broadcasting.

    This was substantiated in the recent testimonies by Dominic Cummings, the former chief adviser to Boris Johnson. ISAG were also familiar with scaremongering techniques, as intercepted emails highlight their tactic of targeting and discrediting individuals, and keeping fear ramped up as a tool in their ZeroCovid campaign.

    To quote Bernays again ‘there are invisible rulers who control the destinies of millions. It is not generally realised to what extent the words and actions of our most influential public men are dictated by shrewd persons operating behind the scene.’

    Using this sinister playbook, between them NPHET, ISAG and the government managed to sow a level of fear, suspicion and division in society that may take years to unravel.

    Flatten the Curve?

    Despite all the hype around flattening the curve to save the health service at the beginning of the pandemic, and the use of draconian measures to do so, alas nothing was done to treat patients at home.

    Several readily available, cheap and relatively safe products, were hypothesised to have positive benefits in the early stages of a Sars-CoV2 infection, but there were systematic efforts to steer physicians away from these.

    The ICGP guidelines for GPs on the treatment of early Sars-CoV2 amounts to do nothing, and wait for patients to get better, or if they fall really ill send them into hospital. Some doctors in the USA lost their licenses for prescribing these medications, and others in Ireland faced censure by the Medical Council.

    According to physicians like Peter McCullough, Professor of Medicine at Baylor University, Texas in conjunction with AAPS (The association of American Physicians and Surgeons), and separately Dr Pierre Kory of FLCCCA (Front Line Covid Critical Care Alliance) Sars-CoV2 was empirically treatable, especially in that first week before the patient became very unwell.

    https://vimeo.com/560523610

    So, despite a concerted effort to vilify them, they treated their patients. Why did Irish GPs, save for a few, fail to do so?

    In doing nothing did many patients needlessly died? With our widespread application of lockdowns and our disregard for focused protection measures, as advocated by the Great Barrington Declaration (which has garnered 850,000 signatures, including 43,000 from medical practitioners) coupled with our refusal to at least try and treat patients, have we done a great disservice to our patients?

    Silencing of Dissent

    Sweden did not adopt anything like the same draconian measures, and their economy and society has not been disrupted to anything like the same extent as Ireland’s. Yet their mortality figures compare favourably, especially when adjusted for the relative age of each population.

    Perhaps one of the main reasons for the concerted campaign to ensure that no other treatments were deemed suitable for the early treatment or prevention of the disease was the FDA criterion for an EUA (emergency use exemption).  No such exemption would have been granted to a product in such an early stage of development, without animal or human study data, except in what are deemed to be extraordinary circumstances.

    €26 billion – the amount Pfizer expects to earn this year after producing the first Covid-19 vaccine – might buy a lot of scientific validation, and political influence.

    The undue haste with which these vaccines have been rolled out demands sceptical enquiry, especially in relation to two particular cohorts: pregnant women and children. As clinicians we generally exercise extreme caution in these groups.

    So why is it that for a condition with an overall IFR of 0.15% have we discarded this caution? Linking vaccination status to the right to work, travel, attend cultural and sporting events is divisive, coercing those who wish to exercise a degree of caution and/or exercise autonomy over their health.

    Without the questionable concept that is asymptomatic spread, there is no justification for vaccinating anyone in low risk groups, and certainly no justification for using bully tactics.

    Despite all these glaring questions, there has been a deafening silence from the medical profession in Ireland, and those that have spoken out have been quickly silenced. Is this how we are going to deal with complex issues in future? Adopting binary, categorical approaches without nuance leaves no room for debate.

    RTE have paid lip service to the notion of an informed debate, hosting Martin Feeley and then later pitching Professors John Lee and Sunetra Gupta into debate with hand-picked stalwarts.

    Moneybags

    In Ireland today scepticism is viewed as a contagion to be eradicated, with compliance seen as the perfect state of health. As a nation we must ask: why have so many been so quiet; why has fear replaced reason, and groupthink taken over once again?

    One must question the role of doctors ‘stuffing their mouths with gold’ as Aneurin Bevan put it in relation to British doctors at the inception of the NHS. A quick look at the 2019 PCRS payments to GPs shows a healthy €85 million in government expenditure. This, however, mushroomed to over €200 million for the same period in 2020.

    Some were clearly making a killing during the pandemic. And whose idea was it to advise doctors not to see patients face-to-face during the pandemic? If a doctor won’t see you who will?

    Further to this windfall will be vaccination payments at a cool €60 per patient. Is it any wonder GPs want everyone vaccinated?

    There may even be boosters for variants required for everyone on the planet! The media should be asking the question: who is benefitting from this Monty-Pythonesque situation?

    Certainly any government with the slightest authoritarian bent, which it transpires appears to be most Western ‘democracies’. It really is worrying how little opposition there has been to Chinese-inspired lockdowns, with opponents dismissed as a far right fringe – even by the apparently left-wing opposition – despite the obvious damage these policies have done to the poorest, who were also least protected by the measures.

    Why did so many European governments fall into line so quickly, when even a passing familiarity with EU politics would indicate that it can take years for Member States to agree on the number of legs that the average cow possesses?

    If you intuit that something is just not right, and baulk at jingoistic phrases like ‘the new normal’ and ‘build back better’ ask yourself cui bono or ‘who benefits’, and don’t let the fear of being labelled a ‘conspiracy theorist’ dissuade you from asking reasonable questions.

    Feature Image: Daniele Idini

  • Covid-19: A New Irish Social Contract?

    Surveying the demise of the Celtic Tiger, Fintan O’Toole devoted an opening essay ‘‘Do you know what a republic is?’ The Adventure and Misadventure of an Idea’ in Up the Republic! Towards a New Ireland (2012) to assessing the health of the Irish Republic. He considered its vitality based on the presence, or otherwise, of three indicators: Non-Domination; Mixed Government and tolerance of Obstreperous Citizens.

    These features of a healthy republic, he wrote, diverge from a narrow form of republicanism associated with Rousseau ‘which argues for the notion of a single, sovereign popular will: ‘the People’ effectively taking the place of the king in a monarchy.’ Up to that point in Ireland, O’Toole argued, this latter, narrow version had predominated, which he associated ‘in vulgar terms’ with appeals being made to ‘pull on the green jersey’’; and where ‘an idea of accountability implicit in mixed government is ditched.’

    ‘For most of the history of the state’, O’Toole concluded that the state ‘failed miserably in the basic task of ensuring citizens were free from subjection to the arbitrary will of others.’[i]

    Now, as Ireland slowly unwinds from an interminable lockdown that tendency of Irish governments to pull on the green jersey, avoid accountability, reject obstreperousness and a conspicuous failure to ensure that citizens are free from the subjection to the arbitrary will of others, is evident once again. This regression has arrived especially through what O’Toole himself described on April 28th, 2020 as the ‘top-down, command-and-control approach’ of the National Public Health Emergency Team (NPHET), which the elected government has deferred to throughout most of the pandemic.

    Times of War

    The COVID-19 pandemic is likely to reshape the Irish political landscape, eroding foundational certainties of left and right. When the dust settles new formations may crawl from the debris, with democracy itself in peril, as the coalition government chooses to extend emergency powers until November, while other countries such as Denmark aim for a swift return to normality.

    In terms of the pandemic’s wide-ranging impact, there are parallels with the outbreak of a global war. As Hannah Arendt put it: ‘The days before and the days after the first World War are separated not like the end of the an old and the beginning of a new period, but like the day before and the day after an explosion.’[ii]

    Placing billions under lockdown around the world had a shuddering effect on daily routines, altering intimate exchanges and gestures, besides radically reducing the ambit of daily peregrinations. It’s a very modern form of trench warfare that confined most of us to within 5km of barracks – spilling out invective on (anti-)social media.

    In Ireland, with the advent of bigger government, there is a confidence among some on the left that their time has arrived, and that a relatively youthful population will vanquish age-old privileges of wealth and caste through a permanently enlarged state.

    However, as Eric Hobsbawm records, one reason Engels (and even the late Marx) ‘began to turn away from calculations that the international war might be an instrument of revolution was the discovery that it would lead to ‘the recrudescence of chauvinism in all countries’ which would serve the ruling classes.’[iii]

    Similarly, nationalism chauvinism – ‘excessive or prejudiced support for one’s own cause, group, or sex’ – has been witnessed throughout the pandemic in Ireland. This is perhaps unsurprising as, historically, infectious diseases have given rise to, and fed, plagues of prejudice and outright racism; the diseased ‘other’ at the gates of the city is a recurring theme. Ruling classes have often put forward strongman rulers to harness this xenophobic sentiment.

    Since March 2020 we have poured over spreadsheets of daily deaths, infections, testing rates and vaccine roll outs to determine how ‘we’ are doing relative to ‘them.’ In Ireland we tend to measure achievements and failures against the noisy neighbour next door, whose boorish leader has somehow managed to transform one of the world’s highest death tolls per capita from Covid-19 into a great British victory pageant, through a rapid vaccine rollout. Boris now looks unassailable, notwithstanding Brexit storm clouds, Dominic’s revenge, Indian variants; and just the suspicion that the vaccine may not prove quite the panacea it seems now in winter 2022. Time will tell.

    Indeed, the narrative arc of Boris Johnson’s response to the pandemic should serve as a warning to the Irish left that ruling classes can easily steal their best clothes. In this respect, Johnson operated with far greater flexibility than Donald Trump, shifting from a ‘take on the chin’ herd immunity approach in March, 2020 to championing what he would have previously decried as a ‘nanny state’ lockdown. He and his chumocracy used the pandemic as a pretext for introducing draconian legislation against protest and civil disobedience, apparently aimed at movements such as Extinction Rebellion.

    Recovery Position

    Similarly, though less dramatically, Leo Varadkar resuscitated his political career after Fine Gael’s disastrous performance in General Election 2020, donning proverbial scrubs for the initial phase of the pandemic. Having identified himself with “early-rising” middle class voters Varadkar was smart enough to realise that his preferred Thatcherite policy of reliance on an Invisible Hand of market forces could lead to a public health disaster during a pandemic.

    Since entering the coalition, Fine Gael Ministers have emphasised a law and order approach – Simon ‘TikTok’ Harris was quick off the blocks denouncing as ‘disgusting, grotesque and obscene’ a comparatively unobstreperous anti-lockdown protest in Dublin by European standards. Fine Gael have also allowed Fianna Fail to act as a mudguard for a failing system of public health: Ireland’s health expenditure is the third highest in the EU, yet we have only 5 ICU beds per 100,000, compared to 35 in Germany and 28 in Austria.

    Fine Gael represents itself as a centrist party, placing emphasis on its belated support for marriage equality and abortion referendums, which obscures from a failure in government to address structural inequalities and ongoing environmental damage. Replacing James Reilly as Minister for Health in 2015 Leo Varadkar promptly abandoned universal health insurance (UHI).

    After becoming leader of Fine Gael and Taoiseach, Leo Varadkar claimed he would represent thrusting early risers – tantamount to saying he would not alter structural inequalities that are most apparent in access to housing. In combination with Fianna Fail, Fine Gael has represented the dominant interest of large property owners, indifferent to whether their wealth is maintained via independent corporate entities, the state, or as in Ireland’s case increasingly, a corporate-state nexus.

    Simple distinctions of left and right are often misleading. Thus, when considering the virtues, or otherwise, of big government it should be clear that administrative levers and patronage may drive inequality; most obviously through mind-boggling salaries, such as the €420k paid to the Director General of a dysfunctional HSE, Paul Reid – ironically a former Workers’ Party activist. Reid has no medical or scientific qualifications, and previously acted as chief executive of Fingal County Council.

    Moreover, left-wing politicians and their supporters are often drawn from higher income groups; a tendency that within Fine Gael circles used to be referred to as noblesse oblige – accompanied by the obligatory glass of fine Cognac – of which the Just Society was the apotheosis. But a left-wing identity may be superficial, as the distribution of state largesse, or patronage, apart from being expressed in high public sector salaries, often benefits established professional elites of lawyers, academics and indeed doctors.

    Leprechaun Economics

    Big government patronage motors along fine in Ireland for all concerned as long as the tech and pharma sectors do the heavy economic lifting. This is the ‘Leprechaun Economics’ that Paul Krugman referred to dismissively. But now the Biden administration’s taxation proposed changes to the global tax system may make the current Irish model unworkable. The ECB is also likely to desist eventually from quantitative easing, with inflation looming.

    Renewed fiscal rectitude and the prospect of multinationals leaving a perpetually unaffordable capital city for workers, will place increasing reliance on those indigenous SMEs that have endured the Crash of 2008, and the unprecedented challenges of the pandemic. Yet whole sectors have been furloughed for over a year, with some such as events and tourism wondering whether they have a future at all. The Central Bank has warned that one in four firms could fail when pandemic payments cease.

    It should be unsurprising, therefore, for a small businessperson living from transaction to transaction to be wary of parties promising higher taxation on the left, and instead be attracted to politicians on the right, or even far-right, that are acquainted with the language of commerce, however superficial this may be, in the case of Leo Varadkar at least, whose concern for SMEs has disappeared after his supportive comments proved unpopular last October.

    An objective for a progressive left should be to attract support from an increasingly marginalised mercantile class, emphasising that a favourable environment for entrepreneurship, as in Scandinavia, is enabled by efficient public service, including a one-tier, functioning health system. The left can argue that leaving healthcare to market forces – as in the U.S. – is not only deeply unfair, but also, crucially, leads to greater costs than a functioning one tier public system which also – as in most European countries – delivers better outcomes overall.

    The inherent danger of Ireland’s two-tier model, where health care provision is subject to market forces is epitomised by a question recently posed by a Goldman Sachs executive: “Is curing patients a sustainable business model?” In an age of profound health insecurities – which are amplified through subtle advertising cues – market forces will continue to distort public health priorities.

    It was the father of economics Adam Smith who warned: ‘People of the same trade seldom meet together, even for merriment and diversion, but the conversation ends in a conspiracy against the public, or in some contrivance to raise prices.’ However, while resisting a buccaneering tendency in the delivery of a vital government service such as healthcare, the left cannot afford to dismiss the dynamism of entrepreneurship in society at large. Just imagine the food you would be served if the government was running all the restaurants.

    Following Public Health Guidance

    While there are a range of financial supports available to SMEs, the world-beating length of Ireland’s lockdown has made trade impossible for many businesses, some of which may never recover. The failure of the two centre-right parties in government to represent their concerns arguably, lies at the heart of Ireland’s deeply flawed response to the pandemic.

    From March to June, 2020, 96% of additional deaths related to COVID-19 in Europe occurred in patients aged older than 70 years. Yet, despite having the youngest population in the Union, according to a Reuters by February Ireland had endured 163 days of workday closures. This was the highest, by some measure, of all the European countries surveyed at that point. By contrast, Denmark had lost just fifteen days, having experienced a death toll almost half that of Ireland’s per capita.

    The uncritical attitude of mainstream Irish left wing parties towards public health officials should also be reconsidered. Recall the major mistakes in particular by Chief Medical Officer Tony Holohan, who saw nothing wrong with fans going to Cheltenham in early March, 2020, ordered care homes to re-open to visitors that same month, and then transferred 4,500 untested patients back into care homes – surely contributing to the second highest level of care home mortality in the world during the first wave. Yet Irish left wing politicians have consistently complained about the government failing ‘to follow public health advice,’ despite Holohan’s long history of cock-ups and cover-ups.

    Even before Christmas NPHET – a body composed primarily of career civil servants and notably short on scientific expertise – seemed to have been all on board for the ’meaningful Christmas’ of Micheal Martin’s imagination. The only significant deviation between the government’s approach and NPHET’s advice was that the latter preferred to permit household gatherings rather than opening the hospitality sector. Cue raucous Christmas house parties, as opposed to what were mainly orderly affairs in pubs and restaurants.

    In fact, Ireland’s ‘third’ wave, which coincided with the more transmissible B.119 variant (although apparently not more lethal as was widely reported) actually commenced in week 48 of 2020 (22/11/2020), while the country was still under Level 5 Lockdown restrictions, according to a report by the HSPC.

    Sadly, public health obscurantism has also brought denial of their own data, which said outdoor transmission of Covid-19 is about as frequent as curlew sightings.

    The latest embarrassment over NPHET refusing to acknowledge the benefits of antigen testing, underlines that if left-wing politicians are slavishly going ‘to follow the public health advice,’ and whatever Yes Minister civil servant advises then we won’t see radical reforms in Ireland any time soon.

    Frank O’Connor

    Guests of the Nation

    Over the course of the pandemic Irish attitudes have hardened against the free movement of people in and out of the country, culminating in the introduction of mandatory hotel quarantines for some foreign, including EU, arrivals at the end of February.

    Contemporary Irish attitudes to hardworking foreigners resident in Ireland recall Frank O’Connor’s classic 1931 short story ‘Guests of the Nation.’ Set during the War of Independence 1919-21 it portrays a bond of friendship that grows up between two IRA men, Bonaparte (the narrator), and Noble, who are detailed to guard two captured English soldiers Belcher and ‘Awkins who have a natural affinity with the country:

    I couldn’t at the time see the point of me and Noble being with Belcher and ‘Awkins at all, for it was  and is my fixed belief you could have planted that pair in any untended spot from this to Claregalway and they’d have stayed put and flourished like a native weed.

    Ultimately ‘Awkins and Belcher are sacrificed at the altar of of a narrow nationalism, just as a today the Populist appeal to ‘protect our own people’ has ordained that the rights of immigrants in Ireland, and abroad, to see their families was disregarded.

    This appears to stem from a widespread notion that ‘we,’ like faraway New Zealand and Australia, can eliminate the disease from ‘our’ shores altogether – devolving into the juvenile #wecanbezeros hashtag adopted by some politicians on the left. The problem is that ‘we’ are a society with lots of ‘them’ immigrants living here, and an enormous diaspora of ‘us’ beyond the shores of an island divided into two jurisdictions, highly dependent on international trade in goods arriving on trucks (with drivers).

    Moreover, apart from the extreme geographic isolation and sparse populations of Australia and New Zealand, ‘we’ in Ireland have legal obligations to preserve freedom of movement under European treaties and the Good Friday Agreement, enshrining a porous open land border. Apart from committing economic hari-kari, pursuit of ZeroCovid appears legally impossible, unless of course we want to pursue an Irexit and build a wall along the Northern border.

    Nonetheless, egged on by febrile – ‘if it bleeds it leads’ – coverage in a national media increasingly reliant on government advertising, a prevailing view is that all deaths from Covid are essentially preventable; emanating from the failing of the state, or the reviled Covidiot, rather than being the tragic consequence of a pandemic, the death toll from which has been systematically exaggerated.

    Moreover, intercepted correspondence within the ZeroCovid ISAG group of independent scientists – who have taken on the Opus Dei role to the Catholic hierarchy of NPHET – reveals, among other disturbing insights, that they were looking ‘for ways to increase insecurity, anxiety and uncertainty.’ As these revelations first appeared in right-wing Gript, however, the left-wing echo chamber refuses to acknowledge it is being played.

    Are you right there Michael?

    Nonetheless, a number of politicians have come forward representing an anti-authoritarian left, concerned by the harms of lockdown and favouring a targeted approach – protecting the elderly – and building up ICU capacity. In a recent blistering Twitter attack the independent (and former Labour) TD for Clare, barrister Michael McNamara – who as chair of the Oireachtas Committee on Covid-19 Response became as well acquainted as any Irish politician with diverging epidemiological assessments of the pandemic – identified a recurring Irish deference to vested authority.

    In response to a Fintan O’Toole article critiquing the DUP McNamara wrote: ‘Instead of criticising unionism, let’s look at the complete mess we’ve made of Irish nationalism and nationhood. We’re ruled by a junta of medics, just as we were Rome Ruled for 7 decades. The Orthodoxy changes but the crawthumping remains the same.’

    He continued: ‘If it wasn’t for Unionism, we’d be like Hoxha’s Albania now. There’d be no way off this island. But there is a beacon. Belfast Airport and Larne are beyond the reach of NPHET, just as surely as the rule of the Archbishop’s palace in Drumcondra didn’t pass the bridge in Portadown.’

    He added more controversially:

    ‘We can’t blame the medics for their experimental therapy, any more than we could blame the clergy for their zeal.  Successive governments have abdicated their democratic responsibility throughout this State’s short history. So why would Unionists want to be “governed” by Dublin?’

    It was a fair question, when one considers the North is reopening far sooner than the Republic. Although this has arrived after a rapid vaccine rollout, the experimental nature of which McNamara raises problems with.

    Facing Up to Errors

    Here we come to the crux of an unhelpful cultural division between left and right that the ruling parties will use to divide and conquer. This is the new identity politics arising out of the pandemic, epitomised by attitudes towards face masks.

    For too many on the left the science on this issue is proven as opposed to followed. Wearing a face mask now appears to have become an article of faith. Yet a recent report by the European Centre for Disease Control and Prevention entitled ‘Using face masks in the community: first update – Effectiveness in reducing transmission of COVID-19’ stated:

    The evidence regarding the effectiveness of medical face masks for the prevention of COVID-19 in the community is compatible with a small to moderate protective effect, but there are still significant uncertainties about the size of this effect. Evidence for the effectiveness of non-medical face masks, face shields/visors and respirators in the community is scarce and of very low certainty.

    Additional high-quality studies are needed to assess the relevance of the use of medical face masks in the COVID-19 pandemic.

    Moreover, the Irish left should consider our dependence on pharmaceutical behemoths that jealously guard intellectual properties, notwithstanding huge state aid grants, and indemnification against adverse reactions. It is akin to the dependence of small farmers in developing countries on genetically modified seed, under a model of Philanthrocapitalism overseen by Bill Gates, who according to a recent article by Alexander Zaitchik has shown “a lifelong ideological commitment to knowledge monopolies,” and devotes hundreds of millions of dollars each year to whitewashing his reputation through “charitable” media grants.

    Moreover, all too often, media debates around Covid-19 fail to acknowledge the link between pre-existing morbidities – ‘underlying conditions’ – and morbidity and mortality from Covid-19. Thus, US Studies have shown that having a BMI over 30—the threshold that defines obesity—increases the risk of being admitted to hospital with covid-19 by 113%, of being admitted to intensive care by 74%, and of dying by 48%, making it almost as relevant a consideration as having been vaccinated.

    In Ireland, moreover, Mayo coroner Patrick O’Connor recently questioned the attribution of deaths to Covid-19, saying: ‘In reality, a lot of people have terminal cancer or multiple other serious co-morbidities. People can die from Covid and or with Covid. I think numbers that are recorded as Covid deaths may be inaccurate and do not have a scientific basis.’

    https://twitter.com/SunTimesIreland/status/1383791062846562307

    Furthermore, by embracing ZeroCovid Utopianism many on the Irish left failed to focus on the failings of a decrepit Irish health system. This epitomises a tendency among politicians to dance to the tune of a corporate media that has placed relentless focus on the disease itself, regularly interviewing mendacious ISAG figures, while generally ignoring underlying social and environmental factors that drive morbidity and mortality.

    The canard that Ireland could simply shut its borders and reach ZeroCovid perhaps points to the need for reform of an Irish secondary educational system, which according to the a rather unkind assessment from the OECD’s Andreas Schleicher is designed to produce ‘second-class robots.’ Perhaps too many of us are lacking the requisite critical faculties to look beyond news headlines.

    In fact a radically different, defiantly left-wing approach to the pandemic been put forward by, among others, Harvard epidemiologists Katherine Yih and Martin Kuldorff in The Jacobin. They pointed out:

    Elites have seen their stock portfolios balloon in value, and many professionals have been able to keep their jobs by working from home. It is the country’s poor and working-class households, particularly those with children, who have borne a disproportionate share of the burden. Lower-income Americans were much more likely to be forced to work in unsafe conditions, to have lost their livelihoods due to business and school shutdowns, or to be unable to learn remotely.

    Beyond ZeroCovid, the Irish left should emphasis the harms of Ireland’s reliance on lockdowns, and harness the malcontents of the poorest, including small business owners. Otherwise they court irrelevance as the traditional ruling parties have already taken on the role of ‘caring’ for the people, while retaining the power to ease restrictions in the face of opposition from the left.

    Science and Technology are not Neutral

    Also, as opposed to running in fear from being labelled anti-vaxxers by a cheerleading corporate media, the left might at least consider the wisdom of foisting vaccines that have been granted under emergency use conditions on all age groups. Indeed, many on the left in Ireland seem unwilling to question dominant institutional narratives, a tendency recently criticized by the Greek socialist Panagiotis Sotiris in The Jacobin, who said: ‘What is missing here is something that used to be one of the main traits of the radical left, namely, an insistence that science and technology are not neutral.’

    It remains unclear whether universal immunization will bring about long-term ‘herd’ immunity; while in the absence of long-term safety data the benefits to young, healthy subjects of vaccination may not outweigh the cost in terms of adverse events from treatments granted under emergency use licences. Sober assessment seems to have given way to an ideological and, at times, a coercive approach.

    In terms of the efficacy of the Pfizer vaccine, writing in the British Medical Journal, Peter Doshi, pointed to how in the media ‘a relative risk reduction is being reported, not absolute risk reduction, which appears to be less than 1%’ for severe disease.’ Ollario et al in The Lancet referred to absolute risk reductions of ‘1·3% for the AstraZeneca–Oxford, 1·2% for the Moderna–NIH, 1·2% for the J&J, 0·93% for the Gamaleya, and 0·84% for the Pfizer–BioNTech vaccines.’ The authors also pointed to how ‘considerations on efficacy and effectiveness are based on studies measuring prevention of mild to moderate COVID-19 infection; they were not designed to conclude on prevention of hospitalisation, severe disease, or death, or on prevention of infection and transmission potential.’

    Doshi has also objected to the undermining of ‘the scientific integrity of the double-blinded clinical trial the company—and other companies—have been conducting, before statistically valid information can be gathered on how effectively the vaccines prevent hospitalizations, intensive care admissions or deaths.’  This came after Pfizer pleaded an ‘ethical responsibility’ to unblind its trial and offer those who received a placebo the opportunity to receive its vaccine.

    Doshi argued that ‘there was another way to make an unapproved vaccine available to those who need it without undermining a trial. It’s called “expanded access.” Expanded access enables any clinician to apply on behalf of their patient to the FDA for a drug or vaccine not yet approved. The FDA almost always approves it quickly.’

    An alternative policy would be to reserve vaccines for those most susceptible to severe symptoms – the old and the obese – along with healthcare workers and others unavoidably working around the world in congested environments. Devoting scarce resources to increasing ICU provision to bring us into line with European averages might be a better approach than relying exclusively on the quick fix of the vaccine.

    The Irish left should now desist from identity politics around vaccine uptake that the centre-right is relishing. ‘Tiktok’ Harris previously stoked tensions with talk of mandatory vaccines and promoting vaccine passports. The left should resist vaccine apartheid, nationally and globally, while demanding the release of patents earned through state supports.

    On the Horizon

    Ireland can expect significant social problems to emerge out of our world-beating lockdown strategy that recalls a prior devotion to austerity; a mental health pandemic and mass youth unemployment are upon us already. Moreover, the young are currently denied the safety valve of an easy hop to another English-speaking country for work. This may be a recipe for radicalism, but unfortunately genuinely dark forces on the far-right are ready to pounce on malcontents.

    It is surely vital that we maintain our European connections, thereby scrapping Mandatory Health Quarantine that is an insult to immigrant groups in Ireland, as well as the diaspora. 90% of scientists believe that Covid-19 will be with us forever, so it seems there will always be ‘variants of concern’ to contend with, just as there are with influenza.

    As a country Ireland has serious work to get on with in terms of addressing a housing crisis and improving our environment. A narrow focus on the pandemic should not be allowed to derail these efforts. This may be like a war but it is not a war. Even prior to vaccines, this is a virus with an infection fatality rate of less than 0.2% in most locations. Moreover, up to 86% of those infected may not have symptoms, such as cough, fever, or loss of taste or smell, according to a UK study from October. We require better provision of public health and an adequate plan to address the ongoing obesity pandemic.

    We also need to start thinking more critically — and speaking more cautiously — about Long Covid, considering ‘at least some people who identify themselves as having Long Covid appear never to have been infected with the SARS-CoV-2 virus.’

    We need to start thinking more critically — and speaking more cautiously — about long Covid

    A New Social Contract?

    The pandemic calls for a new social contract to be negotiated in Ireland that acknowledges republican values of Non-Domination; Mixed Government and tolerance of Obstreperous Citizens. The French COVID-19 Scientific Council led the way in a paper for The Lancet:

    it is time to abandon fear-based approaches based on seemingly haphazard stop-start generalised confinement as the main response to the pandemic; approaches which expect citizens to wait patiently until intensive care units are re-enforced, full vaccination is achieved, and herd immunity is reached.

    They continue:

    Crucially, the new approach should be based on a social contract that is clear and transparent, rooted in available data, and applied with precision to its range of generational targets. Under this social contract, younger generations could accept the constraint of prevention measures (eg, masks, physical distancing) on the condition that the older and more vulnerable groups adopt not only these measures, but also more specific steps (eg, voluntary self-isolation according to vulnerability criteria) to reduce their risk of infection. Measures to encourage adherence of vulnerable groups to specific measures must be promoted consistently and enforced fairly. Implementation of such an approach must be done sensitively and in conjunction with the deployment of vaccination across the various population targets, including all generations of society.

    They argue against reliance on lockdowns:

    Using stop-start general confinement as the main response to the COVID-19 pandemic is no longer feasible. Though attractive to many scientists, and a default measure for political leaders fearing legal liability for slow or indecisive national responses, its use must be revisited, only to be used as a last resort.

    To date, many on the Irish left appear to have had their heads in the sand promoting a Utopian ZeroCovid solution. This should give way to a more balanced appraisal that considers the interests of all of Irish society. With the youngest population in Europe, and as one of the richest countries, the Irish government could have preserved a far higher standard of living for the population during the pandemic. We now need to draw up a social contract that takes a more balanced approach.

    Featured Image: Daniele Idini

    [i] O’Toole, Fintan (editor), Up The Republic: Towards a New Ireland. Faber and Faber, London, 2012, p.1-52.

    [ii] Arendt, Hannah, The Origins of Totalitarianism, Penguin, London, 1966, p.22

    [iii] Eric Hobsbawm, How to Change the World, Tales of Marx and Marxism, Little, Brown, London, 2011, p.79

  • Covid-19 in Ireland: Landfall

    In August of last year I wrote an article pointing to the impending consequence of the Irish government’s rolling lockdown policy, ‘The Perfect Storm’[i] gathering on the horizon over the country. By that I meant a significant second wave of Covid-19 – to hit this winter. I made that prediction based on the following factors:

    An elevated number of potential viral hosts, which is a consequence of suppression of natural-immunity.

    Increased life of the virus in the external environment due to decreased daylight

    Raised levels of social anxiety and subsequent susceptibility to illness/infection

    Continued persistence of the virus at low levels within Irish society

    The ‘storm’ made landfall at the start of January, leading to the imposition of an extreme lockdown for the third time – with children denied their constitutional right to an education –  amid renewed fears the hospital system would be overwhelmed, as many elderly in care homes passed away once again.

    Sadly, this ‘third’ wave actually commenced in week 48 of 2020 (22/11/2020), while the country was still under Level 5 Lockdown restrictions, according to a report by the HSPC.[ii]

    Could additional deaths have been averted if the Taoiseach had not sought ‘a meaningful Christmas’; or if NEPHT’s advice had been followed to the letter – permitting house visits rather than opening restaurants and gastropubs[iii] at the start of December? Based on the HSPC report that seems doubtful. And I would question whether most Irish people would have willingly foregone sociability throughout the depths of winter – there was certainly no political clamour to cancel Christmas – having endured near-constant lockdown since March. But you never know.

    Furthermore, without a Christmas spending spree many indigenous retailers and restaurateurs might have been forced out of business – to the unrestrained joy of Jeff Bezos, Tescos and the rest.

    But in Ireland, as ever, we desperately need someone to blame third time round; anyone other than NPHET that has managed to preserve a reputation for scientific insight despite the damage it is doing to the country. So, instead of questioning the government’s response, youngsters – who may have availed of a brief chink of light to socialize – are scapegoated.

    Other than that we find talk of selfish immigrants returning home over Christmas to see loved ones. And now attacks on those who escaped the overwhelming doom and gloom for a post-Christmas break. Yet, whatever one’s thoughts on the sustainability of flying, it is notable that just 1% of cases since the pandemic began have been traced to travel abroad.

    Lockdown Policy

    In the midst of any crisis scientific arguments compete to establish the best way forward. In the case of Covid-19 in Ireland ‘the argument’ has been remarkably one-sided. Discussions in the media are generally over the severity of lockdowns to be employed – this hitherto unheard of public health intervention with enormous collateral damage, which has somehow been normalised.

    From the outset I have been convinced that the Irish government at the prompting of the WHO – along with most other Western governments – adopted an erroneous approach, based on a flawed epidemiological assessment, which led Leo Varadkar to suggest there could be a staggering 85,000 deaths[iv] in Ireland.

    Virtually alone in Europe, the Swedish health authorities (relatively free of political interference) stood apart, refusing to lockdown in March, 2020. I would argue that this softer approach has been to the benefit of the vast majority of people living there – and may even lead to a lower death toll in the end – compared to the trauma of lockdowns experienced by citizens in most other European countries.

    Notably, during the first wave almost 92% of confirmed deaths from Covid-19 in Ireland were among over sixty-five-year-olds,[v] and when this Irish cohort is compared to Sweden’s considerably older population a very different picture emerges; in contrast to the usual truck of ‘deaths per capita’ and ‘deaths per million.’

    Hats off to the impressively organised states of Norway and Finland, where Covid-19 mortality has remained very low indeed, but vigorous track and trace strategy operating in these countries have proved ineffective elsewhere; even Germany is floundering this winter, having been locked down for months.

    Revealingly, in March 2020 the Director-General of the Norwegian Institute for Public Health Camilla Stoltenberg[vi] recommended that her government should keep schools open – as in Sweden – and was advocating last June for a softer approach in the likely event of a second wave.

    Now, as the death toll from Covid-19 in Ireland steadily converges with Sweden’s – especially when adjusted for the relative age of each population – it remains to be seen whether much-vaunted, but still experimental, vaccines will significantly alter the respective death tolls.

    I maintain that a policy of keeping the Irish population under rolling lockdowns until the whole population is vaccinated will have a worse impact on the nation’s long-term health than any mortality or morbidity that may be avoided.

    Zero Covid Utopianism

    The frankly bizarre ‘option’ of Zero Covid-19 that has been grasped by some on the left, and the right, in Ireland is a form of Utopianism. It ignores the virtual impossibility of eradicating an aerosol, sub-microscopic pathogen such as Covid-19 from Ireland. Moreover, we remain one of the most globalized societies in the world with over half-a-million foreign born resident in the country[vii] and an Irish-born diaspora of three million;[viii] rely on international trade for most commodities; besides having a porous border to the North.

    Moreover, New Zealand and Australia are currently enjoying summer, when respiratory viruses retreat. This seasonal effect is enhanced by a depleted ozone layer over the Southern Hemisphere – causing the world’s highest rate of skin cancers[ix] – which elevates the level of UV light that destroys viruses. Both countries are also insulated from the rest of the world by vast oceans and an uninhabited landmass. Even still, outbreaks occurred in New Zealand and Melbourne last winter, prompting draconian responses.

    Notably, however, the maximum number of cases that Melbourne – with a population almost the size of Ireland’s – experienced in a single day was just seven hundred, and it required an extreme 112-day lockdown[x] – and/or the arrival of spring before an apparent elimination. In contrast, case numbers in Ireland have exceeded eight thousand in a single day.

    Covid-19: Southern Dreaming

    A Zero-Covid approach assumes the island of Ireland is sealed hermetically. Good luck with telling the DUP that they have to follow the rules of the South! And ‘success’ would presumably give way to a permanent state of siege against the viral dangers posed by the outside world.

    At this point even New Zealand’s Prime Minister Jacinda Arden has had enough, acknowledging the long-term impossibility of pursuing Zero Covid she recently said: ‘Our goal has to be though, to get the management of Covid-19 to a similar place as we do seasonally, with the flu. It won’t be a disease that we will see simply disappear after one round of vaccine.’[xi]

    Comparing Ireland to East Asian countries may also be inappropriate as, Wuhan apart, no single country in that region has experienced a significant outbreak. Notably, Japan, which has avoided locking down throughout the crisis experienced forty times as many flu and pneumonia deaths during that period. This suggests other factors – East Asia has been the geographic origin of several modern coronavirus epidemics – may be inhibiting the spread of Covid-19 there.[xii]

    Yet this message has not trickled either left or downwards into popular opinion as the Irish Times continues to print articles in support of ‘the plan’.[xiii]

    ‘Zero Covid’ is as much a vote-winner, as a zero tolerance for crime or any other virtuous objective, but it’s political claptrap from an taxidermized left and a neoconservative right, furnished by scientists that seemingly have no conception of biological realities.

    Reality Bites

    The success of any institution might be summed up by the notion that it is only as good as its ability to predict the future. Throughout human history we have had two powerful methods of prediction: science and religion. If not religion, we might define this in terms of ‘faith,’ or an ‘unscientific’ belief system of some kind or other.

    If the Romans, the Egyptians, the Spartans, or the Native Americans, had done a ‘better’ job predicting the future, the world would be a different place. Thus, the success or persistence of any individual, nation, or civilisation, is based on an ability to reliably predict the future. Our faith in science is strengthened solely by this condition, and undermined when predictions go awry.

    Galileo Galilei, 1636 portrait by Justus Sustermans.

    Galileo’s prognostications in respect of the Earth and the Sun led him into conflict with the dominant powers of his day. The accuracy of his predictions disturbed the established cosmic order, as any heresy does. The predictions of Einstein had a similar effect on Newtonian Physics, and now Quantum Mechanics has become the sacred cow. Final judgements on the success or otherwise of policies are, of course, made through the prism of hindsight.

    Two Schools of Thought

    At present around the world there are two broad scientific schools[xiv] of thought in respect of how to respond to Covid-19. On one side there is a dominant view: that we are in the midst of a once-in-a-lifetime crisis, where humanity is dealing with a virus that will kill, and perhaps permanently incapacitate, many millions more than it has already done; and that the correct response for any government should be to impose a lockdown and mandate masks until the ‘scientific cavalry’ arrive, carrying their novel genetic vaccinations as shields to save the day.

    On the other side there are the conspiracy theorists, Covid-deniers, and a minority of scientists who consider most most masks in use to be ineffective, and who argue that restrictions and lockdowns cause more harm than good. These scientists have advocated protecting the vulnerable and permitting an equilibrium of natural immunity to emerge within the non-vulnerable majority as the least harmful way forward.

    The question for ordinary people and politicians, then, is where does the truth lie? Or, more accurately, who is correctly predicting the future?

    When the dust settles in a few years, perhaps we’ll see that the truth lies somewhere in the middle. An appreciation of a middle way, or synthesis, is evident in Sweden’s chief epidemiologist Anders Tegnell’s acknowledgement in June that mistakes were made in the first wave.[xv]  Such concessions to human fallibility seem to be the preserve of Scandinavian leaders. This may explain why increased restrictions have been introduced in Sweden during their second wave, though its government has refrained from imposing a lockdown, and the emphasis is still on personal responsibility.

    By the start of February, without a lockdown, Sweden appears to be sitting pretty with the death toll falling precipitously during the month of January, suggesting a herd immunity threshold may have been reached.

    [An earlier version of this article read: “surveys indicate that at least forty percent of the [Swedish] population now have antibodies to the virus,[xvi]” We have sought corroboration from Sebastian Rushworth MD @sebrushworth, having been advised that this claim is unreliable]

    Likewise, there are positive signs that India has now reached a herd immunity threshold,[xviii] without recourse to vaccines.

    Benefit of Hindsight

    Last April I resigned my position on the Irish Medical Council to the shock of family, friends and former colleagues. I did so because I believed a catastrophe was immanent, and that hundreds of nursing home residents would die as a consequence of political ineptitude and mass hysteria. As it transpired, 62% of deaths in Ireland occurred in this setting during the first wave of the pandemic, the second highest proportion in the world.[xix]

    I take no comfort that my fears were realised, and have since also resigned as a contracted employee of the HSE. I could no longer, in good conscience, enforce guidelines upon staff and patients I do not consider either efficacious or ethical.

    I would argue that a failure to conduct a proper inquiry into the decision-making that led to this carnage has led to avoidable mortality in this second wave in the care home setting. Any enquiry would surely have highlighted the inadequacy of safety protocols in these settings, and the absence of real expertise on NPHET.

    Before my small Covid-19 rebellion, in March 2020, I circulated a paper on the response to Covid called The Mismanagement of Covid-19 in Ireland. Its premise was (and remains) quite simple: that Covid-19 is a viral illness with a mortality confined to a relatively small and manageable subset of our population.[xx]

    I argued that Ireland’s gross demographic – the youngest population in Europe – is (and was) the key to navigating a safe path through the crisis. With a relatively low population of over sixty-fives – approximately 650,000 – this amounted to a manageable population of those truly vulnerable.

    I also noted how, unlike during influenza pandemics of the past, children and young adults were not dying of this disease, and that the vast majority of adults without serious underlying conditions were also relatively (if not entirely) immune to significant consequence.

    Long Covid

    A current cause for concern with Covid-19, which may be deterring our governments from permitting younger people from resuming their lives is so-called ‘Long Covid,’ or Covid ‘Long Haulers’ as this is referred to in the U.S..

    This is a condition that appears to fit within the category of a post-viral syndrome, or post-viral fatigue;[xxi] which is ‘a sense of tiredness and weakness that lingers after a person has fought off a viral infection. It can arise even after common infections, such as the flu.’

    In October one of the leading advocates for Long Covid patients, and a firm advocate of draconian policies, Oxford University’s Professor Trish Greenhalgh clarified that Long Covid is only very rarely a long-term affliction:

    The reviews we’ve done seem to suggest that whilst a tiny minority of people, perhaps one per cent of everyone who gets Covid-19, are still ill six months later, and whilst about a third of people aren’t better at three weeks, most people whose condition drags on are going to get better, slowly but steadily, between three weeks and three months.[xxii]

    But a paper from 2017 gives an idea of the pre-existing scale of chronic and post-viral fatigue syndrome in the U.K.:

    Fatigue is a symptom of a number of diseases—anaemia, depression, chronic infection, cancer, autoimmune disorders and thyroid disorders among them. But no apparent cause can be found for a state of extreme and disabling exhaustion that has acquired a number of names, the most generally accepted worldwide being chronic fatigue syndrome (CFS). In the UK, where it is (often incorrectly) known as ME (myalgic encephalomyelitis), 150 000 people are said to be affected. Other terms used for the condition are postviral fatigue syndrome (PVFS) and chronic fatigue and immune dysfunction syndrome (CFIDS).[xxiii]

    So, we can conclude that Long Covid is hardly a new phenomenon, and while the pandemic is likely to create an additional burden on health services, the extent of the problem needs to be put in context: perhaps one percent of sufferers are still ill after six months.

    Moreover, the impact of Covid-19 is significant heightened by environmental factors such as air quality[xxiv] and poor nutrition. I would argue, therefore, that the threat of Long Covid is insufficient grounds for closing universities and denying young people the chance of a social life beyond walking the block.

    Indeed, the obesity pandemic that leads to a wide range of morbidities is a far greater challenge to this nation’s health, and a crucial indicator of an individual’s risk of severe case of Covid-19 .[xxv] Yet there has been no serious attempt since the Covid-19 pandemic began to address how Ireland fails to adopt international best practice for addressing obesity.[xxvi]

    Seasonality

    In my March paper I also observed that Covid-19 is a member of the coronavirus family responsible for many common colds,[xxvii] and that such viruses are seasonal, in that they are eliminated especially by increasing UV light (and the population’s tendency to retreat indoors). These were hardly earth-shattering revelations, and have been noted by many other doctors and scientists around the globe.

    I also compared the population of over sixty-five-year-olds in Ireland, to the equivalent cohort in the U.K., noting there are roughly twenty-times the number of over sixty-five in the UK (while the overall population is less than ten times that number); so I assumed U.K. mortality would be in the region of twenty times that of Ireland’s.

    In this respect, Ireland has performed significantly better than the U.K., but other factors such as population density and an elevated risk of severe disease among BAME groups[xxviii], may account for the  higher relative death toll there. It should also be emphasised that the U.K. has almost the highest rate of mortality in the world.

    ICU Capacity at the beginning of the pandemic.

    Like many other doctors and scientists, I argued that in the absence of a proven cure or vaccine at that time for Covid-19, humanity is (or was) very much operating at the whim of nature. Thus, without a cure we were (and to a certain extent still are) subjected to natural forces, as I assumed this virus would spread widely through the population. All we could do, then, was ‘flatten the curve,’ protect the vulnerable, and await a safe vaccine.

    At the outset of the crisis that was the mantra behind which the public united. Flattening the curve would reduce the rate at which the vulnerable would present for treatments in hospitals. This would protect the system form being overwhelmed, bringing an increased chance of survival for those badly afflicted.

    ‘Protect the NHS’ from collapse was a similar cry across the water. That made sense at the outset of the crisis. The reiteration of these ‘priorities’ might now illicit a yawn, as our national health authorities did not use the flattened time and space to increase ICU capacity substantially, which brings the ‘necessity’ of recurring lockdowns.

    Hysteria

    Since March of last year events have taken a strange turn. With fear and hysteria at the helm politicians lost their nerves. The mantra shifted from ‘flatten the curve’, to ‘protect everyone from this deadly disease,’ despite it becoming clear that the infection fatality rate (IFR) is considerably lower than the 0.9% assumed initially. Now a paper on the WHO website states that the infection fatality rate for the disease is less than 0.2% ‘in most locations.’[xxix]

    Perversely, children have become the focus of inordinate efforts; locked indoors, locked out of school and forced into wearing masks. We have insisted upon protecting them from a disease that has not caused a single child death in Ireland throughout the entire crisis.[xxx]

    Troublingly, when Covid-19 panic gripped the nation, politicians and mainstream media listened only to the scientific ‘authorities’ that fed the hysteria and justified everything from political incompetence to profligate expenditure. Hospitals were emptied in preparation for an approaching ‘tsunami’ of illness, as tens of thousands of deaths were incorrectly predicted by politicians and esteemed professors, all of whom continue to profess, and have even grown in esteem.

    Covid patients were dumped from hospitals into Nursing Homes, and tests were withheld from residents lest they run short for the healthy-hysterical. The vulnerable were not only abandoned, but too many of them were crushed in the stampede.

    Thus, there is the shocking case of a resident in a Meath care home discovered to have had a maggot-infested a wound.[xxxi] What began as a campaign to protect the vulnerable, had turned into nothing short of a manslaughter machine.

    At the End of the Day

    The natural endpoint for viral infection in respect of many viral pathogens is of course ‘herd immunity.’ This is the point where a sufficient proportion of a population have been exposed to and develop full or partial immunity to a particular pathogen, such that its rate of reproduction is below 1 most of the time.

    With insufficient hosts, a virus can no longer spread easily. This is not full elimination but an endemic equilibrium within the population, with a certain annual death toll tolerated – such as is the case with influenza, which kills up to a thousand people a year in Ireland, despite the availability of a vaccine.

    This natural evolution, or pathogenesis, is also helped along by the seasonal shift from spring to summer. Increasing daylight reduces the level of viral particles, and people spend more time out of doors, or ventilate their living spaces in warmer conditions. This is how nature brings an end to seasonal colds and flus. Yet curiously this basic piece of natural science was largely ignored in March. Talk of UV light became highly politicised and thence poisoned.

    The Swedes

    Sweden provided a template for a country acting within the bounds of common sense and science. From the outset health authorities there endeavoured to protect a vulnerable aged cohort, leading to a natural-immunity developing within the population. In permitting this to occur they also took the precaution of doubling ICU capacity[xxxii] which, like Ireland’s, had been among the lowest in Europe when the pandemic began.

    Comparison between Sweden and Ireland cannot be made on a like-for-like basis, any more than the Irish can be compared to any other national group; however, some relevant comparisons can be drawn in respect of population demographics.

    Sweden has twice Ireland’s population, but 3.2 times the number of over sixty-five-years-olds. Ireland has not quite experienced just over a third of Sweden’s mortality (11,815 v 3,418); but while Ireland’s death rate from Covid-19 has been steadily increasing over the month of January, Sweden’s has flattened to point where, according to the WHO, Sweden’s death toll has been in single figures since the start of February, while Ireland has been experiencing daily deaths over one hundred.

    Source: WHO

    There may be a further uptick in Covid deaths in Sweden once schools reopen – and even a third wave – but the hopeful signs are that the country is now reaching a herd immunity threshold – one that has brought less suffering overall when compared to other jurisdictions.

    A similar comparison can be drawn between Sweden and most other European states, implying, in most situations, that mortality is not significantly reduced by lockdown policies. Yet invariably whenever one reads about Sweden in mainstream Irish media[xxxiii] comparisons are only drawn with best-in-class Scandinavian neighbours, where lockdowns have also been, for the most part, avoided.

    Lockdowns are likely to increase mortality through missed cancer screenings, dysfunctional health services, serious mental health impacts, besides the ‘shadow-pandemic’ of domestic violence that has occurred under lockdown.

    The writing on the wall?

    What of the good people on the opposite side of the Swedish argument? It is fair to say that lockdowns can flatten the curve. This is apparent if we compare mortality graphs on the Euromomo website that tracks excess deaths across Europe. It shows that Sweden did not see the same kind of spike on their graph of mortality during the first wave as in other countries that locked down, but experienced a steady decline, which in July led the New York Times to state prematurely that ‘Sweden Has Become the World’s Cautionary Tale’[xxxiv]

    Source: Euromomo.

    The question is whether the short-term benefits of lockdowns in terms of averted-deaths are worth the cost? Or, were lockdowns necessary, and will they ultimately translate into lives being saved rather than simply deferring deaths? Perhaps the truth lies in the middle of these arguments but I know which side I lean.

    Lockdowns do not prevent deaths, but slow the rate of infection and mortality. They can only ease the burden on hospital or tertiary care services. The purpose of lockdown should be to insure that the sick can access the best treatment available, and should not be ‘a primary means of controlling the virus’[xxxv] according to leading authorities in the WHO, as we are experiencing in Ireland.

    Although the mortality figures in Ireland still lag behind Sweden’s I suspect this is deferred mortality and does not represent patients who have been cured or saved. The curve has been flattened. Thus far, lockdown policies have had the beneficial effect of decreasing mortality by less than 20% compared to Sweden’s when adjusted for our respective age profiles. In my view, however, what may simply be deferred mortality, cannot justify the burden of lockdowns on the wider population.

    Only when the crisis has passed, and with the benefit of hindsight, will it be possible to determine if the Swedes broadly got things right. Although, it is more appropriate in the context of a disease that has killed thousands of people – and caused suffering to most of the rest of the population – to state that some countries will have managed it better than others. For sure, no one will have got everything ‘right’.

    Assuming vaccines do not represent a panacea, if it transpires that most Irish mortality is confined to the nursing home sector, and that all lockdowns accomplish is to preserve a larger number of potential hosts for successive seasonal resurgences then the pandemic will have been a more painful and long-running saga in Ireland than it might otherwise have been.

    [i] Marcus de Brun, ‘The Perfect Storm’, Cassandra Voices, August 19th, 2020, https://cassandravoices.com/science-environment/covid-19-the-perfect-storm/

    [ii] Epidemiology of COVID-19Outbreaks/Clustersin IrelandWeekly Report Prepared by HPSC on25thJanuary 2021, https://www.hpsc.ie/a-z/respiratory/coronavirus/novelcoronavirus/surveillance/covid-19outbreaksclustersinireland/COVID-19%20Weekly%20Outbreak%20Report_Week032021_25012021_WebVersion_final.pdf

    [iii] Digital Desk Staff, ‘Opening hospitality will mean limiting Christmas gatherings, Nphet warns’, November 26th, 2020, Extra.ie, https://www.breakingnews.ie/ireland/nphet-strongly-opposed-to-parts-of-governments-lockdown-exit-plan-1042387.html

    [iv] ‘Up to 85,000 Irish people could die from coronavirus in worst-case scenario, Taoiseach indicates, as three more diagnosed’ John Downing, Eilish O’Regan and Gabija Gataveckaite, Irish Independent, March 9th, 2020, https://www.independent.ie/world-news/coronavirus/up-to-85000-irish-people-could-die-from-coronavirus-in-worst-case-scenario-taoiseach-indicates-as-three-more-diagnosed-39029363.html

    [v] COVID-19 Deaths and Cases, Central Statistics Office, https://www.cso.ie/en/releasesandpublications/br/b-cdc/covid-19deathsandcases/

    [vi] ‘Norwegian health chief: we advised against closing schools’, 10 June, 2020, Unherd, https://unherd.com/thepost/norwegian-health-chief-we-advised-against-closing-schools/

    [vii] ‘Census of Population 2016 – Profile 7 Migration and Diversity’, https://www.cso.ie/en/releasesandpublications/ep/p-cp7md/p7md/p7anii/

    [viii] Ciara Kenny, ‘ The global Irish: Where do they live?’, February 4th, 2015, Irish Times, https://www.irishtimes.com/life-and-style/generation-emigration/the-global-irish-where-do-they-live-1.2089347?mode=sample&auth-failed=1&pw-origin=https%3A%2F%2Fwww.irishtimes.com%2Flife-and-style%2Fgeneration-emigration%2Fthe-global-irish-where-do-they-live-1.2089347

    [ix] American Institute of Cancer Research, Skin cancer statistics, https://www.wcrf.org/dietandcancer/cancer-trends/skin-cancer-statistics

    [x] Phil Mercer, ‘Covid: Melbourne’s hard-won success after a marathon lockdown’, 26th of October, BBC, https://www.bbc.com/news/world-australia-54654646

    [xi] Luke Malpass, ‘Jacinda Ardern declares 2021 ‘the year of the vaccine’’, January 21st, 2021, Stuff, https://www.stuff.co.nz/national/politics/124012148/jacinda-ardern-declares-2021-the-year-of-the-vaccine

    [xii] Ramesh Thakur, ‘The West should envy Japan’s COVID-19 response’ January 10th, 2021, Japan Times,  https://www.japantimes.co.jp/opinion/2021/01/10/commentary/japan-commentary/west-japan-coronavirus-response/

    [xiii] Gabriel Scally: It is essential Ireland tightens borders in fight against Covid-19, January 30th, 2020, Irish Times, https://www.irishtimes.com/opinion/gabriel-scally-it-is-essential-ireland-tightens-borders-in-fight-against-covid-19-1.4471283

    [xiv] Sarah Bosley, ‘Covid UK: scientists at loggerheads over approach to new restrictions’, September 22nd, 2020, The Guardian, https://www.theguardian.com/science/2020/sep/22/scientists-disagree-over-targeted-versus-nationwide-measures-to-tackle-covid

    [xv] Rafaela Lindeberg, ‘Man Behind Sweden’s Controversial Virus Strategy Admits Mistakes’, Bloomberg, June 3rd, 2020,  https://www.bloomberg.com/news/articles/2020-06-03/man-behind-sweden-s-virus-strategy-says-he-got-some-things-wrong

    [xvi] Sebastian Rushworth M.D., ‘Here’s a graph they don’t want you to see’, 25th of January, 2021, https://sebastianrushworth.com/2021/01/25/heres-a-graph-they-dont-want-you-to-see/

    [xvii] Sheena Cruickshank  ‘A new study suggests coronavirus antibodies fade over time – but how concerned should we be?’ October 27th, 2020, The Conversation, https://theconversation.com/a-new-study-suggests-coronavirus-antibodies-fade-over-time-but-how-concerned-should-we-be-148957

    [xviii] Amy Kazmin, ‘India’s tumbling Covid cases raises question: Is the pandemic burning itself out?’ February 1st, 2021, Irish Times, https://www.irishtimes.com/news/world/asia-pacific/india-s-tumbling-covid-cases-raises-question-is-the-pandemic-burning-itself-out-1.4472406?mode=amp

    [xix] Fergal Bowers, ‘High percentage of virus deaths in Ireland’s care homes highlighted in comparison report

    [xx] Mismanagement of Covid in Ireland’ May 27th, RTE, https://www.rte.ie/news/coronavirus/2020/0527/1143036-covid-deaths-ireland/

    [xxi] ‘What to know about post-viral syndrome’ Medical News Today, https://www.medicalnewstoday.com/articles/326619

    [xxii] Jennifer Rigby, ‘Why long Covid can be really grim, but is rarer than you think’, October 3rd, 2020 The Telegraph, https://www.telegraph.co.uk/global-health/science-and-disease/long-covid-can-really-grim-rarer-think/

    [xxiii] Postviral Fatigue Syndrome, Science Direct, https://www.sciencedirect.com/topics/medicine-and-dentistry/postviral-fatigue-syndrome

    [xxiv] Matt Cole et al, ‘Air pollution exposure linked to higher COVID-19 cases and deaths – new study’, July 13th, 2020, The Conversation, https://theconversation.com/air-pollution-exposure-linked-to-higher-covid-19-cases-and-deaths-new-study-141620

    [xxv] Meredith Wadman, ‘Why COVID-19 is more deadly in people with obesity—even if they’re young’, September 8th, 2020, https://www.sciencemag.org/news/2020/09/why-covid-19-more-deadly-people-obesity-even-if-theyre-young

    [xxvi] Shauna Bowers, ‘Irish policies to tackle obesity ‘fall behind international best practice’ – report’, November 9th, 2020, Irish Times, https://www.irishtimes.com/news/health/irish-policies-to-tackle-obesity-fall-behind-international-best-practice-report-1.4403921?mode=sample&auth-failed=1&pw-origin=https%3A%2F%2Fwww.irishtimes.com%2Fnews%2Fhealth%2Firish-policies-to-tackle-obesity-fall-behind-international-best-practice-report-1.4403921

    [xxvii] Anthony King, ‘Coronavirus family now a prime suspect in previous pandemics,’ February 4th, 2020, Irish Times, https://www.irishtimes.com/news/science/coronavirus-family-now-a-prime-suspect-in-previous-pandemics-1.4463053

    [xxviii] Tom Kirby, ‘Evidence mounts on the disproportionate effect of COVID-19 on ethnic minorities’, The Lancet, May 8th, 2020, https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(20)30228-9/fulltext

    [xxix] Infection fatality rate of COVID-19 inferred from seroprevalence data

    John P A Ioannidis, WHO, September 13th, 2020, https://www.who.int/bulletin/volumes/99/1/20-265892/en/

    [xxx] (According to the CSO there have been 20,402 confirmed cases of Covid amongst the age group 0-24yrs, during the period from Feb 2020 to December 2020 and not a single recorded death in Ireland. https://www.cso.ie/en/releasesandpublications/br/b-cdc/covid-19deathsandcasesseries18/

    [xxxi] Simon Carswell, ‘Widow ‘outraged’ by footage of husband’s facial wound’, August 26th, 2020, Irish Times, https://www.irishtimes.com/news/health/widow-outraged-by-footage-of-husband-s-facial-wound-1.4338831?mode=sample&auth-failed=1&pw-origin=https%3A%2F%2Fwww.irishtimes.com%2Fnews%2Fhealth%2Fwidow-outraged-by-footage-of-husband-s-facial-wound-1.4338831

    [xxxii] Emma Lofgren, ‘’The biggest challenge of our time’: How Sweden doubled intensive care capacity amid Covid-19 pandemic’, June 23rd, 2020, The Local, https://www.thelocal.com/20200623/how-sweden-doubled-intensive-care-capacity-to-treat-coronavirus-patients

    [xxxiii] Suzanne Cahill, ‘Coronavirus lockdowns are still a step too far for Sweden’, February 3rd, 2021, Irish Times,  https://www.irishtimes.com/opinion/coronavirus-lockdowns-are-still-a-step-too-far-for-sweden-1.4473119?mode=sample&auth-failed=1&pw-origin=https%3A%2F%2Fwww.irishtimes.com%2Fopinion%2Fcoronavirus-lockdowns-are-still-a-step-too-far-for-sweden-1.4473119

    [xxxiv] https://www.nytimes.com/2020/07/07/business/sweden-economy-coronavirus.html

    [xxxv] Michelle Doyle, ‘WHO doctor says lockdowns should not be main coronavirus defence’, October 12th, 2020, ABC, https://www.abc.net.au/news/2020-10-12/world-health-organization-coronavirus-lockdown-advice/12753688