Covid three years on: Is it time for an official review of Ireland’s response?

A little over two years ago, Ireland was plunged into the darkest chapter of the Covid-19 pandemic.

Following Christmas 2020, the virus ripped through an unvaccinated population for a second time, with over a thousand people dying in January alone after being infected.

Early in January, deputy chief medical officer Dr Ronan Glynn appealed directly on RTÉ's Six One news to people, asking them to stay home. He was personally and professionally terrified, telling the nation that the legacy of the “meaningful Christmas” was already unavoidable. “There are many people listening to this programme who are infected and who unfortunately will end up in hospital in the coming days.”

The State’s ICU occupancy peaked in late January at 330 beds, between Covid and non-Covid patients. Surge capacity was 350 beds. Collapse was avoided by daily redeployments of dozens of nurses, and the evacuation of patients to less-busy ICUs by ambulance. At times, the HSE feared it would run out of room in its mortuaries.

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Since then, Ireland slowly marched out of restrictions until they were all ditched almost overnight in early 2022. The intervening period has seen Covid shunted from the centre of political and social life in Ireland, but a settled verdict about how the country handled the pandemic is elusive.

Our lockdowns were also harsher and longer than most comparable countries, and came with enormous costs, but saved many lives. They ensured our healthcare system was only fleetingly faced with collapse but failed to protect many thousands of vulnerable people in congregated settings such as nursing homes. Our economy escaped scarring effects and bounced back strongly, but can the same be said about vulnerable children?

While many other jurisdictions have forged ahead with public, parliamentary or statutory reviews of how they handled Covid, Ireland has not. While the Government is eager to trumpet its pandemic-era achievements, it seems innately nervous about having them scrutinised.

Three years after Covid first emerged, are we any closer to understanding the pandemic, its impact and its legacy?

Healthcare

Many of the answers are unknowable, at least in the short term. But any assessment of Ireland’s response should first deal with what it set out to achieve: was it a success on its own terms? The desired effect of lockdowns was to prevent meltdown in the healthcare system by stopping people from catching the virus, and to avoid serious illness and death.

On this basis, lockdowns worked. A study in the Lancet supports the contention that Ireland had a “good” pandemic, with an extraordinarily low level of excess deaths – among the lowest in the world.

Nonetheless, there is cause for deeper examination of the decisions taken at times. The “meaningful Christmas” decision in November 2020 is the most obvious example, when the Government decided to open shops, restaurants, food-serving pubs and then, a fortnight later, permitted extended families to meet up in the run-up to Christmas.

However, attention should also be paid to decisions such as the mass evacuation of older people from hospitals to nursing homes before widespread testing was in place, and before the symptoms of the virus were fully understood. This step is understandable in the context of what we knew in February and March 2020, when it was assumed ground zero for infection and death would be in hospitals.

Research since, however, has shown that many residential care settings did not have adequate or extensive infection prevention policies in place when the pandemic hit.

The Government has clung tightly to the Lancet study as the main anchor for its defence of its Covid policies, and with good reason – it’s simple to understand and makes the Coalition look good. But no one number can adequately capture even just the healthcare impact of the response. Cancer surgeries fell 30 per cent at the height of the pandemic, hip replacements dropped 19 per cent in 2020 compared to the year before, knee replacements by 29 per cent and cataract operations 37 per cent. In the round, life expectancy has fallen by a year in the EU compared to pre-Covid levels, the biggest drop since the second World War. Experts say cancers are being caught later, with outcomes deteriorating.

Behind closed doors

The lockdowns were harsher and longer than most other comparable countries, yet they were characterised for the most part by strong public support and social cohesion. The anti-lockdown movement in Ireland was relatively small, only really bubbling over on a couple of occasions.

However, the pandemic and associated lockdowns led to many difficulties behind closed doors. ESRI research published this summer showed the pandemic resulted in poorer mental health among young adults. Calls to domestic violence charities and the Garda rose during lockdown. Women’s Aid has said the pandemic had an “unprecedented and exhausting impact” on victims of domestic abuse. Orders protecting victims from domestic violence surged in 2020 compared to 2019.

Most primary school children had very limited remote tuition during the 2020 closures – about 10-30 minutes per day. Students in disadvantaged schools were three times more likely to have disengaged with their teachers during lockdown. A spokesman for the Department of Education said that when schools reopened in 2021, “many children and young people with special educational needs, and those at risk of educational disadvantage, experienced significant challenges in readjusting to school life”. Even in July 2020, the ESRI found disruption to learning would be likely to “have long-term consequences for many, especially for more disadvantaged children and young people”.

The Department of Education does not yet have data showing the extent of any learning loss that may be associated with Covid-related school closures, but expects to have it next year.

Shock response

The economic and fiscal response was unprecedented and has largely been validated by the strong bounce-back in the economy that has been seen, especially in the first half of this year. Billions of euros were mobilised at short notice, with delivery mechanisms to support households and businesses drawn up and put in place almost overnight.

“As a matter of economic policy, I would say it was a success,” says John McHale, professor of economics at NUI Galway. Again, however, it is not straightforward. The huge scale of the Covid response provided a template for subsequent State interventions to help in the face of crises: most notably the cost of living. Its legacy is a new maximalist fiscal doctrine with an enhanced role for the State as successive shocks roil the economy. McHale worries about how appropriate it is for the exchequer to always step in, especially when a period of profound inflation is likely to result in structurally higher prices for some time. He worries that a doctrine for responding to crises, which originated during Covid, is now being applied to situations it is unsuited for.

“It is a dangerous precedent to set that it’s Government’s responsibility to ease the strain no matter what the shock is,” he says, pointing to the need to make exchequer resources available for longer-term challenges such as demographic and climate change.

Timid

Perhaps most confusingly, despite having been through a crisis that cost thousands of lives and billions of euros and dominated the entire public policy arena for two years, progress on any sort of official inquiry is slow.

The Department of Health has commissioned a review of the public health components of the response to Covid-19, “with a view towards strengthening health protection generally and future health pandemic preparedness specifically”, as well as informing the development of public health as a discipline generally. But its content is unknown, despite it having been submitted in September. In October, Minister for Health Stephen Donnelly said the findings were “broadly positive”. The Department of Health said it commissioned a range of reports arising from the pandemic, including an expert panel on nursing homes, a World Health Organisation review of public health functions in Ireland, and several the Health Information and Quality Authority (Hiqa). The HSE said it has made “significant progress” reforming public health and implementing the recommendations of the Nursing Homes Expert Panel report, as well as funding studies and reviewing its model of care and clinical guidelines for long Covid.

However, there appears to be indifference about a formal or central examination of the questions begged by how Ireland confronted Covid, and how the State might handle another big shock. “It’s standard procedure in many ways,” wonders a source involved in managing Ireland’s pandemic response at a senior level, pointing out that medics and soldiers always review incidents where lives are lost in a no-blame way, aiming for improvements.

Other jurisdictions are not so timid. In Northern Ireland, the UK’s Covid-19 inquiry has begun examining the Executive’s decision-making over a nearly 2½-year period, including those made by Ministers. The British inquiry is well under way. The European Parliament has set up a special committee to examine lessons learned, too. In Australia, a senate select committee delivered a report in April this year after sitting for two years. Sweden has appointed an expert commission, while Norway completed a 450-page report last April.

Given the level of tension that existed between the Government and the National Public Health Emergency Team (Nphet) at points, where power relationships were ill-defined and the whole system for deciding on pandemic policy could misfire badly, the political and official system in Ireland seems remarkably disinterested in assessing how this could be improved. Part of this is doubtlessly a well-placed fear about blame games, but such dynamics are not uniquely Irish, and have not prevented other jurisdictions from forging ahead. In France, the inquiry into the country’s pandemic response placed the country’s former health minister and prime minister under investigation.

Tánaiste Micheál Martin, before he left the Taoiseach’s office, was nervous about the chilling effect of any inquiry. “Sometimes people can be looking over their shoulder too much in a time of crisis,” he said, while still saying there would be an “evaluation” of how the country managed during the pandemic. There is a suspicion, however, that the political system at a minimum does not trust itself to hold a mature or useful examination of the crisis or, worse, would rather hope it becomes settled political business rather than risk any awkward blowback.

“When Micheál Martin and co look back and they say we did a pretty good job, that leads to the unquestioned rehabilitation of all of us,” says one person who was involved in the State’s pandemic response at a senior level. “The last thing they want is to have all that coal raked over again.”