A public “trust pothole” that existed before the pandemic developed into a “trust chasm”, former World Health Organisation deputy director general Dr Mike Ryan has told a Covid-19 evaluation forum.
The Sligo epidemiologist, who became a familiar face during the pandemic, recommended countries take a “rapid” response to an emerging epidemic, which “does not mean perfect action”.
The quicker the actions, the more likely the advice to the public will need to change, which can be hard to communicate and leave people “very confused”, Ryan said on Tuesday.
Although trust levels were generally high among the public before the pandemic, and people were willing to implement advice, he said gaps in trust existed at that time and this increased to a “trust chasm” during the pandemic.
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This needs to be examined to ensure rapid actions can be taken during the next public health event and uncertainty can be well communicated, he said.
While technology is much discussed in conversations around future pandemic preparedness, he said the role of communities is key and unless they are prepared “we are going to fail”.
During the pandemic, public health teams “did not trust communities enough” to make decisions about their own risks, such as how many times they visited the shops or whether they took the bus, he said.
It is important to implement lessons from the pandemic, but there is a danger in “trying to find someone to blame”. Such an approach would not bring about change, but would simply lead to blame and righteousness, he added.
He was speaking as part of the independent Irish-focused Covid-19 Evaluation Panel, chaired by Prof Anne Scott, which will submit a report of recommendations to the Government upon conclusion. The non-statutory panel was assigned its work by the Department of the Taoiseach.
Scott noted many of the expert panellists emphasised the pandemic hit “very hard very quickly” and that the role of the public must be taken seriously in decision making.
As effective as the National Public Health Emergency Team (Nphet) was, she said it was “medically focused and public health led”. This worked in some ways, but it made Ireland slow to recognise the “downstream impacts” of harsh measures such as school closures and isolation.
Leveraging the public in future would “certainly strengthen our response”, she said.
Fast actions will be imperfect, she added, and blaming people for making the wrong decision in a crisis when they are doing their best will mean no one wants to do these jobs in future. “We did make mistakes”, she said, but people must recognise that most workers try to do a good job most of the time, and they should be given the benefit of the doubt.
On balance, Ireland got many things right, and that is due to a lot of people going “well beyond the normal call of duty”, she said.
Also addressing the forum was Prof Mary Codd, who led a Health Service Executive test-and-trace programme from University College Dublin from March 2020 to September 2021. It was one of nine such centres established “at great speed”, she said.
However, the State was “wholly unprepared”, and the existing public health workforce, even with the help of the Army, was “very quickly overwhelmed” in the first half of March 2020.
Much time was “wasted” tracing the contacts of people who had been infected with Covid 10 to 12 days before. Practically, she said, testing results needed to be turned around within 24 hours or they were a “waste of time”.
The issue of infections within long-term care facilities was identified “very quickly”, she said. There were immediate issues with staff personal protective equipment, while “quite a bit less” than half of centres had pre-pandemic infection prevention control systems in place. This was despite national guidelines in this area, she said.
People aged over 70 in residential facilities died at 21 times the rate of their peers who cocooned at home, she told the forum
