Many people spent Monday scratching their heads trying to understand what had happened since last week to justify the National Public Health Emergency Team’s shock escalation of their concerns.

Last Thursday, acting chief medical officer Dr Ronan Glynn wrote to the Government noting a number of trends of concern but said “the current epidemiological data does not strongly support a move to Level 3 nationally at this time”.

Just three days later, chief medical officer Dr Tony Holohan, back at the helm after a period of personal leave, recommended nationwide Level 5 measures for four weeks.

Hospital Report

In tone and content, the two letters are similar, and many of the trends highlighted by Holohan are the same as those mentioned by Glynn the week before, with some deterioration in figures over the few days.

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However, the second letter highlights other trends not mentioned in the first, and these may have clinched the argument for the public health officials meeting on Sunday. These include a “sustained increase” in cases among older people, seven new outbreaks in nursing homes last week and a rise in deaths, from four in August to 34 in September.

Everyone is bound to be haunted by the scale of deaths that occurred in nursing homes last spring. The spectre of a possible repeat of this fiasco must have loomed large when officials were considering what to do now.

Sudden lurch

Otherwise, the proposal to jump three levels of the Government’s framework plan makes no sense. We are supposed to be nimble and agile in responding to this virus. A stepwise approach would see areas constantly being bumped up and down levels in accordance with prevailing trends, not lurching suddenly almost from one end of the spectrum of restrictions to the other.

An alternative explanation would look to the authors of the two letters; the first written by an interim postholder, the second by an experienced and forthright chief medical officer well-versed in dealing with Ministers. Dr Holohan’s prescription is, arguably, more internally consistent in that he paints a dire picture of the harms being wrought by the virus and then proposes administering strong medicine to deal with it.

Cases are rising generally across Europe, but Ireland is ahead of the curve in entertaining proposals for a second lockdown. Infections in Spain and France may be soaring, but other countries – Germany, Greece, most of the Nordic nations – seem to be coping with more modest increases.

In most of western Europe, death rates remain comparatively low despite the rise in cases. For example, smaller countries such as Luxembourg and Iceland have higher case rates than Ireland, but virtually no deaths to speak of in recent months.

Stretched health service

Here, officials constantly say cases among vulnerable older people are inevitable, though this is not the experience of other countries. It begs the question as to whether everything that could be done had been done to reform work practices and improve infection control in some nursing homes.

Maybe it is Ireland’s uniquely stretched health service that lies behind the decision to go for another lockdown. Holohan’s letter refers to 243 out of 281 critical care beds currently being occupied; it is easy to imagine capacity being exceeded should hospitalisations continue to rise.

Capacity is elastic, however. Every winter, elective work gets cancelled to free space for sick flu patients. The same would happen with Covid-19 if pressure increases on ICU beds. In addition, another 17 beds are supposed to be opened under the winter plan.

Does the system have enough capacity to withstand a significant rise in virus cases? We simply don’t know because the modelling that has been carried out has not been published.

And if it is a lack of ICU beds, then why aren’t more being provided? Critical care beds don’t come cheap, but they cost a lot less than locking down an economy, forcing businesses to close and workers onto social welfare.

At best, Holohan’s forceful return to the public arena might serve to shock some people into better observance of social distancing rules. It has also exposed a shambolic decision-making process that is ripe for reform.

In reality, it shows how split society is on how to deal with the virus, how much detail is still lacking on the overall costs and benefits of the public health-led approach and how uncertain the way is out of this crisis.