None of the decision-makers who entered the room for the Cabinet sub-committee meeting on Monday night were under any illusions about where the situation was going.

Many of them had been in contact with each other over the proceeding days – via text, over the phone or in person in their offices in Government Buildings, in the Department of Health and at the HSE – as the worsening Covid numbers took hold and the State's hospitals filled up.

The previous week had seen coronavirus cases climb steadily. By Friday they had hit nearly 5,500. On Saturday and Sunday officials were making preparations for the inevitable reintroduction of some restrictions. After months of going forward, as Taoiseach Micheál Martin liked to call it, and of promising there was no going back, the State’s Covid gears were about to be jammed into reverse.

Hospital Report

On Monday the Minister for Health Stephen Donnelly sat down with the chief medical officer Dr Tony Holohan, chairman of the National Public Health Emergency Team (Nphet), to prepare for that evening's Cabinet sub-committee meeting. They spent some time going through the latest numbers and the epidemiological situation – known to officials as "the epi" – before Holohan proposed a series of measures he believed could start to control the runaway increases in case numbers, and therefore pressures on the hospitals.

More than 10,000 children estimated to be out of school for Covid-19 reasons

---

What happens if ICU beds run out in Irish hospitals?

---

Covid-19: 3,138 new cases reported with 643 patients in hospital

---

The list was a distillation of work by Nphet combined with the views of the politicians on what is publicly and politically acceptable. This deliberative process had been under way informally over the weekend in conversations and texts. It would form the basis of the measures agreed later and announced to the country on Tuesday evening.

Concentric circles

The decision-making is located within a series of concentric circles, centred on the Taoiseach. He speaks constantly with his closest advisers and the leaders of the other two coalition parties. From there the process moves to the Cabinet sub-committee, which thrashes out the health and political cases and implications of the proposed measures. Once agreed there it is put to the Cabinet for approval, which is always forthcoming.

Martin, Donnelly, Green leader Eamon Ryan, Minister for Finance Paschal Donohoe and their advisers filed into the conference room in Government Buildings on Monday evening, accompanied by officials. Tánaiste Leo Varadkar beamed in from the Middle East, where he was on a trade mission (sometimes visibly on his phone during the meeting, some participants noted).

The HSE chiefs and public health officials joined by video link, presenting a sobering picture of the current state of the hospitals and – more worryingly – the likely trajectory over the coming weeks. Even if the restrictions soon to be discussed were effective, they were still looking at potentially exceeding existing capacity.

Paul Reid’s contribution, some of those present say, was pretty scarifying. The health service is “at greater risk than at any time during the pandemic”, he told the room.

There was consensus on most measures, including restricting nightclubs and working from home. But the increased use of antigen testing proved – yet again – to be a flashpoint with Holohan. There was a lengthy argument about it, only concluded when the Taoiseach made clear that the matter was closed, say a number of people who were present or briefed on the proceedings.

Resistance

Sources at the meeting say the Taoiseach was visibly irritated, saying he couldn’t understand the resistance. The antigen programme – both for subsidising the tests for the public and providing them free in primary schools for pods or tables where a positive test is recorded – would proceed, Martin made clear, whatever Holohan thought about it.

The chief medical officer would later seek to dissuade Donnelly from proceeding with the antigen plan, writing to him in strong terms urging him not to proceed, even after Cabinet had decided to go ahead.

After the officials and advisers left the politicians remained to conclude their decisions, which would be brought to Cabinet the following morning for approval. Later that day journalists trudged to Government Buildings on Tuesday for the Taoiseach’s latest address to the nation. “We need to act now to deal with this surge,” he solemnly intoned. Here we go again.

So what now?

Few senior figures in Government are willing to bet against further restrictions in the coming week or two. But they remain adamant that another lockdown is neither politically acceptable nor socially bearable.

The hope is that the shock of the sudden U-turn, along with the warnings about the pressure on hospitals – culminating in Paul Reid’s alarming letter to hospital chiefs on Thursday warning of the “unthinkable” consequences of hospitals being overwhelmed – will have the same effect on the population that it had on Ministers.

Most people involved in the decision-making believe cases will stabilise, and all the Nphet projections show cases plummeting after the peak. But there will be difficult times before that happens.

A close eye will be kept on Europe what measures are being implemented, and whether or not they work. Four senior sources agreed that if ICU is coming under more pressure more restrictions will be sought and almost certainly implemented.

Interventions

What might that look like? Senior coalition figures want interventions designed to slow transmission, not a lockdown to stop it entirely. The argument runs that a harsh lockdown could take months to have any effect, may not be observed by people, and perhaps does as much damage as good.

Capacity limits for indoor dining, public transport, nightclubs (perhaps in exchange for removing the curfew) have all been mentioned, as have mask mandates for outdoor mass gatherings (ie, matches).

Government sources believe Nphet may mull restrictions on gatherings in the home or retail settings. But this is more a matter of speculation than policy at this juncture.

However, if the situation worsens appreciably a circuit-breaker with sectoral closures may come as the recommendation – something the politicians will hate.

If this week’s interventions are successful the emphasis from public health will likely be on messaging over Christmas, not curbing freedoms.

With around a million people (supposedly) not in the office next week who were there last week, the Government hopes heavy messaging on public health behaviours, the restrictions and boosters will start to do their work.

But this is hope, not expectation. Right now that’s what they’re running on.