Coronavirus and protecting the health of the public

 

Sir, – Ruadhán MacCormaic states that low income is a risk factor in the developing Covid-19 epidemic (“We have a vaccine for the coronavirus: being rich”, Opinion & Analysis, March 7th). In Ireland, the infected cases have been almost exclusively associated with travel in northern Italy, principally to ski. While your columnist has some very valid points to make about the effects of infectious epidemics, he might have waited until the facts matched the story he wanted to tell. – Yours, etc,

Dr THERESE BOYLE,

Dublin 7.

Sir, – Starting and finishing an article about health issues with the same statement would seem to demand two things. The statement should be true, and the material in between ought to verify that fact. Ruadhán Mac Cormaic’s declaration that “We have a vaccine for coronavirus. It’s called being rich” fails on both counts.

First, it is believed unlikely that a real, rather than metaphorical, vaccine will be available until 2021. The suggestion that wealth will be protective in some other way is almost certainly incorrect. Large variations in outcomes from infection, as he correctly notes, have been observed in different locations. While China may be criticised politically in various respects, communism tends toward equality in ways capitalist countries do not. The fact that a greater than four-fold variation in coronavirus-associated mortality was described within China would appear to refute his thesis, but your columnist cites it as evidence of the benefits of wealth. What it actually illustrates is that the Wuhan outbreak hit an utterly unprepared healthcare system, and stretched resources beyond breaking point. Authoritarian control of population behaviour probably mitigated the rate of spread elsewhere in China, and it seems that helped.

The suggestion that some middle-class people “can work from home and take sick leave” appears to identify privilege where it simply doesn’t exist. Many people work because they have to. It is not difficult to self-isolate if you’re unemployed, conversely. If you are running a small business, or dealing with clients or patients, it’s potentially ruinous.

The US is the richest nation in the world. It spends the most on healthcare, by a very large margin. Nonetheless, it is reported that 16 of the first 250 Covid-19 cases there have died, suggesting an initial mortality rate far in excess of poorer countries.

A reality of life in Ireland, and most of Europe, is that the fastest growing demographic group is the elderly. It is also true that many older people are wealthy.

Indeed, as life-expectancy correlates closely with affluence, those over 70 and 80 are often better off than the median citizen.

Ominously, though, mortality rates for coronavirus of over 14 per cent have been quoted for those aged over 80.

A characteristic of human perception is the existence of confirmation bias – we tend to over-interpret evidence that supports our existing beliefs and prejudices, and not notice information that refutes them. Perhaps your columnist is extremely “woke“ to the privileges of wealth, and sees validation of this view everywhere. But given that there is no vaccine, treatment or effective intervention for Covid-19, we must aim to collectively slow its spread. This is to allow the healthcare system adapt and learn, in a controlled way, and to permit investigators to identify what works as the infection is better characterized.

Believing that money, nationally or personally, will provide any protection may be a dangerous mistake. – Yours, etc,

BRIAN O’BRIEN,

Kinsale,

Co Cork.

Sir, – Conversations about coronavirus are dominant in every community across Ireland.

A constant theme is the concern about the lack of risk-assessment appropriate to the scale of the problem. A second point is the technical nature of conversations by experts on television and radio.

In healthcare infections, an appropriate risk-assessment process is a fundamental action in infection prevention and control. In recent years, one noteworthy advance in hospital care has been our approach to preventing and controlling infection in response to serious infection outbreaks in our hospital system. It is mystifying as to why the vigilance shown and the lessons learned during those infection outbreaks is not evident in the national response to Covid-19.

Risk assessment is a systematic examination of all aspects that could cause the virus to spread, followed by a process of maximising prevention. With Covid-19, we appear to have an indifferent and vague approach to banning crowds and parades and to testing at the airport of passengers arriving from high-risk countries. A detection of even one case justifies such a policy. Ironically, the Department of Agriculture makes a special announcement about reporting any contact with farm animals.

It is in the best interest of the country to maximise resources to preventing spread. Current economic arguments about containment, and maintaining activity as normal as possible, will fade into insignificance in the event of the costs associated with a widespread national outbreak.

Given the scale of hospital activity required in other countries to manage Covid-19, an important consideration in our country is the lack of hospital beds and in particular intensive-care beds.

Regarding the national narrative on Covid-19, daily on television and radio we hear many repetitive conversations, among medical experts, where the content is lacking in practicalities, common sense, and plain language.

We must not lose sight of the importance of prevention over treatment and cure. – Yours, etc,

SEAMUS COWMAN,

(Professor Emeritus,

Nursing,

Royal College of Surgeons

in Ireland),

Castleknock,

Dublin 15.

Sir, – Covid-19 does not recognise borders, and we need social solidarity across Europe and a concentrated effort in combating and containing the virus to minimise its health and commercial impact. – Yours, etc,

SUZANNE DOYLE,

Tully,

Kildare.

A chara, – The Irish Times reports that for churchgoers, “the sign of peace should be suspended. Priests have been advised to give the congregation permission to nod or smile instead” (“Sick people should not attend religious services, HSE says”, March 4th).

Priests don’t give “permission” to people to nod or smile. Members of the congregation don’t need “permission” to nod or smile at one another, any more than TDs need permission to exchange an elbow knock or an ankle tap.

In the Catholic Church, at the sign of peace before communion, the congregation is invited to exchange an appropriate sign of peace according to custom; this may vary from place to place, and within a congregation.

In our culture the most common such salutation is a handshake, but this is never mandatory, and there are many variations.

The sign of peace is not suspended. In a situation such as we now have, on good medical advice, the format may change.

Please accept this letter as a non-infectious salutation of peace to the readers and staff of The Irish Times! – Is mise,

PÁDRAIG McCARTHY,

Sandyford,

Dublin 16.