When I wrote here last week on the issues of tobacco, alcohol and the State’s public-health policies and priorities, I touched on a deeper question as to whether and how far it was legitimate for a liberal democracy to seek to control individuals’ behaviour in pursuit of general health outcomes by law. Can people lawfully choose to engage in activities or consumptions that greatly increase the chances of their becoming chronically or fatally ill?

Does the fact that the State provides free or heavily subsidised health services and picks up the bill carry with it an entitlement to prevent by law behaviour that endangers the health of the individual citizen and increases the costs of providing such services?

Now we seem to be on the cusp of deciding that we must live with Covid. That means that some will die from Covid

Hospital Report

Clearly we have to distinguish between behaviour that endangers the health of the person whose behaviour is in issue and behaviour that endangers the health of others. In the former case, it is a question of saving people from themselves; in the latter, a clear justification can exist for safeguarding one citizen’s health from being put at serious risk by others.

Complicating that analysis is the issue of controlling the supply of addictive or psychotropic substances. In that case, the free choice of the consumer is often no longer in play and the consumer may become a danger to others.

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Proportionality

Then there is the matter of proportionality. Sports injuries are a risk which just has to be borne even if the risk can be controlled. We accept the fact that fast road traffic kills hundreds and injures thousands and we strive to reduce that risk. We do not prohibit road traffic or introduce red flag laws to eliminate that risk.

Now we seem to be on the cusp of deciding that we must live with Covid. That means that some will die from Covid. The viral disease is likely, I think, to become endemic with or without further mutations. Omicron seems to be bearable notwithstanding its virulence. With any luck, the crest of the Omicron wave will abate this month.

While that is no guarantee that there will be no further Covid waves, there is a good chance that Covid will reduce to a sustainable endemic level and that social, economic and cultural activity will gradually return towards normal.

The notion that lockdowns are a thing of the past is attractive. Dismantling existing limits on socialising and leaving it up to the individual to choose whether to go drinking or to the cinema or theatre or concerts seems to be within reach.

But, reverting to the issue of the limits of public-health enforcement, it seems to me that we have got to lift the political debate from point-scoring and “I told you so” wisdom after the event.

The health establishment cannot be the only determining expert voice – if only because they are simply guessing as to the efficacy of double vaccinations and boosters

It is well to remember that apparently serious people attempted up to a year ago to convince politicians and the public that Ireland’s response to Covid should be a total ban on travel and extinguishment of the epidemic by a complete internal lockdown. Their zeal was genuine but, we now know, utterly misguided.

Visions of body-laden military trucks in Bergamo and mass graves in the Americas drove our responses in 2020.

Official figures

There is a major problem with allowing the health establishment decide “the science” which should be followed. “Death with Covid” is quite different in Ireland from “death by Covid”. Covid “cases in hospital” must also be distinguished from “hospital admissions because of Covid”. I believe that those official figures are unreliable as guides to pandemic policy.

Likewise, I am fairly confident that the true extent of Omicron infection is vastly greater than reported. Why should people with symptoms and positive antigen tests bother to contribute to official statistics if their symptoms are relatively unserious? When they recover, how long will they isolate in practice?

The constraint of hospital and ICU treatment is real. But the time lag between imposing new behavioural regulation and the level of hospital and ICU cases actually caused directly by Covid means that by the time any new restrictions have an appreciable effect the Omicron wave may well have peaked and be in decline.

The case for keeping society open is strong. The health establishment cannot be the only determining expert voice – if only because they are simply guessing as to the efficacy of double vaccinations and boosters. We have to muddle through the pandemic and take an optimistic view unless and until that becomes demonstrably wrong and unsustainable.

We may well err, but I, for one, would favour erring on the side of keeping our society open and functioning rather than closing it down to prevent risk to the health system, deformed as that is by chronic failure to provide from its huge resourcing for the known risk of a pandemic such as this.