‘There’s no easy answer’ - says GP as country put on 'Level Three' restrictions

On Monday night the Government went earlier than expected and announced a tightening of restrictions and a new campaign of enforcement in response to COVID-19. They declined to follow the advice of the National Public Health Emergency Team (NPHET) which suggested infections would surge if the country was not placed in an immediate lockdown.

This was the first significant break with public health advice. The Cabinet moved the entire country to Level Three restrictions from midnight on Tuesday for the next three weeks, rather than the Level Five requested by Chief Medical Officer (CMO), Dr Tony Holohan.

The NPHET recommendation was to avoid the public health disaster that presented in Italy in March. At present Ireland has around five ICU beds per 100,000, this compares with Italy which has 15 per 100K.“The peripheral hospitals are creaking, NPHET are seeing that and they had to call it. They can’t wait for the Italian situation to arise and say ‘well we missed that’. They know there is a very likely situation like that coming if we leave it the way it is at the moment,” Cavan GP Dr Niall Collins says.

He added:“There’s no easy answer,” Dr Collins said of the position the country finds itself in. “I wouldn’t like to be the person making the call because it’s crystal ball work.”

Balancing economic repercussions and other health considerations with advice that will impact on the lives of the medically vulnerable who contract the virus is at the heart of the government decision. That decision is provoking a very strong emotional response from the public.

Dr Collins says NPHET’s recommendation of Level Five restrictions made sense: “I’m not surprised. You can’t compare Ireland with other countries. It’s apples and oranges. Ultimately what matters, what matters in the context of Covid is what your hospital system is like. Ireland’s is absolutely inferior to most hospital systems in Europe.”

Ireland’s ICU capacity is particularly restrictive. The five beds per 100,000, compares poorly with other European states like Germany which has 40 per 100,000.

“Dublin, Cork and Galway have central hospitals. All other hospitals are peripheral hospitals,” Dr Collins explained. “At present the central hospitals are coping, but the peripheral hospitals are creaking.”

Also those peripheral hospitals rely heavily on non-Irish doctors to fill vacancies. Travel restrictions due to COVID-19 and the demand in other countries have reduced the number of non-Irish doctors available.

“We are down doctors in a system that’s not fit for purpose most winters. The nursing staff are tired and stressed after a seven-month unrelenting workload. Many were exposed to Covid, a potentially life-threatening illness. Many medical and non medical staff are no longer willing to keep doing the extra hours and cover for the staff shortage that Covid is causing. It’s a recipe for disaster,” the doctor said outlining the reason for NPHET’s recommendation.

The rate of positive result is now around four per cent of all tests, says Dr Collins. This has been steadily increasing from one per cent just three weeks ago. This is a cause for concern: “It’s a slow trajectory to a war zone, but it is a trajectory to a war zone.”

Even with the threat posed by the virus, Dr Collins says the call the government had to make was not cut and dried: “If we keep going the way we are going, then the peripheral hospital will collapse. Then the wider hospitals will be affected. We can’t prove that. It’s speculation, but it’s probable.

“But, if you do lockdown thing, then there will be delayed cancer diagnosis, delayed heart attacks, delayed strokes, people being de-conditioned. The impact on the elderly, people being stressed, losing money, losing their business, mental health issues - the morbidity and mortality from that could be every bit as high as the morbidity and mortality of not locking it down. We don’t know.”

In explaining the government decision to depart from NPHET advice, Taoiseach Micheál Martin said he sought a balance between public health and the need to “protect lives and livelihoods” as lockdown “would lead to the loss of hundreds of thousands of jobs”.