Covid 19: Dr. Tony Holohan Has Done Well But We Need Other Expertise Too

There are those who insist that Dr. Tony Holohan has, in effect, been running the country. It’s an interesting perspective as we head into another week of lockdown in Ireland.

The word is that the people in charge at the Department of Health were told that the big decisions in relation to dealing with Covid-19 were theirs to make, for up to six months. In effect the keys to the kingdom were handed over to them. Might this be true? It is certainly how it has been playing out.

Only a very small number seem to be fully in the loop. Even members of the cabinet, according to some insiders, find out about decisions after the fact. Maybe that’s the way it has to be. Up to a point. But in the end, democracy has to win out. That is a principle that every politician must bear in mind. And every public servant too…

Next weekend has been earmarked for some time as the moment when we begin to put the pieces back in place – as the starting point of a careful relaxation of the draconian curbs that have been set in place to control the spread of the coronavirus Covid-19. It might not be immediate, the implied wisdom had suggested, but we would get there.

BIG BROTHER SURVEILLANCE

That’s now in doubt, according to the Taoiseach, Leo Varadkar, the Minister for Health Simon Harris, and the Chief Medical Officer, Dr Tony Holohan. They say that those who have ventured out into what are ordinarily considered public spaces are putting at risk the hard-won gains we’ve made, and they’re threatening to maintain the lockdown as a result. Behave yourselves, they say, or else we’ll have to extend your period of detention. And it’ll be your own fault if it comes to that.

Whether it’s the message or the strict schoolmasterly tone in which it is delivered we don't know for sure – but, one way or another, it’s ruffling feathers. The jolly emergency spirit of the first 60 days is frazzling a bit. While most people are still on-message, increasing numbers are chafing at the bit, and some are starting to roam.

So said Chief Medical Officer Tony Holohan at the briefing on Thursday April 23, when he told those present that if it was up to him he wouldn’t recommend any easing of the lockdown. That’s grist to the mill, but what really raised the eyebrows was the evidence he cited for his assertion, including detailed graphs. It was widely reported home and away.

Here’s how the BBC described it:
"The Irish medical authorities are using technology normally associated with measuring earthquakes to check whether the Republic's citizens are complying with the lockdown. Chief Medical Officer Dr Tony Holohan said data appeared to show increased car traffic noise and reverberation. The data was gleaned from the Dublin Institute for Advanced Studies' National Seismic Network. It indicated that more people were either driving or out walking."

In addition, here’s a sentence from the Twitter feed of Tony Holohan himself:
"The data we received this afternoon shows an increase in patterns of driving, walking and transit among those who use Apple devices in recent days."

Okay, it’s a pandemic, a national and international public health emergency. It’s imperative that as much as possible is done to control it and limit its impact and we’ve done pretty well, the tragic neglect of nursing homes and care facilities apart. But that can’t stop us from waving the yellow card here. Facilitated by the Government, the medical authorities appear to have put in place a surveillance regime that is far too much like Big Brother incarnate for comfort.

FIT AND HEALTHY

So, what else is being gathered? And who, in the Department of Health, the HSE or Government, is responsible for overseeing this? Is the Data Commissioner engaged? And who makes sure that civil liberties are protected? Or is it the case that civil liberties have been decommissioned? If that is indeed the case, as Liam Herrick of the Irish Council for Civil Liberties has indicated, we’ve got more problems to address than the pandemic itself.

And you know, the details presented on the increased movement among people stand in contrast to the patchier presentation of information on prevalence and deaths. Included in this must be some appreciation of who is dying and their prospects before they were infected.

For example, how many might have been taken at some point by pneumonia, often known in geriatric medicine as “the old man’s friend”? That term was first used at the turn of the 20th century by the so-called father of modern medicine Sir William Osler. Its continuing relevance was tested by Vladimir Kaplan et al some years ago and they found that the evidence still supported Osler’s view.

Also, with all the information that’s being gathered, surely it’s possible for Dr. Tony Holohan and his team to refine the list of those most at risk; and similarly refine the broad age-bands used to grade one’s risk status. For example, it’s risible to confine fit and healthy people in their 70s to their homes (even if that’s not actually a legal requirement) when others, who are far more at risk, are not similarly injunction-ed. To illustrate: some weeks ago The Guardian quoted an unnamed ICU team member who treated Boris Johnson as noting his high risk profile, being “55 and fat.” So, shouldn’t fitness be a factor too?

And another question: if you’re going to gather it, shouldn’t such detailed Big Brother surveillance be able to identify whether particular groups have misunderstood or slipped up on the lockdown? If so, shouldn’t they, and not everyone, be the focus of communications and explanations?

HOW FAR DO YOU GO?

All of this highlights the relationship between the Government and the National Public Health Emergency Team (NPHET). NPHET is chaired by Dr. Tony Holohan. It has 33 members, all either specialists or very senior public servants. There is no representation from the political sphere or from business.

It is, of course, absolutely right that policy and actions be guided by the experts. We should, as a community, both heed their expertise and advice and emphatically advance it over the anti-scientific rantings of loonies and louts. But it is also imperative (a) to have transparency and political oversight; and (b) that the many other needs out there – in the economy, society, and so on – are properly and fully factored into the final decisions that are being taken.

This issue was raised last week by, among others, the new leader of the Labour Party, Alan Kelly. He asked why no notes or minutes of the NPHET meetings had been published since the end of March. “We cannot see how decisions are being taken. This is not acceptable,” he said – and he is right. There are no minutes for any of the eleven sub-committees either.

We have to be honest too. The lockdown has, above all, been driven by the desire to control the numbers needing intensive care. A runaway pandemic would have overwhelmed our health system, even the single-tier system that is now temporarily in place and about which some commentators are very enthusiastic. That imperative is widely understood and supported and the measures taken have paid off, in that regard at least, to date.

But how far do you go? Is there a risk that, in their pursuit of that high-level and very urgent goal, a large panel of very dedicated specialists might lose sight of the other pressures and needs, in a complex and technologically advanced economy and society? The answer, in case it is not obvious is: yes. There is a risk of exactly that.

EASING RESTRICTIONS

By way of example, take the unseemly contretemps over the arrival of fruit pickers from Bulgaria to work for Keeling’s in north County Dublin. The company did everything by the book, as did Ryanair who flew them in to Ireland. Yet, Keeling’s were first vilified by social media narks; and then undermined by Leo Varadkar, Simon Harris and Tony Holohan, all implying that the company had done something irresponsible. But they hadn’t.

Here’s the thing: we need food and drink! We can’t just assume that they’ll appear by magic. As well as being planted, crops need to be nurtured and, in time, harvested. But who picks them and where? Somebody has to – but very few Irish want to. The same is true in the UK. In Burgundy the vignerons report a major crisis from a shortage of skilled personnel.

It’s a huge problem – and that’s why we have skilled Eastern European workers flying in. It’s a good job we do have them.

High level public servants, and indeed quite a few politicians and journalists too, know this, of course, but don’t necessarily foreground it in their thinking. The truth is that the strawberries of this world are as important as the Apples!

There’s nothing fatal in all of this – but we really do have to ask what happens afterwards to the legislation and to the new assertive role of the Gardaí; and how we’ll unwind the virtual surrender by the Government of executive authority to an unelected junta of public health experts and administrators.

Nobody can dispute that the crisis emerged with astounding speed and that all parties did their best to manage what unfolded. That we did far better than the UK, and it increasingly looks, the US is also true. With the exception of a singular failure in relation to nursing homes and care settings, Dr. Tony Holohan and his NPHET team did the State some sterling service. But none of them are employers. None of them are farmers. None of them run bars or restaurants. None are artists.

They do not know what it is like, trying to make things happen in that more precarious economic world. As the first small steps emerge – increasing the permitted distances of travel, opening certain retail facilities and extending “family bubbles” – we need to start thinking beyond the very specific bounds of the crisis and easing restrictions. We’re going to have to reopen society and the economy.

THE FUTURE IS HAPPENING NOW

This will have to involve small changes rather than grand adjustments from how people operated in the past. It will be a matter of finding real-world solutions. To take but one example among many, bars and restaurants won’t be able to reduce numbers dramatically and survive. Most are on a knife edge at the best of times. And these are not the best of times.

Innovation and creative solutions aren’t generally the forte of doctors. That is not the game they are in. So a moment must come – ideally sooner rather than later – when they step back from the plinth (as one suspects they’re only too keen to do) – with our heart-felt gratitude ringing in their ears, and return the State to the people and their representatives.

In the meantime, we need ever-greater involvement of voices from the economy and society in the decision-making process. We need, even now, to be actively planning our route back to full activity, full employment, full participation.

There is a future and – whether we like it or not – it’s already in the making.
• The Hog