With Ireland reopening, what now for Covid expert groups?

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Tomorrow restaurants open their doors, shutters go up on pubs serving meals, and hairdressers will take up scissors in visors and face masks in a dramatically altered socially distant environment. People will be allowed to travel anywhere they want in a country under the leadership of a new Government.

It is an optimistic start for Micheal Martin, the Fianna Fail leader who became Taoiseach yesterday. The optimism may not last. Public health experts are apprehensive about the virus returning. The legacy of expensive contracts and Covid-19 apparatus agreed in anticipation of a hospital surge that never happened carries over from the outgoing government.

What will stay and what should go as the country moves forward are decisions for the new coalition which, like the outgoing one, will be advised on Covid-19 by the National Public Health Emergency Team (Nphet).

The group, led by the chief medical officer, Dr Tony Holohan, and advised by a scientific Expert Advisory Group (EAG) and 11 academic sub-groups, is likely to be a major influence on the Taoiseach as he steers the country out of Covid-19.

The last government was accused of deferring to the group, and the minutes of its meetings were published in the interests of transparency, only after political pressure.

As an opposition leader, Mr Martin led the charge against Nphet and its advisory groups, demanding transparency and questioning the wisdom of the government’s key Covid-19 strategists.

He called for towns, regions and workplaces where Covid-19 clusters were discovered to be identified. He has declared himself in favour of the public wearing face masks. He has questioned the “science” behind the two-metre social-distancing rule and queried the deliberative processes of the expert groups.

“Every significant study ever undertaken on the response to emergencies has shown that trust depends on transparency and that effectiveness depends on allowing different voices into discussions,” he told the Dail eight weeks ago.

Now he is in power, will he deliver further on the transparency that he and others demanded while in opposition?

In recent weeks, the EAG has asked its 27 members to keep its behind-the-scenes deliberations confidential at least until such time as they have agreed a final position.

The Sunday Independent has learnt the EAG proposed that all members sign a confidentiality agreement. New arrangements have been put in place which require questions and submissions to be mediated through the chair.

The Department of Health declined to elaborate on the nature of the “recent incident” and suggested confidentiality will apply only until the group has signed off on its decisions and after its minutes are published on the department’s website.

The department also disputed that its members have been asked to sign anything. They had instead “agreed among themselves” to keep their deliberations confidential until the process had concluded, a spokesperson said.

It confirmed that Nphet does not require its members to sign a confidentiality agreement, but added in a statement: “The department understands that, following a recent incident, the members of the Expert Advisory Group recently decided to keep the proceedings of the group confidential until the minutes of EAG meetings or outcomes of deliberations are published on the official Government of Ireland website.

“This is to ensure that the deliberative processes of the Nphet and the Government are afforded the opportunity of being conducted appropriately. Minutes of the EAG up to mid-May have already been published, and a process is under way to ensure publication of the minutes on an ongoing basis.”

Minutes of the EAG meetings show that the experts have been divided on numerous issues, including the wearing of face masks. When a recommendation that healthcare workers should wear masks to protect against the spread of Covid-19 was put a vote, one key member, Professor Martin Cormican, asked that his opposition be noted in the minutes.

The role of EAG is to monitor and review evidence and to provide clear, evidence-based expert advice to Nphet. The decision on confidentiality comes at a time science and politics have clashed over balancing public health and the economy and therefore the speed of exiting lockdown.

There are plenty of other things to occupy Micheal Martin in the months ahead as the country starts counting the cost of Covid-19 and emergency measures put in place at the start of the pandemic are reviewed or dismantled.

Alternative uses have been found for some of the structures ordered ahead of the expected surge. The HSE ordered 20-bed medical pods to take an overspill of patients in the car park of the Mater Hospital in Dublin. They are now being used as a community assessment hub for vulnerable people, in conjunction with Safetynet, a medical charity, a spokesperson said.

The Department of Justice has separately confirmed that the temporary mortuary built at the Royal Hospital Kilmainham to accommodate 488 bodies in refrigerated stacked bays was removed late last month. The temporary mortuaries erected on site in Limerick and Cork have also been removed.

The Government’s €20m lease on the Citywest Hotel as a self-isolation facility for those unable to do so at home will end in October. The “arrangements” the HSE struck with 109 hotels, guest houses and student accommodation for frontline staff with vulnerable relatives at home are under review. The HSE disclosed this weekend it has spent €1.5m accommodating frontline staff in places such as the Ashling Hotel and Green Isle Hotel in Dublin, which have been in use since May 22. But fewer staff are using the service. The HSE said that last week it paid for approximately 1,300 bed nights for staff at a reduced rate.

The State’s estimated €115m-a-month contract with 19 private hospitals ends on Tuesday. The HSE has been asked to negotiate a new deal, but Mr Martin has called the previous one a “mess”.

The deal excluded private consultants and has been criticised as an underused resource, with an average bed occupancy of 43pc during the pandemic, according to figures released to Sinn Fein.

Figures released to the Sunday Independent show 9,285 public patients were treated at the Galway Clinic up to June 25. The Mater Hospital transferred 128 patients and 1,680 urgent surgeries to the Mater Private and will squeeze in more patients before the deal expires on Tuesday.

More than 12,700 public patients were treated at the Hermitage private hospital in Lucan. The entire medical oncology department of Tullamore General Hospital migrated to a private facility to treat public patients in 16 beds. Last Friday, a urologist from Letterkenny General got in within the nick of time, having booked theatre space for eight urology patients who would otherwise be on the public waiting list.

The enormous costs associated with the State’s hurried preparations ahead of the anticipated Covid-19 surge will be scrutinised in time by financial oversight bodies such as the Comptroller and Auditor General. But transparency is a recurring theme. The Irish Nurses and Midwives Organisation and Siptu have repeatedly asked the Department of Health to disclose the hospitals and healthcare settings where staff became infected with Covid-19. The HSE disclosed only part of this information to the unions last week.

The HSE has not disclosed either where the 900-plus deaths of nursing home residents occurred. Figures leaked to the media are disputed by the nursing homes concerned.

A group of epidemiologists and public health specialists at University College Dublin ventured their own analysis based on what limited public data they could gather. Their report said 36 facilities accounted for 60pc of all Covid-19 deaths in nursing homes and 41pc of all deaths in Ireland.

It estimated one in 34 nursing homes residents died from Covid-19. The death rate was a staggering 308 times higher among nursing home residents than in the general population. The report was submitted last week to the Expert Review Panel on the nursing homes crisis.

One of the authors of the report, along with Dr Mark Roe, was Patrick Wall, professor of public health at University College Dublin. He is also a member of the Nphet’s epidemiological modelling advisory group. According to Prof Wall, science is more important now than ever.

“There is a question mark about whether we are going to have a second wave and it is important we do not regard this as being over,” he said.

“We now have 26,000 cases of Covid-19 and we are studying them. We know the virus was not evenly distributed in the Irish population. We don’t understand why we have so many healthcare workers infected. Then we have the new Irish working as care assistants and living in over-crowded conditions.

“Now is the time when we must analyse the evidence for facts we can base our decisions on. If we do get a second wave, we cannot just lock down the country again.”

Source: Irish News