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COVID: A back seat driver hurls from the ditch — and misses the point

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The Irish Times of Friday, 19 November contained a column about the COVID situation in Ireland by its Business Correspondent, Mark Paul, whose columns are written under his own name and the soubriquet Caveat.[i]

The headline over the piece read:

When all is said and done, it is clear Government didn’t do enough to stop this surge

The sub-heading attributed to Caveat is this:

Don’t buy the narrative that says people’s ‘behaviour’ has brought disaster upon hospitals and, now, businesses

Mr. Paul begins with an explanation for the piece:

As hospitals once again fill with the sick and hospitality businesses bear the brunt of restrictions, it is reasonable to examine what some people have said and done in recent times, and ask how it may have contributed to the hole we are in now.

Mr. Paul identifies two candidates for the apportionment of blame for getting us into the hole, the people on one side and the Government on the other. The Government, he suggests is placing the blame solely on the people, in order to absolve itself of any responsibility for the crisis which has snuck up on us.

The author suggests the people have behaved only as they might reasonably have been expected to and, indeed, were encouraged to behave by the Government.

As recently as five or six weeks ago, the Government was maintaining the position that it would end almost all restrictions, including social distancing, from October 22nd. That sent a signal to people that is proving hard to reverse…

There are always anecdotes to disprove the rule, but I believe most people’s behaviour has largely remained within acceptable boundaries of a new normality. It isn’t even a typical normality.

Many people are still more cautious than before. There may be slippage, yes, but it would be unfair to suggest that broad swathes of people behaving unreasonably is the root cause of our current havoc.

So, what is the root cause of the havoc, then?

…the vaccines do not work as well or for as long as we were told they would.

Standing in the dock alongside the vaccines is… the Government.

A consensus appears to be emerging that, no, they did not do enough, and that sense is coagulating around key issues such as boosters, antigen testing and air filtering.

“A consensus appears to be emerging… and that sense is coagulating…” sounds like an argument heading towards strangulation by many tortuous qualifications, or at least struggling hard for breath.

His eventual conclusion which, though “ringing”, is not quite as forceful as the headlines over his column, indeed more in tune with the somewhat anti-climactic coagulating consensus concept.

…as the storm clouds gather once again, and people lie sick and dying and businesses are dragged closer to the brink, we should ask if everything that could have been done to prevent this scenario was attempted by those with the power to act. It doesn’t seem so.

Let’s examine his case.

Three general points to begin.

First, when confronted with the choice between allocating blame between the people and the Government, how often do you see columnists pointing the finger squarely at the people? Borrowing from Mr. Paul, I would suggest that, “while there may be anecdotes to disprove the rule, I believe” most columnists point the finger at the Government. After all, if the choice is between dissing his newspaper’s readers and aligning alongside those readers to diss the government, what is a self-respecting columnist to do?

I present in support of that “belief” of mine exactly as much evidence as Mr. Paul presents in support of his claim that people have, on the whole, acted reasonably in response to the pandemic; i.e., no evidence at all. Like Mr. deValera of old, he simply looked into his own heart. That is not to imply that I believe people have been feckless rather than reasonable, simply that sweeping claims such as he has made carry weight only to the extent that they are supported by evidence rather than faith.

Second, it should by now be a statement of the bleedin’ obvious, but it is people’s behaviour and interaction that drives the transmission rate of the virus. And given the ways and especially the rate at which this virus spreads, it takes the missteps of only a few to lift it into exponential orbit. Remember the famous “R number”? If the number of people to whom an infected person passes the virus is less than one, relief. If greater than one, misery.

Whether or not you want to ascribe blame to people for that is a separate matter. But, as an aside, while squabbling over how we got into this “hole” might not be useless, it is far less useful than proposing a cogent plan to get out of the same hole. Government can only act to limit interactions, to counter their potential effects (principally through vaccination) and to deal with their outcomes.

Second and relatedly, let’s look more closely at this particular choice of words:

…the vaccines do not work as well or for as long as we were told they would.

It would have been helpful to say the least if Mr. Paul had told us precisely who did what telling here, but he doesn’t. He simply throws out an assertion.

This was a new and mutating virus, new vaccines, quickly trialled and approved, never represented or established as being 100% effective indefinitely through their initially prescribed dosage, nonetheless immediately, immeasurably but immensely useful.

I think we can reasonably presume he means the Government, NPHET or some related official body. I am especially taken by the weaselly “we were told” which makes no clear accusation, leaves no fingerprints, but neatly dangles the possibility that “we” (the ordinary decent people) were misled because of incompetence, maybe even deliberate mendacity. We, who have been lions throughout this difficult time, have been led by donkeys or lesser animals.

Let’s look at the things he suggests the government should have been doing beginning, in reverse order, with air filters and antigen testing. Mr. Paul explains the importance of these as follows:

Numerous commentators have already noted where the State and Nphet has gone wrong on antigen testing and the lack of promotion of HEPA air filters. Both have been proven to be useful tools, but have been neglected.

It might be mentioned in passing that Mr. Paul had earlier described these as “key issues”, not mere “useful tools”. In most people’s language, those two descriptions differ distinctly in import.

Well, “numerous commentators” note lots of things. I know I’m sounding like a broken record by now, but it would have been useful to hear what “commentators” he had in mind and what precisely they said on these subjects. Words should be chosen and used with care and justification, not tossed around like confetti.

I haven’t heard anybody dispute the contention that HEPA air filters can reduce exposure to COVID in indoor environments especially when combined with universal masking. I don’t have the expertise to assess what impact their “promotion” might have had in curbing the surge. The filters are helpful in reducing COVID spread, but critical, decisive or “key”? I would need to hear more and Mr. Paul doesn’t give more.

Antigen testing has got a lot more mentions in the newspaper during the pandemic. If they are a useful tool, they are nonetheless to be handled with great care.

Antigen tests are less effective than PCR tests at detecting whether somebody has the virus or not. The probability of them giving a correct result is lower. In particular, they generate a comparatively high rate of false negative results. As a consequence, they are, at best, a screening or filtering device rather than a specifically diagnostic one.

If people are experiencing symptoms, they should bypass antigen, go straight to the PCR test and isolate pending the result. Antigen tests can be helpful in detecting whether somebody experiencing no symptoms might nonetheless be infectious. Even if you are feeling fine, a positive result should always be heeded. But a negative or ‘not detected’ result cannot be relied upon as confirmation that you are COVID-free.

Many people understand the possibilities and limitations of the tests, but not everybody. The day before Mr. Paul’s column, The Irish Times reported the findings of an Amárach poll conducted for the Department of Health about public understanding of the tests[ii].

The poll found that only 48% of Irish people know that antigen tests are less effective than PCR tests at detecting the virus. 36% thought the test was a quick way for people with symptoms to get tested. 27% thought they were a convenient way for someone to make sure they do not have COVID-19. Those three findings indicate significant and worrying misunderstandings among the public of the scope of antigen tests.

But air filters and antigen tests are the supporting cast to Mr. Paul’s main claim:

If the Government had moved on boosters more forcefully in October and November, we might not be in as much danger as we are now. That is a fact. Instead, Ministers hid behind Niac.

The pedant in me wrestles with the question of how something that might or might not be can be called a “fact”, but we won’t dwell on that.

Also, when Mr. Paul speaks of Ministers “hiding behind NIAC”, the body which actually knows something about these matters, the onus is surely on him to tell us how should the Government decide when to reject rather than abide by its advice. On whose advice should it rely instead? Commentators? Or should they just take a flyer? And how responsible would that be?

Mr. Paul may be alarmed at the alleged slow progress on boosters, but there was no hint of disquiet in the report by his colleague, Simon Carswell, on the roll-out in the same newspaper the previous day[iii]. As of 16 November, he said about 400,000 boosters had been administered:

… about 90,000 healthcare workers, 23,600 residents of long-term residential care facilities aged 60 and over, 131,200 people aged 80 and over, 114,200 people aged between 70 and 79, and 22,200 people aged between 60 and 69. Almost 60,000 third doses have been given to the immunocompromised.

Presuming these are entirely distinct categories of recipient, this indicates an aggregate dispensation of just over 440,000 boosters altogether at that time.

The pace of the roll-out is determined by official guidance that boosters should only be given at least five months after people have received their last vaccine dose. There are still some over-60s (including me) who have yet to hit that threshold and few, if any, over-50s outside the designated higher risk categories. Ireland is by no means unique in applying a five month interval. The UK applies a standard interval of six months, reducing to five in exceptional circumstances.

On the other hand, Israel opened up booster availability to all adults in August and the US has done so this month. But remember, Israel’s initial vaccination campaign began earlier and moved much faster than the rollout in most other places. By March, over 60% of residents had received a first dose, providing a body of evidence that underpinned the conclusion in August that effectiveness began to wane after five months. Although its overall vaccination take up has been less than stellar, the US opened up availability to all as far back as 19 April, more than six months ago.

If there is an international “race” to deliver boosters, Ireland is not doing badly. Some countries have not started booster programmes yet and others do not isolate booster deliveries within their overall published vaccination statistics. So, what follows is only a partial, randomly selected, comparative snapshot.

As of 21 November, Ireland’s booster numbers had reached 580,000 or 11.6% of the population, much less than the UK (22%) and Malta (18%), both of whom had been much faster out of the blocks in their roll-out of the initial vaccines. But we were well ahead of France, Germany and Spain, all clustered around 7–8%.

The case can possibly be made that Ireland should open the booster to all sooner, but it isn’t obviously more compelling than rolling down through the age and condition categories in the order of the associated risk as was done for the first roll-out. And even if there is an arguable case for doing things differently, that does not establish Mr. Paul’s claim that we have been somehow tardy or delinquent.

For once though, Mr. Paul puts forward “evidence” that we might have been negligently so.

In hindsight, the debate around boosters may not have been helped by commentary from senior figures in the World Health Organisation (WHO), including Mike Ryan, the Sligoman running the WHO’s pandemic response…

Ryan has been correctly praised in the pandemic, especially in Irish media, for the forcefulness of his advocacy for the developing world and the clarity of his public communications. But this near-deference also meant that even when he was clearly wrong, which he appears to have been all along on the need for boosters, his words contributed to a climate of Government hesitancy on them.

Ministers may not have wanted to be seen to defy the global Irishman who has repeatedly suggested that westerners getting boosters are taking “two lifejackets”, while others in the developing world drown.

My inner pedant pops up again to ask how somebody can appear to be wrong and be clearly wrong at the same time — and there is a tension between the definitive claim that Mr. Ryan’s words contributed to a climate of government hesitancy and the speculation that Ministers may not have wanted to be seen to defy him. But that’s neither here nor there.

The real issue here is that Mr. Paul makes a sneering smear of sleeveenism (the snivelling dull peasants at home doffing their caps to the smart lad who has made a big name for himself abroad) which screams out for even a smidgin of evidence but for which none whatsoever is presented.

Overall, Mr. Paul’s column is a conceptual reheat of so many others over the past 20 months. It is natural to feel that the government should leave no stone unturned to get to grips with the virus. So, the argument: “Here are things they could be doing that they are not already doing enough, if at all” easily morphs to “They should be going full throttle on all of those things” and then magnifies to: “If only they were doing those particular things — and doing them properly, we’d have the back broken on this.” Last year, it was things like testing and tracing and mandatory hotel quarantine that would make the crucial difference between salvation and despair. The so-called “Zero-COVID strategy” was the apex of this phenomenon. If we really put our noses to the grindstone, we faced the enticing prospect of being rid of COVID altogether, an isolated beacon of healthy brilliance in a struggling, miserable world.

Now, well, you have Mr. Paul’s list. Make of it what you will. Though it should be pointed out that in a column less than a month earlier, he was arguing the case for weighing the costs of pursuing incremental strategies to prevent COVID deaths against a broader calculus of benefits foregone elsewhere in our economy.[iv] The brake has a role to play as well as the accelerator.

Mr. Paul’s Linkedin page tells us he has a Masters Degree in Journalism from the Dublin Institute of Technology. If he has any relevant scientific qualifications, he is too modest to mention them. Everyone is entitled to express their opinion. Newspapers have to fill their pages and engage their readers as best they can. But no inherent authority is implied by the designation “journalist”, “columnist” or “commentator” or by the masthead of the newspaper in which those opinions appear, only by the rigour and robustness of their content.

Even with the aid of a strong microscope, it is hard to detect much authority in this column.

[i] https://www.irishtimes.com/business/when-all-is-said-and-done-it-is-clear-government-didn-t-do-enough-to-stop-this-surge-1.4732486

[ii] https://www.irishtimes.com/news/ireland/irish-news/antigen-tests-report-concludes-widespread-misconceptions-as-to-how-they-work-1.4732277

[iii] https://www.irishtimes.com/news/health/q-a-who-is-getting-covid-19-vaccine-boosters-and-when-will-they-get-them-1.4731646

[iv] https://www.irishtimes.com/business/health-pharma/let-s-talk-about-acceptable-covid-death-rates-before-restrictions-kick-in-1.4707096

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Daire O'Criodain

Daire O'Criodain

Former diplomat and aviation finance executive, active now mainly in not-for-profit sector. Living in rural Clare. Weekly posts on Wednesdays.