Fergus Finlay: Nphet rises above the noise to deliver sound public health advice

Dr Tony Holohan, chief medical officer at the Department of Health, and chair of Nphet;  Ireland's National Public Health Emergency Team are doing the country a great service.

Right now, mortality rates across Europe as a result of Covid-19 are six times higher than Ireland. At the start of October, we were in the middle of the European league when it came to hospitalisations and admissions to intensive care. Now we’re at the bottom – an amazing improvement in a short time. Our infection rates have dropped, while throughout Europe they have climbed inexorably.

Can anyone seriously look at those basic facts and argue that we’ve been given bad advice?

We’ve been asked to suppress the virus twice, in the interests of protecting each other. And we’ve pulled it off. In some ways it’s a miracle, because Ireland is in many ways the least well-equipped country to deal with something like this, because of the healthcare decisions we’ve made for nearly 30 years.

So why, every time there are new decisions to be made, do we have to get involved in the same noisy, silly ritual?

All week long, the headlines were about the tussle between Nphet and the Government. Like it was a war to the death, a struggle for power. 

Back-bench TDs spend their time muttering about unelected dictators.

On RTÉ's Prime Time, one expert had to defend Nphet and himself against another who described Nphet as a joke and called for them to be stood down immediately.

Every time we come to a turn in the road in this pandemic, a moment when decisions need to be made, it always seems to be set up as a gladiatorial battle. The questions that dominate the public commentary are all about who won, who lost, who leaked, who made the better speech. The usual suspects get free rein on the news bulletins to say the usual things.

And of course we all have to wade through the multitude of armchair experts — people who don’t know how to spell epidemiology, let alone practise it, telling us that Nphet couldn’t find its way out of a paper bag. 

And as for that shower in Government! (I should probably admit that I had to rely on the computer’s spell checker to make sure I had written epidemiology correctly myself!) As Michael Clifford put it in last Saturday’s Irish Examiner, it’s all about the outrage.

Anyway, at the end of the week, Nphet issued its advice in a long letter to the minister. It was published by the Government and is there for all to read. And then the Government took its decisions and published them too. 

#NPHET met yesterday to consider new #COVID19 recommendations for Government. This letter from @CMOIreland to Minister for Health @DonnellyStephen outlines the basis for these recommendations.

Read it in full here: https://t.co/oeuDi57AhJ

— Department of Health (@roinnslainte) November 27, 2020

There are some differences between the advice and the decisions — not an awful lot, actually, but it’s all set out in print for us to read and compare if we want to.

Except most of us don’t want to. We just want to get on with our lives to the greatest extent that we can. We want to stay safe and to keep everyone else safe. But we also want to see our kids and grandkids, especially at Christmas – provided, and only provided, that Government measures reassure us that it’s safe to do so. And by and large, that’s what Nphet and the Government have arrived at.

A few differences in nuance here and there, to be sure, and probably a bit more foreboding in Nphet’s message than in the Government announcement. But I think we all get it.

It’s the noise around it that’s not just unnecessary, it’s a pain in the face. Debate is healthy, and no one is above criticism – they’re both givens. 

But it’s beginning to seem a bit like we’re all shouting and roaring because we want to be heard, and for no other reason.

I think there are two fundamental points to be made.

First, there’s a fascinating piece of research attached to the Nphet letter to Government. It’s research into public opinion, carefully analysed by three behavioural scientists from the ESRI. What it tells us is that Nphet and the Government have, by and large, got it right. But the noise strongly suggests they’re all wrong.

Dr Tony Holohan says if there's an increase in socialisation, then there will be a rise in the number of cases. "The growth rate [of the virus] correlates really closely with the change in the number of contacts" | https://t.co/A9ml1O0WYg pic.twitter.com/QT3KhITcIp

— RTÉ News (@rtenews) November 30, 2020

I don’t want to fall into the trap of over-simplifying a careful piece of research, but some of its central facts are clear enough. A clear majority of us don’t want to give it a lash at Christmas time – we want a quiet and safe Christmas.

We watched a Late Late Toy Show last weekend that was pure genius, presented by a genuine broadcasting legend. If the rest of Christmas is as close and intimate as that, that’ll do fine. It’s not surprising, is it, that the research shows that only a tiny minority of us want to see pubs open without the tightest possible restrictions?

And a clear majority of us think the Government is getting the balance right most of the time. In Nphet’s letter to the Government, it’s clear that nearly nine out of 10 of us think the restrictions on our lives are just right or not tight enough.

But that’s not what the noise is telling us. 

The loudest commentators, and the representatives of special interests, argue constantly, effectively, that the economy matters more than public health. 

And they get an awful lot of space to make those arguments, all the time.

They’re legitimate arguments, and the people making them have an absolute right to make them. I’m not disputing that. But the real story is far more complex.

The second fundamental point is this: Nphet has one simple job to do, albeit in a complex situation. Their job is to give advice.

Many of my close friends and colleagues over many years worked as political advisers. They were all people of integrity and honesty, as were the people we worked for. We didn’t always get it right, but we always did our best.

Doing your best as an adviser involves a few things. You gather your facts as thoroughly and as honestly as you can. You make your argument as directly and as cogently as you can. You set out the options, if there are options (sometimes there aren’t). You try to agree among yourselves, so the people you’re advising don’t get conflicted advice. And then you respect the fact that it’s not your job ultimately to make the decision.

That’s what Nphet does. And it’s all it does.

Suppose they didn’t. Just imagine how badly served we’d be if Nphet pandered to what they think we wanted to hear, or pulled their punches in their messages to Government and the public. How many more people would have died if they spent all their time trying to be nice?

I’m sure they don’t get it right all of the time, because nobody ever does. But they’re doing what we asked them to do, with honesty and integrity. 

Right through Christmas, when we’re doing whatever we’re doing, Nphet will be working. They’ll be watching, assessing, monitoring and reporting.

If the numbers they report warrant another shutdown, they’ll tell us that. Straight from the shoulder. It won’t be sugar-coated, and there won’t be plámás about any of it. They’ll be doing it to save lives, and because it’s their job to call it as they see it. If we have sense we’ll listen. And stop some of the noise.