Michael Clifford: Lockdown delay cost lives — Government and Nphet should have acted sooner

Acting in the best interests of the wider population at the time would have required some courageous leadership from both Nphet and Government. It didn’t happen. File photo: Julien Behal

That was the most expensive Christmas we’ve ever had or ever will have. The cost in human terms is not exactly quantifiable, but possibly dozens of people lost their lives and many more were rendered seriously ill. The cost in monetary terms won’t be known for a few months yet, certainly not until we exit the lockdown.

Is anybody, or any entity, culpable for such a disaster? 

In the first instance, the blame lies with anybody who was reckless in their behaviour. Recklessness in this instance could have involved too many nights out, too many gatherings or scant consideration for the care that we are all obliged to take during this pandemic.

Then there is official culpability. Since the extent of the current wave of the pandemic has materialised, there has been plenty of finger pointing. A number of opposition politicians, and a few experts, have suggested that the country should not have been opened up on December 1 as it was.

At the time, the National Public Health Emergency Team (Nphet) had recommended that indoor dining not be permitted over the festive period. Despite this, the Government allowed it.

Was that a mistake? Possibly. The extent of the contribution of indoor dining to rising infections is not known. If that outlet for socialising had been closed off, is there any real reason to believe that things would be any better now?

Around December 1, there was a large consensus among the public that some form of Christmas socialising should be permitted. Opinion polls at the time put the level of public support for opening up at well over 70%. Any suggestion that the Government was reckless or focused mainly on appeasing industry is unfair. 

Everybody wanted Christmas and believed it could be possible after the year that we'd had. Nphet had no serious objection. Attempting to deliver Christmas was a reasonable public service objective.

Where the Government, but particularly Nphet, fell down was in the weeks that followed, when it became obvious that things were not working out as forecast. The deterioration in infections was rapid in the early weeks of December. Despite that, Government remained firmly focused on delivering Christmas. 

The result was that the current lockdown was delayed by up to two weeks. That delay was crucial. 

Just before Christmas, the Imperial College in London published a report on the lockdown in the UK last March at the outset of the pandemic.

One of the key findings was the impact of the timing of the initial lockdown, which was only introduced after some dithering by Boris Johnson, the UK prime minister.

“Introducing national lockdown one week earlier would have reduced the first wave of death toll from 36,700 to 15,700,” the report states. 

That’s more than a doubling in the number of deaths because of a delay of seven days.

One of the report’s authors, Dr Marc Bageulin, commented on the finding. 

“This work highlights the importance of an early intervention in order to reduce the number of cumulative deaths," he said. 

The specifics of that report were not available to Nphet or the Government until it was published on December 23. However, all in the broader scientific and political communities were well aware of the importance of acting quickly once a trend was spotted. 

Yet, when the alarm bells began ringing in mid-December, proposed action was scheduled to begin only once Christmas was over and done with.

By December 17, Nphet was writing to Government insisting that new “level 3 plus” restrictions be introduced by December 28, a full 11 days later. 

Unlike during the second wave in October, the public health people had identified that infections were not confined to the young, but were occurring right across all age groups. That should have immediately signalled potential problems in the capacity of the health service.

Arguably, the information to hand should have prompted Nphet to encourage major restrictions immediately. Yet the public health people appear to have been conditioned to accept that some form of Christmas socialising must be permitted, come what may.

Four days after that warning to Government, chief medical officer Tony Holohan wrote to Stephen Donnelly, the health minister, as the situation was getting alarmingly worse. Now the medical opinion was that “level 5” restrictions would be required after Christmas. 

These new restrictions, it was recommended, should kick in from December 26, which was still five days away.

Again, action was being dictated not by the advance of the virus but by the timing of Christmas, irrespective of how bad things got. 

What is unclear is whether Nphet was acting on the basis that it had been unofficially conveyed from Government that Christmas was sacrosanct.

One way or the other, the Government had cover in terms of the public health advice. So, as with other recommendations from Nphet, it took it on board and threw in a few alterations to provide a little more solace to the public at large.

The decisions taken in those few days between December 17 and 21 were crucial and, quite possibly, devastating. 

The outcome of the delays in effecting restrictions was the polar opposite of “flattening the curve”. The rate of infections was allowed to balloon and multiply.

On December 21, HSE chief executive Paul Reid told a Cabinet subcommittee that cases could be between 1,300 and 1,800 by early January — and that was considered alarming at the time. As it turned out, cases were between 5,000 and 7,000 in the first days of the new year.

Had Christmas become such a major political and social imperative that it took precedence over acting quickly to save lives?

All the indications are that, had the Government effectively done a U-turn and cancelled Christmas, the public would have begrudgingly accepted it.

In the UK, for instance, Boris Johnson did a major U-turn and imposed restrictions ahead of the holiday. Admittedly, things were worse over there, but opinion polls pointed to two out of three people agreeing with the move.

It is certainly the case that some would have carried on socialising in this country, regardless of the imposition of new restrictions ahead of Christmas. That is inevitable. But all the evidence suggests that swift action would have had a major impact on the rate of infections — and consequently deaths and hospitalisations.

Acting in the best interests of the wider population at the time would have required some courageous leadership from both Nphet and Government. It didn’t happen.

In the fullness of time, after we have arrived at the far shore of this awfulness, there will be inquiries into how things were handled. The decisions taken and not taken in the week or so before Christmas 2020 will feature prominently.