by Frank Schnittger
Tue Mar 31st, 2020 at 03:00:08 PM EST
Covid-19 seems to be doing what even Brexit could not achieve - reinforcing the border within Ireland. From the get-go Ireland and the UK have been pursuing different strategies to deal with the Pandemic. Ireland has been pursuing the WHO mandated strategy of physical isolation, closing all schools and non-essential workplaces, testing as much as possible and tracing and isolating the contacts of those who test positive.
The UK, on the other hand, flirted with a "herd immunity" strategy, was slow to shut down mass sporting events, schools and non-essential work places, tested only those hospitalised and never attempted contact tracing. When presented with evidence by epidemiologists that this could lead to a quarter of a million deaths Boris Johnson's government did a U-Turn and belatedly introduced much more comprehensive measures, all the while denying there was ever a change in policy.
However with the number of infections doubling every three days, the two week delay in implementing stricter measures could lead to a 32 fold increase in infections and deaths, and more if the health care system is overwhelmed. Even now, health care professionals in the UK cannot get tested unless hospitalised themselves, no contact tracing is being attempted, and suspect cases are told to self-isolate for 7 not 14 days, as is the case in the Republic of Ireland.
If the Republic succeeds in suppressing the disease while N. Ireland does not, the government may have little option but to close the border to prevent new infections being re-introduced via the north.
Calls by the Irish government to coordinate and harmonise the public health response north and south of the border have fallen on deaf ears with the Unionist health Minister, Robin Swann following UK government policy in lock-step despite health being a devolved responsibility. When Sinn Féin reversed tack to support the closure of schools in line with policy in the south they were accused by the nominally non-sectarian Alliance party of "politicising the pandemic".
Even normally level headed and moderate unionist commentators like Newton Emerson and Alex Kane, writing in the Irish Times, went further and accused Sinn Féin of engaging in tribalism and sectarianism. On the 22nd. of March I wrote an unpublished letter to the Editor of the Irish Times in response:
Both your unionist commentators, Newton Emerson and Alex Kane, have complained in no uncertain terms about Sinn Fein breaking ranks with other Northern Executive Parties and advocating for the closure of schools before that became official British government policy.
Newton Emerson goes so far as to accuse Sinn Fein of sectarianism while Alex Kane uses the only slightly less pejorative accusation of reverting to tribalism. Both seem to feel that maintaining inter-party unity is more important than public health considerations.
Newton states that the differences between the British and Irish government positions were minor, probably only a matter of timing, and that the pandemic was two weeks more advanced in Ireland than in N. Ireland in any case.
To address those arguments objectively, three points must be made. Firstly the level of fatalities in the UK is, proportionately, much higher than in Ireland. The level of confirmed cases is, proportionately, only lower there because the UK policy is to test only those patients ill enough to require hospital admission whereas the Irish policy is to test anyone showing relevant symptoms.
Secondly the global pattern has been for the level of confirmed cases to increase by an average of 30% per day, leading to a doubling of cases every 3 days. Over 15 days that results in a 32 fold increase in the likely number to cases, and ultimately deaths. There was no time to lose, and even a delay of some hours could have a significant impact on ultimate mortality. This is not some minor policy or timing difference.
Lastly, while not aware of Michelle O'Neill's personal motivation, the overwhelming preponderance of expert advice, from the WHO, from the Chinese doctors with most experience of managing the pandemic, and ultimately, from the Imperial College in London, was that the earlier such measures were adopted, the more lives would be saved.
Newton and Alex claim to have objective science on their side, but it was indeed they who were acting in a sectarian and tribalistic fashion in being unwilling to ascribe any weight to these factors. John Maynard Keynes was once criticised for changing his mind. He is reputed to have retorted "when the facts change, I change my mind. What do you do?"
Perhaps Newton and Alex should bear that in mind...
But it gets worse.
Gabriel Scally was born and brought up in Belfast. He is President of the Epidemiology and Public Health section of the (British) Royal Society of Medicine, and is Chair of the Soil Association. He was chair of an Inquiry into the CervicalCheck Screening Programme in Ireland which was (rightly) highly critical of the Irish government, so he is no government patsy. He has just written a devastating article in the Irish Times in which he accuses UK scientific advisers of deliberately misleading the UK public as to their true aims:
In the Republic with its network of over 40 community testing facilities, the aim is to reach 100,000 tests per week by the end of April, whereas the North has set a goal of performing just under 8,000 tests per week.
These very different policies get to the heart of the North-South differences. The Republic has watched and learned from the experience of countries, including South Korea and China, that have controlled the disease successfully. Also, the Government has followed advice from the key organisations in outbreak control; the World Health Organisation (WHO) and the EU's European Centre for Disease Prevention and Control.
In contrast, the UK has ignored both experience elsewhere and the relevant international bodies. Indeed, at a recent press conference, the deputy chief medical officer for England assured journalists that WHO advice was only relevant to low- and middle-income countries. In shades of Orwell's 1984, Whitehall does not want people learning about the views of WHO and the successful efforts to control the virus in other countries in case it undermines their novel and unevidenced approach. The UK government was told on March 4th by their "scientific advisers" that media reports of successful public health strategies in other countries could spark public concern if those interventions were not being applied in the UK.
The approach taken in the North is essentially the one promulgated from Whitehall. So far, devolved governments in Scotland and the North have shown little sign of challenging or deviating from that strategy. The unified approach held firm even when it was revealed by the small coterie of senior officials guiding policy that their actual aim was for the population to actively develop "herd immunity". The concept roughly being that when the proportion of the population that have had the disease is high enough, then there will not be enough uninfected people left for the virus to continue to spread. It is an approach that is regarded by many senior public health physicians as dangerously flawed.
A key aim of the battle against the virus must be to gain precious time for development of an effective vaccine and for trials of antiviral drugs. There is also the hope, fingers crossed, that summer weather in the northern hemisphere might help. These are all reasons why the approach of no community testing and reliance on the development of "herd immunity" is deficient.
If the North and the Republic retain divergent approaches, in the Republic there may be a smaller proportion of the population who are infected with the virus and deaths may be at a lower level. In the North, a larger part of the population may be infected at an earlier stage and pressure on the health service, and deaths per head of the population, may be higher.
The political leaders in the North need, on coronavirus, to decouple themselves from the Whitehall approach
That's bad enough, but the real problems will occur in the future phases. Lifting travel, education and work restrictions will be possible in due course, but without both effective mechanisms to detect and deal with new cases that will inevitably arise north and south, and common restrictions on travel to and from the island, we could find ourselves yet again in the midst of a mass outbreak. Two different approaches to testing and contact tracing are just not compatible with achieving the level of control needed to win the battle. (my bold)
In 2001, at the height of the foot and mouth disease outbreak in the UK Ian Paisley quipped that while N. Ireland might be British, the cows were Irish (and therefore should be kept within an all-Ireland quarantine zone and not subject to export bans to the EU). As recently as last September, Boris Johnson used this to justify N. Ireland remaining effectively in the EU Single Market and Customs Union:
The late Ian Paisley's 'Irish cows' could hold the "germ" of a solution to the border backstop, Boris Johnson has suggested.
The Prime Minister used the former First Minister's suggestion that people in Northern Ireland were British "but our cows are Irish" to bolster support for an agri-food regulatory regime in Northern Ireland that would see it stay in alignment with the EU.
Northern Ireland's cows were saved from the mass slaughter of Britain's herds, but it seems that what's good enough for cows is too good for people of Ireland. In pursuit of their slavish adherence to British government policies, it seems that today's N. Ireland unionist politicians and commentators are prepared to sacrifice many lives for fear of being seen to be too closely aligned to Irish government policies.