How will Ireland face new phase of Covid post-Nphet?

In a post-Nphet world, Ireland is facing yet another new phase of Covid without many of the familiar faces and structures from earlier in the pandemic. But who is calling the shots, and what is happening behind the scenes?

Since March 8th, there have been 241,954 cases of Covid notified through either PCR or antigen testing. Direct comparisons are crude, but that’s more than the number of cases detected by PCR testing in the first two waves of Covid.

That was the last date Minister for Health Stephen Donnelly did a significant media interview – he travelled to the United States for a week during this time, and is now ill. There has been no dedicated memo for Cabinet on Covid-19 since February 22nd.

It is disorientating, given that two years of Covid have been narrated by politicians, public health officials and a bank of stats, graphs and projections

February 17th was the last time chief medical officer Dr Tony Holohan wrote to Mr Donnelly in his capacity as chairman of the National Public Health Emergency Team (Nphet). The same day, he sent a proposal for the ongoing monitoring of Covid, with Nphet being wound down. On that day there were 629 people with Covid in hospital. No new group has yet been approved by Mr Donnelly, although Leo Varadkar says this is "imminent". Dr Holohan has not appeared in the media or sent a tweet since. There are now 1,425 people in hospital with Covid.

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On February 2nd, the Irish Epidemiological Modelling Advisory Group, chaired by Prof Philip Nolan, decided that given "current modelling challenges" and "in the context of low harm despite high levels of infection" it would "pause infection and healthcare demand modelling". The group continues to meet, but no new projections have been produced. On that date, there were 63 people with Covid in ICU. That declined to 37 on March 11th, before climbing again to 53 on Thursday.

It is disorientating, given that two years of Covid have been narrated by politicians, public health officials and a bank of stats, graphs and projections; only Prof Nolan has broken cover, characterising the surge as an “exit wave” in Washington DC last week.

Officials believe there is no signal from the data to suggest there is trouble on the way in terms of serious disease or death, although the risk is with so many of the sensors stood down, it could be too late when one manifests itself.

The widespread cancellation of elective procedures has a big impact, meaning Covid now presents as an issue that compounds long-standing problems

Pandemic management systems have been dramatically downgraded because vaccines blunted Covid's lethality. Despite the numbers in hospital, the HSE's chief clinical officer Dr Colm Henry estimates only about 300 of those due to Covid are vaccinated and boosted. Officials believe the risk of being overwhelmed is manageable, with senior sources hopeful that the wave will subside naturally. The view is that the level of mortality and serious disease can be withstood, and the restrictions needed to reduce it could not be justified. As one official said during the week, despite the congestion in hospitals, "there's no clear proportionate measure that would reduce that strain". Lockdowns and restrictions are not currently on the menu.

However, living with Covid is not cost free. Rather than dissipating, Covid has become a particularly troublesome headache for the healthcare system. It has been hit, again, with the double whammy of caring for and isolating Covid patients, with more than 5,000 staff now off due to Covid. It has learned to live with Covid, Dr Henry said, to an extent – delayed presentations of serious illness and backlogs in screening programmes are less significant. But the widespread cancellation of elective procedures has a big impact, meaning Covid now presents as an issue that compounds long-standing problems in the health service.

“We have a waiting list initiative,” Dr Henry says, “we have targets alongside that – certainly the current pressures on unscheduled care between presentations [in hospitals] and Covid will have clear implications for our plan for waiting lists.” As Covid changes, its capacity to confound and frustrate stays constant – and if the response needs to be adapted, it’s unclear how those decisions will be made.

The Department of Health and the Minister's spokesman declined to make Donnelly or the chief medical officer available for interview.