After the Government instituted an effective nationwide ban on house visits, and moved three counties to Level 4 on Wednesday, senior health sources were unmoved.

The analogies they reached for involved deckchairs and the Titanic.

Given the National Public Health Emergency Team (Nphet) recommended the next day that the country be moved to Level 5 for a period of six weeks, it’s clear it is not persuaded by the gradual creep towards harsher restrictions. Indeed, it seems that a week which started with much of the country at Level 3, could yet end up with part, or all, of the country at Level 5.

Hospital Report

But why is the need so great? Part of the reason is the sense that Level 3, or Level 3 plus, has not been effective. Undoubtedly, there has been some impact. For example, in Dublin the 14-day incidence rate was 120.9 per 100,000 of population on September 18th, the date Level 3 was introduced in the county. The capital was by then far the worst performer nationally - this compared to a countrywide incidence of 62.37.

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The most recent data shows that the incidence nationwide is now 206.7 per 100,000. In Dublin, it is 194.1, so while the virus has grown in recent weeks, it has done so at a less pronounced rate than in the rest of the country. That is cold comfort, with deep concern within Nphet at the growth of the virus nationally. Dublin’s performance relative to the rest of the country is, bluntly, less of an indication of how well the capital is performing and more an indication of how badly things are going elsewhere.

Pressure on hospitals

The pressure is beginning to show on the hospital system. On September 18th, there were 75 Covid patients in hospital, 15 of whom needed critical care. On Thursday, that figure was 235, with 29 in critical care. There were no available critical care beds in eight hospitals, one of which, CUH, told GPs this week that it was “congested” due to the impact of Covid-19, and that staff were off sick with the virus.

The indicators of disease in the community are also growing.

On September 18th, 2.3 per cent of tests were coming back positive over the previous seven days. That rate is now 7 per cent. The State’s systems for managing the spread of the virus are also creaking. The median time to complete all contact tracing calls for positive cases was 1.3 days on September 18th - it is now 2.8 days.

The HSE said on Friday the median time taken for the full test and trace process to be completed on community samples is now 4.1 days. Last month, it was 3.5 days.

Meanwhile, there is frustration at all levels about public compliance with the advice. This week Cabinet discussed ongoing concerns that changes in restrictions are not having the desired impact - people are still meeting, and spreading the virus. Ministers were also briefed on new tactics, with social media campaigns set to be rolled out using well-known voices on Instagram and Tik Tok, while the Department of Health is undertaking ethnographic research among young people to identify why compliance is low.

The Government is also working with a class of 27 college students, 17 of whom contracted Covid-19, to communicate just how infectious and dangerous the virus is.

As the chief medical officerDr Tony Holohan warned this week, it is clear the virus is not under control. Sources say this week’s Nphet meeting was among the most grave since the pandemic began. They are calling for speed and clarity in the State’s response, warning there is no time to move through the levels, pausing to argue about which shade of grey applies at each one.

Wider lockdown

In such a situation, the logic of virus management dictates that society should go into a wider lockdown to protect vulnerable populations and essential services. However, the logic of politics is not so linear.

The political economy of managing the virus has changed. In March, a wider lockdown had near-universal political and societal support. Now, opinion is less uniform, and often with good reason.

Living alongside the virus - which means trying to keep the economy moving, and delivering non-Covid healthcare - is vitally important. There is also the economic cost to contend with. Cabinet was told this week the cost of moving to Level 4 in the three counties will be in the region of €4.8 million per week across the Government’s PUP and CRSS schemes alone. Such sums are small given the huge amounts budgeted for earlier this week, but the population and commercial footprint of these counties is also relatively small.

Opinion at Cabinet is not uniform; some Ministers believe that it could be time for a wider lockdown. They argue that the country is moving through the levels anyway, that the virus is rampant, and that wider categories of essential work mean more economic activity can be sustained in Level 4 and 5.

Others question whether the public will accept weeks of lockdown; they ask what the metrics of success are, and question whether there is clarity on when and how unlocking will take place again. Meanwhile, healthcare capacity has improved, as has knowledge of the virus, how it spreads, and how it is treated. Even cabinet hawks, however, concede that it is very hard not to accept Nphet advice on Level 5 twice.

As the Government faces down yet another crunch decision, the way forward is far from clear.