"Houston, we have a problem. But what are we going to do about it?"
That was the question posed at a meeting of the Emergency Department Taskforce on Monday.
The group was originally convened by Tánaiste (then Minister for Health) Leo Varadkar in 2014 to tackle overcrowding.
It is co-chaired by the HSE and comprises officials from the Department of Health, patient safety groups and groups like the INMO.
Many on the taskforce feel its influence has been heavily diluted since then, as evidenced by the fact the Minister for Health Stephen Donnelly did not turn up for Monday's discussion.
This is despite the fact members felt he should hear first-hand about what is happening in hospitals as a result of the latest wave of Covid-19 cases.
There was a long agenda and detailed presentations and as the numbers were parsed (the jump in admissions, the high daily case-loads, the level of staff absenteeism) the question repeatedly became: what are we going to do about this?
“We need to set off the alarm bells here, we need to draw attention to how serious the situation is in hospitals,” said a source who attended.
The attendee even considered suggesting the return of the National Public Health Emergency Team (Nphet) in a sign of desperation for a clearer structure that would give guidance about the path ahead.
Letter
In the end, a letter was issued to the Minister which asked him to urgently convene “the necessary public health resources and advisors to consider any and all measures that may now be appropriate in order to provide an increased level of protection to health and social care service provision.”
Yet the Government is extremely reluctant to go back to the days of heavy-handed laws telling people what they can and cannot do.
Some Ministers believe that while hospitals are very busy, the situation is no worse than March 2018 or 2019 in terms of the numbers on trolleys.
They believe that the focus should be squarely on pushing the booster vaccination campaign and on reminding people of the actions they can take themselves: isolation and wearing masks in crowded settings. That should be the focus, “not laws”, one source said.
That said the Government is very aware of the drum-beat from some quarters for making mask wearing mandatory again but as one senior figure said: “the public themselves are making up their own mind. (There is) nothing stopping people wearing masks if they want to.”
Even in the HSE, there is a belief that while mask wearing is important, focusing on this as a silver bullet at the detriment of other actions would be counter-productive.
In any event the emergency Covid legislation which has underpinned all of the restrictions is due to lapse this Thursday the 31st of March and there is little to no desire in Government to stop this. The attitude is that waves will come and waves will go, this will be a feature of life for some time to come, and the panic button should not be pressed every time things go awry.
No change
Mr Donnelly met outgoing chief medical officer Tony Holohan last Thursday and at that stage, no changes were being recommended.
The main thrust of that meeting was that there needed to be a concentration on the need to isolate when symptomatic and to wear masks in public transport if possible.
Despite the message coming from Government, there is an anxiety about what the next few weeks may bring, evidenced by the fact that some Ministers have asked for updated modelling.
In the absence of that modelling, some are doing their own guesswork and estimating that Covid-19 patients in hospital could peak at 2,200 in the coming seven to ten days, and after that cases, and patients and those in hospital should start to fall.
But, this being political guesswork, no one is sure.
Before they wound up their work, members of the Nphet discussed the fact that cases would rise and the pressure would intensify once all restrictions were lifted.
It was inevitable.
Yet it appears no long-term modelling was done to prepare the country for what could lie ahead.
Much of this could be thrashed out by the touted successor group to Nphet, if it were set up yet.
Sources say there was no update on this, or indeed Covid generally, at Cabinet on Tuesday.
There have been reports that there are disagreements between the CMO and Mr Donnelly about who should be on this group with the Minister favouring more external expertise.
Sources have also said he is very keen to ensure a better gender balance and that there has been too much talk in recent years of restrictions around, for example, golfing than on restrictions in maternity wards.
However, the events of recent days, and the meeting of the emergency taskforce on Monday, shows a desire and need for leadership which many would have expected to come from the Minister for Health.
Yet the overriding sense is the car has no driver and the destination is unknown.
Avoiding a coronavirus crash is what all of the stakeholders want: how to do that is the question.
