A State of Emergency

The Story of Ireland's Covid Crisis

Richard Chambers

• Publisher: HarperCollinsIreland
• Year: 2021
• Print ISBN:
  9780008502850
• eBook ISBN:
  9780008502836
• Topic: Medicine
• Subtopic: Health Care Delivery

PART I

Chapter 1: The Beginning

Dillinger’s Restaurant, Ranelagh, 10 January 2020

Tony Holohan, his wife and two teenage children were in Dillinger’s in Ranelagh for dinner. Surrounded by the buzz of laughter and groups of young diners meeting over cocktails and craft beers, Holohan was preoccupied. He couldn’t fully concentrate on the meal, digging at it with his fork, his mind wandering to what was happening in China. He’d read a medical journal article on clusters of pneumonia of unknown origin in Wuhan and he did not like what he was hearing. ‘If something is going to knock us over, this is it.’

By early January, Holohan, Ireland’s Chief Medical Officer (CMO), had casually contacted a number of his closest colleagues, a sounding board of experts working across the health sector who would tell him straight if they were worried about this siren blaring in the East. He’d call Cillian De Gascun, Director of the National Virus Reference Laboratory (NVRL) at University College Dublin (UCD); Ronan Glynn, Deputy CMO; Kevin Kelleher, Assistant National Director for Public Health at the Health Service Executive (HSE); and John Cuddihy, the interim leader of the Health Protection Surveillance Centre (HPSC).

They’d have the odd chat in the evenings, talking about this new virus, what stood out to each of them, the links to a seafood market, the lack of transparency from China, the worrying signs of severe illness, the question mark around human-to-human transmission, and the fact that there was nobody in the world with any immunity to this thing.

The weekend of 25–26 January, Holohan was down in Limerick for his sister’s fiftieth birthday. On the way back to Dublin, with his daughter driving the car, he called his insiders once more. It had just dawned on him that firmer action was now needed.

‘Guys, I think we need to have a NPHET meeting. We need to formally organize.’

NPHET, the National Public Health Emergency Team, was not a new construct. There had been a number of NPHETs before. There had been NPHETs for moments of concern including the H1N1 swine flu, and just the previous year, 2019, for the CPE superbug scare. This time was shaping up to be very different.

The meeting was held in the Department of Health’s upstairs boardroom on 27 January. Eleven people attended, led by Holohan. As the officials came together, there was a touch of excitement in the air. ‘It’s always nice to be in the room,’ says Cillian De Gascun, who looked around the conference room high above central Dublin, as small talk filled the air. Officials chatted to each other before the meeting and on their way out. Some were familiar to each other, others were close colleagues who’d served years together in health services. ‘Agh, it could go the way of SARS or MERS,’ some officials reassured themselves; ‘there was a feeling that even though we had convened, this could be a short-lived thing’.

The gathering was short, a check-in more than a crisis engagement. An opportunity to get faces in the room together. Boxes were ticked. The HSE’s Emergency Management office said it would have a sufficient supply of personal protective equipment (PPE) for the ‘coming weeks’, with contracts in place to access more should it be required.

It was a meeting few people took notice of. There was no media reporting of the convening of NPHET or the HSE’s National Crisis Management Team for a number of days. All attention was on a hotly contested general election campaign. Politicians had yet to see the storm clouds gather.

* * * *

‘This one could get out of the bag.’

Professor Máire Connolly had been around long enough to know that something different was happening here. The Galway woman is one of the foremost experts in emerging infectious diseases and pandemic preparedness in Ireland, or anywhere for that matter. She had worked for many years in a lead role with the World Health Organization (WHO) and few people have stacked up as many airmiles in tracking global disease threats and natural disasters – she’s been in Afghanistan, Kosovo, Iraq, Gaza, Uganda, Iran, Indonesia, to name just a few. In 2005, a New York Times profile interview focused on the emergency relief work that took her, and often her husband, Dr Mike Ryan, also of the WHO, across the globe, often in separate directions. It was dangerous work. Connolly was confronted by soldiers brandishing guns in East Timor who didn’t understand her mission to hang mosquito traps. ‘Can’t you two ever stay in one place at the same time?’ her mother asked her in those days.

More than anyone else in the country, having led the PANDEM pandemic response project since leaving the WHO, she understands the risks of communicable diseases. What she heard in January did not sound at all good to her. The Christmas decorations were still up at home as she spoke with her old colleagues in Geneva the day after New Year’s Day. The rumblings were not encouraging. One colleague was particularly concerned about data coming from the WHO’s office in Beijing. The alarm bells were already sounding for Connolly.

Governments and health departments around the world have tended to look at experts in emerging infectious diseases as shroud wavers. They had sounded the alarm about the swine flu H1N1 and the bird flu H5N1. The sky didn’t fall. The world didn’t cave when SARS arrived in 2003 or MERS in 2012. Neither did it take notice of the ominous sign that two novel coronaviruses had emerged in a ten-year period. There was little fear of a third.

The hope, and it was a hope, for the global community was that this new virus would go the way of SARS-1 and be controlled, contained, and moved on from within a matter of months.

‘The fundamental difference,’ says Connolly, was that with SARS, ‘if you get infected on day zero and you become sick on day five, you have a week before you become infectious.’ With Covid, ‘it became clear quite early on in the pandemic that there was transmission going on that wasn’t symptomatic – you were transmitting it before you were clinically unwell. If you get infected on day zero, you can end up transmitting the disease on day three and then you become sick on day five. Or you could be someone who doesn’t get sick at all and manages to transmit the virus.’

The world had dodged a bullet with SARS-1. With Covid, it would not be so lucky.

This was the root of all that followed. With a new virus, there is a lot to learn, and you have to learn fast. The world’s authorities simply didn’t get what everyone came to know about the virus in the following months: that it can spread from people who do not have symptoms, or who do not yet have symptoms; that face coverings are an effective measure to control transmission; that it can spread through the air beyond the two-metre close contact boundary.

‘It’s the risk of fighting the last war,’ says Dr Cillian De Gascun, ‘and trying to learn from SARS and MERS. This didn’t seem to be terribly transmissible at this stage.’ It was a lesson that would be hard learned over many weeks and months to come. Only in the spring that followed would public health authorities put into place recommendations on measures like masks and travel. By then it was all very much too late. The virus seeded itself across international travel and gained dominion over Ireland and the wider world.

The Independent Panel for Pandemic Preparedness and Response, commissioned by the WHO to review the early response to this new threat, was damning. This was the twenty-first century’s ‘Chernobyl moment’ and the world’s authorities had failed to act swiftly enough to raise the alarm. What followed was a ‘lost month’, February 2020, when countries began to see cases emerge within their own borders and then, belatedly, put measures in place.

In Ireland, the threshold to be considered a suspect case was high. To be considered a possible case, you would have to display the symptoms of high fever, a cough and shortness of breath and also have travelled from China within the previous fourteen days. The risk of transmission was deemed by the European Centre for Disease Prevention and Control to be ‘low’.

* * * *

For Dr Colm Henry, it was the first instance of ‘magical thinking’, a descriptor that came to define much of the pandemic. Henry, originally from Cavan town, was a geriatrician by speciality in the Mercy University Hospital in Cork and, since April 2018, had been the Chief Clinical Officer of the HSE.

‘Magical thinking characterized the whole year for me, meaning that your thinking evolved to what you wanted it to be. There was a sense of otherness about it, that it was something that was happening over there. The magical thinking began the moment we heard of it, thinking that it belonged someplace else.’

Henry was on holiday in South America when he first noticed the stories about the new virus. His own magical thinking, he says, was along the lines of ‘It can’t be that bad’; sure wasn’t he in a concert hall with hundreds of people and wasn’t everything fine?

During his two weeks away, his phone rang with urgent matters from the HSE. ‘Strangely enough, none of them were related to Covid-19.’ The virus was still very much in the peripheral vision.

* * * *

The first time the Government was alerted to the coronavirus was on 28 January, the day after the first NPHET meeting. Health Minister Simon Harris brought a memo to his colleagues that included advice from the WHO to implement measures to limit the risk of importing cases ‘without the unnecessary restriction of international traffic’.

For the ministers around the table, this was all just background noise at this point. One senior minister says, ‘The first time the government really became aware from a crystal clear point of view that this was going to be a major deal’ would not be for at least another month.

The virus was not a feature of the general election; the airwaves and conversations on doorsteps were dominated by housing and rows over whether or not to commemorate the Royal Irish Constabulary. ‘It is quite something, isn’t it? If we are really honest, all of us, Ireland wide, we had no sense of this,’ says Sinn Féin’s leader Mary Lou McDonald. ‘I’m assuming that somewhere in officialdom, those in public health and epidemiology had their eyes on the ball, but I can tell you – the political system didn’t.’

The civil servants in the Department of Health felt liberated in the political vacuum. They had the space, the bandwidth, to focus on organizing themselves unimpeded against the threat growing in the East.

‘I think what would have been different if there hadn’t been an election,’ says one senior government adviser, ‘is that there would have been a structure put in place by Government rather than by officials themselves. Because of the election, the civil servants took over at the very start. Everyone there knew that Harris wasn’t going to be the Minister for Health. Leo Varadkar wasn’t going to be the Taoiseach. So the civil service were using this as their opportunity to get a bit of power back from the Government and run things the way they saw fit.’

The Department of Health was otherwise, in effect, in sleep mode. ‘A lot of things slow down in government departments because ministers aren’t in a position to bring forward policy,’ says Holohan. ‘The only things that happen are the things that simply must happen.’

The Department and its management board was confined to core business. At a meeting in a Miesian Plaza boardroom, in the vacuum of the usual policy-driven objectives, the top civil servants clicked pens and looked at an empty to-do list for the weeks ahead. ‘Has anyone got anything at all?’ After a brief pause, Holohan chimed in. ‘Well, it’s funny you should say that,’ he said. ‘I think I have something.’

* * * *

A dejected Simon Harris was in his office at the Department of Health, stuffing cardboard boxes. He was set for the road. It was the Monday after the election on Friday and the public looked to have called a halt to Fine Gael’s nine years in government. According to people closest to him, he would be checking out. The general election was called to head off a motion of no confidence in him as the Minister for Health, off the back of the hospital overcrowding and trolley crisis. In his own mind, he felt that whatever the outcome of the vote, he would no longer be occupying the minister’s office in Miesian Plaza. While the results left an uncertain split between the three largest parties, Harris wanted closure and to move on.

As he packed notes, stationery and personal belongings into boxes to be dropped out to his constituency office, his private secretary stuck her head in the door. ‘Are you mad?’ she said. ‘This could go on for months yet.’

Harris, at thirty-three still a young politician, was facing a crossroads. He’d told his confidantes that he’d do whatever was required to keep things ticking along, but he was on his way out. The office of the Minister for Health is almost right beside the office of the Chief Medical Officer and the offices of many of the senior members of the Department’s board of management. Harris’s relationship with Tony Holohan appeared to be coming to an abrupt end. It was a relationship that was complicated, to say the least.

The two had worked closely throughout Harris’s four years in Health. They had teamed up on the legislation to provide for abortion services following the referendum to repeal the Eighth Amendment. They had clashed on the CervicalCheck controversy. Harris had publicly aligned himself with patient advocates such as Vicky Phelan, Lorraine Walsh and Stephen Teap, while Holohan had been heavily criticized. Things did improve between the Minister and the Chief Medical Officer, though almost out of necessity. ‘They didn’t have a very good relationship throughout Simon Harris’s tenure,’ says one Department of Health official. ‘It changed then. They were grand, they got on well. Once Covid arrived, they had to dig down in the trenches together.’

By the time Simon Harris was back in the Department, and his colleagues at Government were safely back in theirs, the running of the Covid show was already in full swing. ‘By the time they got back,’ says one senior official, ‘and realized there was something going on here that they needed to turn their attention to, other than their own elections, we were up and running.’

NPHET had already conducted a number of meetings. Dr Tony Holohan and his deputy Dr Ronan Glynn were already giving interviews to the national media. The caretaker administration was content to let the civil servants and health advisers carry on.

On the first day TDs returned to Leinster House, Ronan Glynn had organized a briefing for people in the political sphere who were returning to work on the national level to try to bring them up to speed on the growing risk associated with the coronavirus. The meeting was held in Buswells Hotel, across the street from Leinster House, a familiar haunt for lunching politicians and staffers and also a venue for lobby groups and NGOs to hold launches that could draw in politicos. Glynn sat downstairs in the briefing room. He noted that two people attended the meeting, neither of them elected representatives. ‘I fully understand why there were very few people there,’ he says, ‘but equally it shows that even at that point, it still hadn’t captured broader attention.’

A week later, the conversation was growing. The blindfold of blissful innocence was coming off. Glynn held a second briefing, this time in the Audio-Visual Room of Leinster House 2000, the modern annexe of the Dáil. This time, about twenty people attended, dotted around the tiered benches of the AV Room’s small lecture hall set-up. There were perhaps ‘a handful’ of politicians in the audience, according to one of them: Micheál Martin, leader of Fianna Fáil. Martin had some experience in public health, having served as the Minister for ...

Table of contents

• Cover
• Title Page
• Copyright
• Dedication
• Contents
• Part I
• Part II
• Picture Section
• Acknowledgements
• About the Publisher