Dr Gabriel Scally: Further waves of infection and death if north and south differ
IT has been an enormously difficult few weeks, the like of which few of us can have ever experienced.
But another major challenge awaits us in our struggle against this deadly virus.
It will be no easy matter to draw up the roadmap for the eventual removal of the wide range of restrictions that are currently in place, both north and south, in order to combat Covid-19.
Over the next few weeks a major difficulty facing those making the decisions in each part of the island will be ensuring that the versions of the map are compatible with, and supportive of, each other.
Happily, there is now an official agreement between the two parts of the island that could facilitate the achievement of a harmonised approach.
The second paragraph of the Memorandum of Understanding contains a clear statement that there is a ‘compelling case’ for ‘a common approach to action in both jurisdictions’ where appropriate.
There are two key areas where that ‘common approach’ is vital if we are not to lose all the gains that have been made during these weeks of enforced restrictions. Restrictions that have been supported overwhelmingly across the whole of Ireland.
Failure to develop an agreed approach could well result in further waves of infection and death. That is a risk well worth avoiding.
The first and most complex issue that requires a common approach is the strategy of community testing, contact tracing and isolation.
Since March 13 the two parts of the island have been headed in entirely different directions.
The north, following the lead given from the decision makers in Whitehall, ended its programme of testing and tracing in the community.
In contrast the south has continued, despite the problems of laboratory supplies, to increase the reach and volume of testing and tracing.
It is becoming ever more apparent, even to some in Whitehall, that the absence of community testing is a major problem and that it will need to be resumed (and at a high volume).
The two parts of Ireland should work hand in hand to develop, as rapidly as possible, a robust network of local teams, locations for community testing and the IT and laboratory capacity that will be needed.
The second requirement for a highly effective plan will be a jointly agreed and uniformly implemented approach to public health controls at ports and airports.
According to recent analysis, more than nine out every 10 people in the world live in countries that have partially or completely closed their borders to visitors, and sometimes even to their own citizens, because of Covid-19.
The UK and Ireland are part of a small and disparate group of countries, apparently including Mongolia, Mozambique and Mauritania, that maintain an open borders policy.
The experience of China is very important in respect of border policy. Although they reached a position where there were no domestic cases of coronavirus being reported in the whole of China they still had a significant number of cases arising in Chinese people who were returning home from abroad.
It should be inconceivable that people could come through any port or airport in Ireland without passing through public health controls which would involve, as a minimum, taking temperatures and swabs for testing.
Alongside this full contact details and travel details should be required. This would have to be accompanied by isolation facilities near at hand to which arrivals could be confined if necessary.
Agreement on this will undoubtedly be difficult to achieve, but it needs to be done on purely public health grounds and only for the duration of the crisis. It is an essential component of any comprehensive plan.
The third aspect that I would dearly love to be in place before easing of restrictions would be properly specified and guaranteed protection for the elderly and disabled, and for those who work at caring for them.
This is particularly so for those in institutional care of any kind, but also applies to people having routine care provided to them in their own homes.
Making sure that this is in place, north and south, should be a pre-requisite before any significant loosening of restrictions
If I was allowed to specify just one more thing it might well be that there was a rapid north-south consensus agreement about the data that needs to be collected and published.
This would be so that we could closely monitor progress and make sure the necessary action was taken wherever on the island it was needed. It would be in all our interests.
None of this is going to be easy. It will require a boldness of thought and action that at any other time in our collective history would be regarded as inconceivable.
And, along the way there is always a substantial risk that we will fall back into patterns of thought and action dictated by our cultural background, political affiliations or prejudices and antipathies.
But if ever there was a time when we should set these aside and do the right thing, it is this time.
:: Dr Gabriel Scally is Honorary Professor of Public Health at the University of Bristol and President of the Epidemiology and Public Health section of the Royal Society of Medicine.