COVID testing

Opinion: How to get national buy-in to a COVID-19 strategy

  • Society

The second wave is upon us – a growing swell whose peak we may not see this side of 2021. That is a profoundly depressing vista, as Ireland faces into the winter. It is hugely frustrating for the young and healthy, and for those whose livelihoods are being decimated, and a cause of growing fear for the elderly and vulnerable.

Commenting on COVID-19 in Ireland from 4,000 miles away in Ethiopia risks missing the insights of Irish experts and under-appreciating the efforts of many who are toiling tirelessly. But perhaps distance brings a different perspective.

The herd immunity proponents overlook the reasons why we didn’t let the coronavirus spread uncontrolled among the young and healthy in the first wave. Decades of under-investment in health infrastructure and staff mean that Ireland’s hospitals, ICUs and GPs would struggle to manage such a laissez faire approach and the longer-term effects of the virus are unclear.

The right goal

Those who advocated elimination have refrained from saying “I told you so”. Greater vigour in ramping up community testing from early August, together with a delay in relaxing physical distancing measures, might have got us closer to elimination. This was the right goal, if never fully achievable, given our geography and economic model. But that’s not where we are now. There is consensus on the need to protect the vulnerable, but a deficit of ideas on how to achieve this – on how to change people’s behaviour.

An efficient, high-volume test, trace and isolate capacity will continue to be essential, but far from sufficient for controlling an increasingly asymptomatically transmitted virus. The biggest problem, however, across liberal democracies worldwide, is public fatigue and waning support for the reintroduction of government-imposed restrictions.

Getting most people to buy-in is not sufficient. The coronavirus thrives and spreads where 10 or even 5% of people ignore or are unable to adhere to restrictions. Yet all of us will be required to physically distance, apart from close family and essential work interactions.

Some of our values – respect for autonomy, especially in our homes, and the right of free assembly – become weaknesses in the fight against the virus. And measures by governments to curtail these freedoms can be the wedge in the door to an autocratic society. Yet without close to universal adherence to physical distancing measures, winter will be a dark place in Ireland’s hospitals, nursing, family and funeral homes.

If Government-imposed measures are likely to fail – neither this nor any likely future government has been given the legitimacy by the people to impose the draconian measures that are acceptable in many southeast Asian countries – where will the necessary legitimacy and public support for greater statutory powers and interventions come from. And instead of relying only on increased State powers, how can we become a society where we feel the confidence and have the strength to point out to – and accept feedback from – our friends, neighbours and strangers, when rules and guidelines are flouted.

Cohesion has fragmented

Disdain for informers is deep-rooted, especially in rural areas, and community cohesion has fragmented in urban areas, where COVID-19 thrives. This is why an organised broad-based community driven approach is needed, to build public consensus and persuade those who can to physically distance (and adhere to the other public health measures), and to enable those who struggle – due to economic and other vulnerabilities – to do likewise.

No liberal democratic society has undertaken a deep-rooted and systematic community dialogue to build national consensus to bring about the fundamental societal changes needed to overcome COVID-19. Yet Ireland is uniquely well-placed to do so.

A virtual Citizens’ Assembly could bring together in dialogue all of the sectors whose support and consensus is needed. The aim of the assembly would be to agree on what measures are needed to control the virus, while protecting the economic, social and psychological wellbeing of all sectors and members of society – a tall order.

Involving all sectors is critical to ensuring legitimacy for the fundamental, temporary changes needed in how we live our daily lives. No democratic, constitutionally-bound government has such legitimacy; and the current one is gradually losing the public, if not its legitimacy.

Pressure groups

A COVID-19 oversight group may make for more efficient government, but risks undermining public confidence in the role of NPHET, already sidelined by pressure groups.

A Citizens’ Assembly would provide a transparent, public platform for sectors to be heard and to listen and to, in turn, persuade and where necessary regulate their members to adhere to guidelines agreed through consensus.

An assembly of the people could also overcome the current poverty of ideas. It is deeply worrying to hear Acting Chief Medical Officer Dr Ronan Glynn having to implore the young and not so young to physically distance. One example of the failure of the current approach was in the guidelines for reopening pubs, which failed to engage the vintners’ sector around the need to change how we drink in pubs.

A Citizens’ Assembly could gather the community power of Irish society, in a way not seen since the foundation of the State, to together overcome the biggest threat in a century.

Space precludes listing the participating sectors. They cover age, sex, ethnicity, commerce; health, social and economic vulnerabilities; and sport and social activities, together with those whose contributions are most critical to managing the health, social and economic impacts of COVID-19, including Government.

A Citizens’ Assembly, like previous ones, will require inputs from a broad range of experts, including but expanding beyond scientists, clinicians and public health (behavioural as well as epidemiological) experts, to include human rights, economic, legal and constitutional expertise.

I am confident that others will bring far greater expertise than I can to shaping and bringing forward these ideas.

This article was originally published in The Irish Times on 1 October 2020

Ruairí BrughaProf. Ruairí Brugha is a medical doctor, public health specialist, Professor Emeritus and recently retired Head of the Department of Public Health and Epidemiology at RCSI.