Stephen Donnelly (Wicklow, Fianna Fail) | Oireachtas source

I thank the House for this opportunity to consider the measures that have been introduced in response to the recent rise in cases of Covid-19. As Deputies will be aware, earlier this week the country moved to level 5 of the Government's medium-term strategy for dealing with the virus, Resilience and Recovery 2020-2021: Plan for Living with COVID-19. I do not propose to rehearse all of the measures that are encompassed by that move. Colleagues are aware at this stage, following the address by the Taoiseach on Monday, of the primary measures that have been taken. Among the most significant is the decision to close non-essential retail outlets, to restrict restaurants to takeaway service only, and most difficult of all, the requirement for people to stay at home as much as possible, and to exercise within 5 km of their homes. I emphasise that the Government and I understand that people are extremely frustrated at the restrictions which we have all been living with since March of this year. I understand the difficulties and the anger that have been generated by the ways in which life has been altered. However, it remains the case that we are in the midst of a once-in-a-century pandemic.

As The Irish Timesreports today, Europe's reported coronavirus cases more than doubled in ten days, surpassing 200,000 daily infections for the first time. Various European countries have reported their highest ever number of daily cases. Hospitals across Europe remain under strain. Covid-19 hospital admissions and occupancy rates are rising. Belgium has had to postpone non-essential hospital procedures. There have been reports that stretched Dutch hospitals are going to have to transfer patients to Germany. The Czech Government has had to seek help from the United States National Guard. Our European neighbours are also using various measures, including curfews and the closure of bars, restaurants and non-essential retail outlets to limit the spread of this virus. Germany is now grappling with more than 10,000 coronavirus infections daily, the most it has experienced since the outbreak started, while admissions to hospital intensive care units have doubled over the past two weeks.

It is important to remember that while there have undoubtedly been some positive developments with regard to improved outcomes for Covid-19 patients in critical care, and some drugs have been shown to be somewhat effective in certain circumstances, we essentially remain without any therapeutic intervention that we can rely on as a cure. I am hopeful that in the near term, that situation will improve, but that is the case today. The World Health Organization recently reported from its international Solidarity trial, which Ireland is also participating in, and concluded that a number of drugs for which many people had high hopes, such as remdesivir, hydroxychloroquine and interferon, had little or no effect on the course of the disease when examined through a gold-standard, randomised trial. That trial involved more than 12,000 patients in 500 hospital sites in more than 30 countries.

As the House is aware, there is also a major global effort to develop a vaccine for the virus. Ireland is part of the process that will be procuring supplies for the EU and has signed on to the first contracts that have been put in place. That leaves us with what are termed non-pharmaceutical interventions and the terms which we have all become very used to over the past eight months, including social distancing, cough and sneeze etiquette, wearing a mask and avoiding crowded situations. Most people have embraced these new behaviours. We all slip up from time to time. We can all forget and stand too close to someone in a shop or not wash our hands when we had planned to, but I think it is reasonable to conclude that most have demonstrated remarkable fortitude in the face of what has been an extremely difficult year. However, we also know that it has been sometimes necessary to bring forward legal instruments to ensure that public health was provided for by means of particular measures. We are not alone on this. Many countries have done the same.

I would also like to update the House on the situation with regard to testing and tracing. As Deputies will be aware, the HSE has worked intensively over recent months to put in place a comprehensive testing and tracing operation. Capacity is in place to test up to 20,000 people a day. With this level of testing, more than 111,000 were swabbed last week, and we are finding more cases than we would have previously. In recent weeks, while we have increased resources significantly as demand has increased, the numbers of positive cases and close contacts have risen even more sharply. The impact of the sharp rise in cases and volume of contacts meant that demand on the tracing system last weekend temporarily exceeded its capacity. The HSE put in place one-off temporary measures to address this situation. This understandably caused anxiety. However, as our Chief Medical Officer, Dr. Tony Holohan, said clearly, we need to recognise that in a mitigation period in a pandemic, which is what we are currently facing, when a surge on the scale of what we are currently seeing is apparent, it is clear that we cannot contact trace our way out of where we are. We need the social restrictions that are now in place and we need everyone to help us make them work. The number of cases now being detected on a daily basis has exceeded the ability of the contact tracing system. Indeed, the events of this weekend underscore the need to move to level 5 restrictions.

It is important to state clearly that we as a country continue to face a major threat from Covid-19. Its lethal potential has not been altered. We know that most people who get the virus will have mild symptoms that resolve themselves but we also know that we can expect to see a proportion of people infected with the virus require hospitalisation, a smaller percentage requiring admission to critical care, and, tragically, some people have died and more, unfortunately, will die. As of yesterday, we have seen 1,871 of our fellow citizens die from this disease. Many others have suffered extremely debilitating bouts of illness, requiring hospitalisation and, for some, assistance with breathing via a ventilator. I express my deepest sympathies to the families and loved ones of all those who have died. I also once more wish to extend my heartfelt thanks to all of the healthcare staff who have worked far above and beyond the call of duty over the past eight months in responding to this crisis.

If a situation occurs, as it has now in Ireland, where the virus is spreading rapidly among the population, the ramifications of that begin to pose an enormous threat to the health of our entire country. It is vital in such circumstances that we work to prevent the spread of the virus from moving so rapidly that it overwhelms the capacity of the health service to treat those requiring care. There is no health service in the world that has an infinite capacity to meet the level of demand that uncontrolled spread of Covid-19 would impose. We witnessed the scenes earlier this year in a number of very advanced healthcare systems - in Italy, Spain and New York, to name but a few - where the hospital network came under the most severe pressure. As I said earlier, real pressure points are beginning to emerge across Europe. This is the situation that we are working hard to avoid in Ireland.

As the House is aware, critical care plays an essential role in the provision of care to patients who are seriously ill as a result of Covid-19. Ireland has an acknowledged historical deficit in critical care capacity and we are working to address this. Deputies may wish to note that baseline permanent adult critical care capacity in Ireland at the start of 2020 was 255 beds.

Funding for a further 40 adult critical care beds and two paediatric critical care beds was provided as part of the response to Covid-19 in March. Investment announced in the recent budget will bring the overall number of permanent beds by the end of next year to 321, an increase of 25% on the numbers last January. The acute system also has the capability to respond with surge capacity if required, although not without consequences in terms of staff redeployment, curtailing other services and greater clinical risk as the number of surge beds rises. This is precisely the scenario we are working to avoid. The acute hospital system and critical care service coped with the initial surge in admissions largely due to the success of public health measures in flattening the curve and the subsequent fall-off in Covid cases and non-Covid care.

While we are continuing to work to address the deficits, it must be recognised that the development of critical care capacity is not straightforward and involves much more than simply sourcing a bed and putting it in a hospital. It is a system of care that requires trained available nurses and doctors as well as appropriate equipment. As of 21 October 2020, 247 critical care beds were occupied. There were 35 confirmed Covid patients in critical care, as well as a further 15 suspected cases.

I recognise the genuine concerns that have been expressed by Deputies about other aspects of healthcare delivery. To be clear, we are not prioritising care for people with Covid over people with, for example, cancer. We are making every effort to ensure that we retain capacity within the health service to treat all patients. My concern, and the concern of NPHET, is that we would lose the ability to respond to non-Covid ailments, such as cancer, to stroke patients and to people injured in accidents as a result of the strain that would be placed on hospitals in the worst-case scenario. There is no option available to us where we can ignore the growth in the disease and expect hospital functions to continue as normal and to be available to all who will need them in the coming weeks. This is a public health matter, first and foremost. It has economic, legal and societal ramifications that have to be mediated through the political system. However, the virus can only be suppressed if we all buy into the public health measures in place here and across the world. Social distancing and other measures, such as good hand and respiratory hygiene, remain our primary defence.

I wish to conclude by giving a message to people throughout the country for the coming six weeks. It is about non-Covid care. During the initial efforts to flatten the curve, many health services were closed, as were schools, colleges, childcare and most of the economy. What happened was a serious reduction in the number of people presenting to their GPs and, for example, being referred to the rapid access clinics for cancer. The number of people presenting with strokes and other conditions fell to a level that deeply worried those working in emergency medicine and across the healthcare system. For understandable reasons, there is still a lower level of referral and presentation by people across the country. People are scared and anxious. They want to know that their healthcare system is safe.

For example, one of the programmes we all support, and I have discussed it at great length in the Oireachtas, is the national screening services. I was informed in the last few days that 90% of women invited for smear tests or the new test are not turning up. I do not blame anybody. People have many reasons, and it has been a very difficult year for many. However, it is essential that people continue to engage in the healthcare system. We could find ourselves in a situation, through the measures we are taking, whereby we save many lives that otherwise would have been lost to Covid-19, but, on the other side, we could end up losing many more lives and healthy years for people to live as a result of them not engaging and presenting as early as they normally would.

We have moved to level 5, but it is not like the first time. It is identical to the first time in one critical way, which is in the core message from the public health doctors, the Government and the vast majority of Members of the House that people should stay at home for the next almost six weeks. There are exceptions to that, but the core message is to stay at home, where possible, so we can drive this virus back down again and reopen in early December. How it is different is that more aspects of our lives are open, such as childcare facilities, primary and secondary schools, colleges, adult disability services and, critically, the healthcare system. The healthcare system, GPs, primary care facilities, diagnostic services, emergency departments, outpatient clinics and operating theatres are all open. The doctors, nurses and allied health professionals are all going to work. I hope we all can tell the people we represent that healthcare is open. Indeed, one of the reasons we moved early to act pre-emptively against this rise in Covid-19 is to ensure we do not find ourselves in the position we were in last time, or in the position some other European countries find themselves in now whereby they are having to close down large parts of their healthcare systems to cope with Covid. That is not where we are, and it is why we are moving early and decisively.

The message is to stay at home or within 5 km of one's house. We must look out for, and take care of, each other. Essential visits are fine, just as they were last time. For visits to relatives or friends who may be vulnerable or in trouble, we introduced something I pushed hard for, the concept of the social bubble for single adult households. Nonetheless, this will be a hard six weeks. We are heading into the winter, whereas we were heading into summer on the last occasion. That made a big difference. The message is that people should stay at home if they can or within 5 km of their house. There is a set of exemptions to that which are available on gov.ie. I reiterate, as Minister for Health, that the healthcare system and non-Covid healthcare are open. The best way we can protect and keep each other safe is to ensure that everybody continues to engage with the healthcare system. That is how we will save as many lives and as many healthy years for people as possible.

I must inform Deputies that I must leave. I had hoped to stay here so I ask Deputies not to take offence. I am meeting the 221+ group and because the business ran on, I must leave now. I apologise to Deputies for leaving.

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