Dr Marcus de Brun a GP based in North Dublin who joined the Medical Council in 2018 at the invitation of Health Minister Harris has resigned over criticism at the government response to the Covid-19 virus in relation to the handling of nursing homes where many of the death occurred amongst the most vulnerable part of the population.
Here is some of the findings from his report which is attached here. Covid-19 Mismanagement in Ireland Bear in mind the report was written on April 14th.
First off he correctly defines and then homes in on the fact that it primarily is more lethal to the older section of the population. It is this group which the government initially paid least attention to and instead rushed to lockdown all the young and healthy people instead.
The etiological agent responsible for the Covid-19 pandemic is recognized to be a coronavirus. These are described as relatively simple RNA viruses that were first identified in poultry in the 1930’s. This family of viruses presently contributes to some 20-50% of cases of the seasonal or annual ‘common cold’. (1)
Coronavirus might reasonably be described as a ‘common’ cold virus. However, it is clearly a cold virus with a difference, in that it is potentially fatal among certain defined population cohorts.
To date a major difficulty with Covid-19 has been the enormous variability in morbidity/mortality data, the variability between countries, and the variability in individual outcomes. However certain risk factors have been almost universally agreed upon vis; ‘age’,
and the presence or absence of underlying health issues. This article will focus primarily upon the significance of ‘age’ as a risk factor for Covid-19 related mortality, and as it should perhaps feature in current management strategies
Covid-19 has consistently shown itself to be of increasing morbidity and mortality among older people with defined underlying health issues. Popular media sources in several jurisdictions often fail to highlight the fact that the median age of mortality, is generally above 80yrs of age, and the presence of defined underlying diagnoses, are common among fatalities.
It is very likely that the many deaths presently being reported as ‘deaths from Covid-19', would more correctly or more reasonably be described as deaths associated with Covid-19. There is a subtle distinction here, one that is frequently lost in popular media. The lack or inappropriate reference of such a distinction can only serve to add to what might be described as a ‘pandemic of panic’.
Further on when he discusses the level of anxiety and panic in the media he says:
For example, there have been recent media reports of ‘children’ having succumbed to infection with Covid-19. Recently the tragic death of a 13yr old boy in the UK, was reported under the following headline by the BBC on 13/3/2020:
“Coronavirus: 13-year-old boy dies, says London hospital trust.”
The case was simillary reported in Ireland and around the world as a ‘Coronavirus death’. However the same initial BBC report, ends with the following statement.
“It is important that a coroner assesses whether a postmortem is necessary to further understand the exact cause of death.” (5)
[Indy Editor: Additionaly mainstream media is now reporting that Children have strange symptoms possibly linked to Covid. In fact these stories are about children who have Kawasaki disease which in extremely small number of cases leads to heart problems. The media are currently going out of their way through use of headlines which they know many people just read, to try and suggest there is a new form of Covid link to children. This is not the case].
On Herd Immunity he had this to say concerning the vaccine and herd immunity:
At present there is no vaccine available for Covid-19. The absence of a vaccine has greatly contributed to the ‘pandemic of panic’, in respect of the virus. It is commonly believed that this means there is no ‘cure’ for the virus.
There is however an entirely inevitable and ‘natural cure’ for the virus. The fact is, that 80-90% of those infected will by all accounts experience nothing more than symptoms generally associated with a standard ‘cold’ or ‘flu’. There is no ‘cure’ for Covid-19, in the same sense that there is no ‘cure’ for the ‘common cold’. The cure for both conditions lies in the reality that infection is not dangerous for the vast majority of victims. Following an infection, the significant majority who survive, are expected to remain immune to (the same) virus for quite some time. This is the same reality for cases of the ‘common cold’ and seasonal ‘Flu’.
Once some 60-70% of a given population have been infected, effective immunity has been established within that population (6). This ‘immunity’ is commonly referred to as ‘Herd-Immunity’. It is the process whereby populations become immune to the common-cold; and in the absence of a vaccine, ‘Herd-Immunity’ is the only available mechanism whereby any given population will become progressively immune to Covid-19. Indeed, this is the case most community acquired viral infections that are not amenable to vaccination.
Spread, becomes increasingly difficult, and the virus eventually expires.
It is a regrettable that the concept of ‘Herd-Immunity’ has been somewhat vilified in the media, since it was first openly discussed by UK officials at the onset of the crisis in the UK. The political ‘encouragement’ of it’s development, has been portrayed in a negative manner, as a something of an ‘experiment’ or a cruel and rather inhumane response to the crisis. (7&8)
Herd-Immunity is an inevitable consequence of the Covid-19 pandemic. In the absence of a vaccine and if environmental or climate related factors are not influential upon reducing spread of the virus, Herd-Immunity is the only viable means of eradication.
‘Herd-Immunity’ is not the enemy, it is a natural and inevitable part of the process. Once some 60-70% of a population have been infected and recover, existing infections are unlikely to spread within that population. On each occasion that an infected individual meets another person in the community, the virus has a significantly reduced opportunity to spread. When a newly encountered ‘potential host’ is in fact immune to the virus (by virtue of that he or she has fully recovered). Spread, becomes increasingly difficult, and the virus eventually expires.
He then moves onto the Risk Groups which are the very people at the start the government neglected the most. In his report where he points out the differences between countries and within groups, he says:
Italy for example, has had a much higher proportion of fatalities than other European nations. A cursory review of some of the environmental, social and cultural differences between jurisdictions sheds immediate light upon the influence of these environmental/demographic factors.
- The Italians have the oldest population within the EU
- The Italians have a higher than average number of smokers
- The Italians kiss each other 2-3 times when the meet and greet
- The Italians congregate in large numbers for regular religious gatherings.
There are of course other ‘environmental’ factors that have no doubt had a significant influence upon the Italian mortality figures, and the above are simply obvious ones that are immediately apparent. Given these factors, the ‘surge’ in cases, the size of the Italian at-risk population, and the inevitable collapse of the Italian Health Service, would validate their national response in respect of strict isolation, lock-down and economic paralysis etc.
A comparison between Ireland and Italy in respect of demographics might not be fruitful, and instead a more reasonable comparison might be made between Ireland and the United Kingdom.
Given that Covid-19 has its highest mortality among the elderly, and those with underlying health problems, data pertaining to one of these factors (age) is readily available from the published census data of both jurisdictions:
“The UK has an ageing population (ONS, 2018k). There are nearly 12 million (11,989,322) people aged 65 and above in the UK of which: 5.4 million people are aged 75+, o 1.6 million are aged 85+, o Over 500,000 people are 90+ (579,776) o 14,430 are centenarians (ONS, 2018f, 2018e)” (9)
Therefore, it must be recognized that presently some 18% of the UK population are over 65 yrs old. Let us now compare this to the Irish population:
Ireland Demographics Profile 2019. 5,068,050 (July 2018 est.) 65 years and over: 13.32% (male 312,694 /female 362,455) (10)
Whilst the percentage of over 65yrs might not seem hugely different between both jurisdictions (13% Ireland, vs 18% UK) Closer scrutiny of these figures reveals major distinctions that are crucial to understanding the different morbidity and mortality figures within either case.
In the UK, 12 million residents are over the age of 65, whilst in Ireland 675k residents are over the age of 65. One must pause here and reiterate for the purposes of clarity. There are 675k over 65yr olds in Ireland, there are 12 million over 65yr old’s in the UK.
In respect of age alone there are circa 20 times more at-risk patients in the UK than there are in Ireland. As such if we restrict our comparison of both jurisdictions simply to age alone, we find a compelling correlation between the number of deaths in both jurisdictions
.... What these figures illustrate, is that in respect of age alone, as the primary factor influencing Covid-19 mortality; Ireland would be expected to have a mortality rate that is in the region of 18-20 times lower than the UK. In respect of population densities, this factor would have to be reduced even further.
Demographic realities present the Irish authorities with a singular advantage, in that, focused and intensive management of a potential population of 670k at risk, individuals, is certainly conceivable
.......... The fact that at least 33% of over 65yr old’s, and 60% of over 80yr old’s were living alone prior to the arrival of Covid-19, would suggest that a significant number of the at risk population in Ireland are already practicing some degree of social isolation, and have been doing so prior to the crisis. As already mentioned Ireland has one of the lowest population densities in Europe, and as such, ‘living alone’ in Ireland, is (arguably), significantly more isolated than living alone in the UK.
If we therefore roughly estimate that 33% of the over 65yr old population live alone in Ireland, a significant portion of the remainder are residing in ‘two person’ households, and only a small fraction of the remainder are living in households with more than two residents. As such, the age-related ‘at risk’ population in Ireland, is already significantly more socially isolated and socially distanced than those of the UK. In this sense, were Ireland to decide upon an alternative demographic and ‘medical-risk’ based approach; isolation of at-risk groups, could have potentially been achieved with relative ease, and relatively minimal economic cost.
Unfortunately in Ireland the current popular strategy has sought to isolate the entire population first and those most at risk, vis the elderly and nursing home residents, have featured as something of an afterthought
And on the lockdown which the government rushed into at the behest of the WHO, he has this to say:
Political failings within the current strategy
On the 13/3/2020. The Irish Govt closed schools, and began its social distancing program, in order to curb community transmission. Shortly afterwards, the measures were escalated to a near total social and economic shutdown, with the closure of all non-essential businesses, and a directive to all citizens to stay at home, not to venture more than 2km from their homes etc. Police have been given extra powers to enforce the restrictions. Gross impositions have been placed upon civil liberties and economic function. All with the stated objective of delaying presentations to hospital, of ‘flattening the curve’.
These actions whilst perhaps noble in their ideal, are having and will have profound effects upon public-health, and the economic function of the entire nation. Impending economic recession, unemployment, the health consequences arising from near total shutdown of Community Health services, have yet to be accounted for.
Unquestionably the most vulnerable cohort of patients in Ireland are those residents of Nursing Homes. This fact should have been entirely obvious to all involved in the management of the crisis. Most of these individuals are of course elderly and most have significant underlying health conditions. Nursing home residents cannot or could not be expected to avail of the same measures applied to the general public. Their needs and care were only considered at a Ministerial level on 30/3/2020, long after the arrival of the virus on 28/2/2020. It beggar’s belief, and remains an evolving tragedy, that these vulnerable people were not considered as the first priority for the state, rather than being the last to be considered.
Up until 9/4/2020, nursing home residents were refused testing in nursing homes where Covid-19 had already been detected. Nursing home staff were advised: ‘ to presume everybody has it’.
..... Many of these measures are clearly not part of a cohesive strategy, but are likely being made up as we go along....
On 12/3/2020 the Irish government closed all schools and initiated the formal process of social isolation and economic shut down. Five days later on 17/3/20 the Taoiseach of Ireland Dr Leo Varadkar, issued a press briefing that was reported as follows:
“Ireland’s leader Leo Varadkar has warned that the number of infected during the COVID-19 outbreak would increase 30 percent every day.
Ireland’s Taoiseach (Prime Minister) Leo Varadkar told a press conference at the Department of Health on Monday evening that 15,000 cases of the Coronavirus (COVID-19) by the end of March.” (13)
The important point here, is that government’s estimation of 15k cases by the end of March, was made during school closures, and social measures already in place. The rise in cases was predicted to occur during the measures already commenced on 12/3/2020. There is no evidence to validate the claim that the government intended to avoid its predicted 15k cases through the application of social measures already in place. The predictions of 15k confirmed cases, and a 30%daily increase in cases were made five days after many or most of the social measures were already in place.
It was precisely for this reason (expected 15k cases) that the extra ICU beds were procured, supplies of PPE were purchased, patients recovering in hospital were transferred for convalescence at community facilities, and numerous hotels around the country were converted into covid-19 makeshift hospitals etc.
The increase in cases, was predicted to occur during the existing measures. This increase did not occur. On March 31st the total number of confirmed cases in Ireland was 3235. At the time of writing 12/4/2020 there were circa 9k confirmed positive cases in Ireland
During the same press briefing the Irish Government, announced that positive cases were expected to “increase by 30% daily”. Based on this prediction from a starting point of 15k cases on 31/3/2020 the Government expected a total of 590,606 cases in Ireland as of 14/4/2020. The actual 9k total figure of confirmed cases is obviously far short of the government’s estimates. Surprisingly few questions have been asked of the Government in respect of the gross disparity between its estimates and the emergent reality of confirmed cases in Ireland. And surprisingly fewer questions have been asked of the National Public Health Emergency Team (NPHET), whom it is presumed, were at least partly responsible for these estimates.
It has been and will no doubt be claimed that the reduction in confirmed cases is a consequence of the govt response. However, if we are to make this assertion with any degree of credibility, the Government can only assert that the ‘additional’ measures put in place from the date of its predictions, are responsible for the reduction in expected cases. Given that social distancing and school closures were already in place, the dramatic decrease in expected cases is very unlikely to be solely attributable to the additional measures alone. This type of beneficial effect from the additional measures would be unlikely to have a parallel in any other jurisdiction.
People may remember the media panic at the start about the number of ICU beds and respirators. Actually if you are on a respirator it can be very traumatic to the body because a tube is inserted inside you and it can lead to inflammation. Up to 80% of people (in normal times) who end up on a respirator die anyhow. So this is not really the place to allocate resources. It should be up front keeping people healthy.
Prior to the arrival of covid-19 in Ireland, there were in the region of 250 ICU beds within the Irish jurisdiction. (14) A key priority of Government was to significantly increase this capacity.
There have been 350 deaths associated with Covid-19 in this jurisdiction since the arrival of the virus, to the date of writing this article. Currently (at the time of writing) 150 of those beds are occupied. It is very likely that additional ICU capacity has been unnecessary to date, and that many if not all of the additional ICU beds procured by the state are currently empty.
Indeed, the Chief Medical Officer in Ireland Dr Tony Holohan, on a recent non- Covid-realted admission to a Dublin Hospital, commented on the general lack of attendance at Irish Hospitals since the outbreak of covid-19.
[ Please see related stories on the number of people dying of heart attacks in the UK because they are not going to hospital. That has to be happening here in Ireland too. See Rolling thread at: https://www.indymedia.ie/article/107401 ]
The point being laboured here is the potential manner by which ‘expedience’ or bias at a political level, may be contributing to the escalating political response. Regardless of the actual efficacy or need, for many of the Governments imposed measures, there does appear to exist a discernible bias towards an increase in those measures, in spite of the emergent data.
Our present scenario may be comparable to that of a patient who insists upon antibiotics for his cold, and then believes that the medicine is curing him of the virus. Antibiotics are of course ineffectual in the treatment of viral illness; they do more harm than good. Much politics is already invested into policies that have been implemented upon the back of incorrect or unsubstantiated predictions to date.
Govt sources may be under some internal pressures to misrepresent factual data, in light of the apparent inaccuracy of its initial predictions. This issue may well become more apparent once competent researchers have an opportunity to impartially evaluate the response to date. As an example of one of the many political ‘untruths’ in respect of published information, take the following statement from merrion.ie released recently. This is from the Irish Governments official press release, 9/4/2020
“There are now 6,574 confirmed cases of COVID-19 in Ireland.”
http://merrionstreet.ie/en/News-Room/News/ Statement_from_the_National_Public_Health_Emergency_Team_9t h_April.html
The word ‘untruth’ is a strong word and it is used with some with reservation, however, the above statement can only be described as such. There most certainly are NOT: “…now 6574 confirmed cases of covid-19 in Ireland”
Testing in Ireland has been ongoing for some 40 days, and the duration of a Covid infection is no more than two weeks. It is far more plausible that at the time of this statement there are (or were) no more than 1500 confirmed cases in Ireland.
Govt sources might counter an accusation of bias or ‘political expedience’, with the reasonable assertion that the current measures are being dictated to them by NPHET.
In respect of the ‘National Public Health Emergency Team’, a brief review of the qualifications of members might indicate part of the reason we may have gone so badly wrong in respect of predictions and management strategies to date. (15)
Two crucial areas of expertise would be expected to be fully represented on such a team; a Virologist, and an Epidemiologist. Interestingly, in respect of membership of NPHET; there is no Virologist, and there is no Epidemiologist.....
There is a lot more in the report and readers should download it and read it.