Pandemonium E-Book

Jack Horgan-Jones

• Herausgeber: Gill Books
• Kategorie: Geisteswissenschaft
• Sprache: Englisch

Veröffentlichungsjahr: 2022

Beschreibung

The Inside Story of Ireland's Pandemic: Every Decision, Every Player, Every Text, Every Leak Ireland's lockdowns were among the harshest and longest in Europe. As the state was battered by waves of disease time and again, unparalleled pressures and untold tensions emerged as the country went to war with Covid, and policymakers and politicians did battle with each other. How were the key decisions made? Who held all the power? Boasting unrivalled access to the key decision-makers and drawing on hundreds of hours of interviews and thousands of pages of documents, including confidential and unpublished material, Pandemonium reveals the moves, the power-plays and the – at times jaw-dropping – tactics of a government with the health of a nation in its hands. 'If a movie is ever made of how Ireland responded to the Covid-19 pandemic, Pandemonium may well provide the script … You will feel as if you were in the room when key conversations happened and decisions were made.' Professor Luke O'Neill 'Illuminates the corners of institutions usually able to operate in the dark' Fintan O'Toole 'A page-turner … an exceptional insight' Matt Cooper 'Unflinching and unrelenting' Dearbhail McDonald

Leseprobe

For Kate, Olivia and Eve – JHJFor Theresa and Mary-Jane – HOC

Contents

Cover

Title Page

Dedication

Authors’ Note

Prologue

Chapter 1: The Phoney War

Chapter 2: ‘An Explosive Effect’

Chapter 3: The Black Line

Chapter 4: ‘Pay Attention’

Chapter 5: Complex Relationships

Chapter 6: No Masks

Chapter 7: No Swabs

Chapter 8: 15,000 a Day

Chapter 9: Bonos Días

Chapter 10: The Unknown Man

Chapter 11: The Army Council

Chapter 12: Cancelled

Chapter 13: Suppressed

Chapter 14: Reopening and Replacing

Chapter 15: ‘This Is Going to Be Complicated’

Chapter 16: Two Drinks, One Dinner

Chapter 17: Gobshitery on Speed

Chapter 18: Living with Covid

Chapter 19: October Surprise

Chapter 20: The Ugliest Meeting

Chapter 21: Lockdown

Chapter 22: 1 Government Centre

Chapter 23: Level Fun

Chapter 24: Serious Trouble

Chapter 25: The Surge

Chapter 26: The Tunnel

Chapter 27: Shot in the Arm

Chapter 28: Snake Oil

Chapter 29: Quarantined

Chapter 30: Happy Tony

Chapter 31: Delta

Chapter 32: Omicron

Chapter 33: Subversives

Epilogue

A Note on Sources

Acknowledgements

Copyright

About the Authors

About Gill Books

Praise for Pandemonium

AUTHORS’ NOTE

From early 2020 to early 2022, Ireland endured three harsh lock-downs that severely curtailed every citizen’s daily activities. Outside of these lockdowns, some form of public health restrictions was retained as the Covid-19 pandemic dominated the political and economic life of the State.

An analysis of data from the Oxford University stringency index, which measures how tight restrictions were at a given time, shows that Ireland had the most restrictive regime of comparator countries – the EU27 and UK – for 121 out of the 685 days between 1 March 2020 and 14 January 2022: just over one-sixth of that nearly two-year period. The analysis was undertaken for the authors by Kevin Cunningham, a statistician and lecturer in TU Dublin.

The State had heavier restrictions than the median country in the EU for 69 per cent of the time, and fewer restrictions than the median country for 18 per cent of the time.

It’s clear that Ireland’s lockdowns were extraordinarily tight, measured on this index, but it did not have the harshest restrictions on aggregate. When compared to Europe, Ireland was joint fourth with Portugal, after Italy, Greece and Germany. Those other four countries have the highest share of their population aged over 65, whereas Ireland has among the lowest share of that demographic. At the same time, Ireland has significantly fewer intensive care beds than many of these countries, not least Germany, yet restrictions have been broadly the same. On some measures, Ireland was closer to the top – 2nd on workplace closures – but on others it was lower: on school closures and restrictions on gatherings or public events, Ireland was 10th or 11th in Europe; on international travel controls, Ireland was markedly more relaxed, coming in 21st of the countries measured.

When compared to the EU and UK, Ireland had significantly fewer deaths attributed to Covid per one million of population.

The index tells us some things about Ireland’s experience of the pandemic, but no one index can adequately capture the full impact of restrictions across society. Every way of measuring experiences as all-encompassing as lockdowns or tight restrictions has some weaknesses. The combined impact of the public health measures on delayed care, or the mental health of the population, cannot be neatly captured in one graph. Each decision taken by the government during the pandemic has had incalculable ramifications throughout a period when the entire resources of the State were mobilised to one end, the only comparison for which in recent history is a state of war.

This is the inside story of that war with Covid-19.

PROLOGUE

‘It is important to understand that the future is not like the past.’ A short message with a two-page attachment dropped into Leo Varadkar’s private email inbox just before 5.15 p.m. on Wednesday, 4 March 2020. Kevin Cunningham, a Dublin-born, Oxford-educated statistician, political pundit and pollster, was so worried about the coronavirus that he felt compelled to write to the Taoiseach.

For a few days, Cunningham had been part of a loose band of commentators, medics and experts loudly warning about coronavirus on Twitter. The whole process made Cunningham uncomfortable; he had been gaining credibility as a pollster, but now he risked coming across as just another overexcited guy, outside his professional lane, shouting about something on the internet.

It made him more uncomfortable to be one of those people who also randomly emailed the Taoiseach with their concerns. But the two men had history. Cunningham had performed polling analysis for Varadkar when he ran for Fine Gael leader in 2017, and the pair had corresponded when Cunningham was working on the People’s Vote, a British grass-roots campaign seeking a second referendum on the UK’s decision to leave the EU. The statistician had political capital, and he decided to burn it.

I really don’t think we can wait.

The UK may play around until it gets to 100 cases because they’ve 160k beds. We’ve obviously got 14k, which are full. So we must act earlier. We know where this is going to go. We must use this time.

Panic will be much, much worse than when there’s no room in hospitals for people who cannot breathe.

The attached document began by outlining ‘statistics versus experience’:

It is important to understand that the future is not like the past. When World War 1 began they thought it would finish at Christmas. When people look at past elections they presume it will be like similar elections. The sample sizes of identical events are too low to recognise things that will occur that don’t reflect our life experience. The medical profession experiences the winter flu on a regular basis and are treating this epidemic as if it were similar, but more difficult.

The numbers do suggest that the issue is much worse than this and the numbers should be treated in their own right as important in the same way the winter flu follows the data. I’m not going to suggest that I know more than others in this sphere … That said, the mathematics are fairly straightforward.

Cunningham included a small table showing that the virus was growing at a rate of anything from 3 per cent in the previous nine days in Singapore to 52 per cent in the previous seven days in France. It was at 37 per cent in the previous nine days in Italy, and weak public health measures in Germany, Spain and France were failing to prevent rapid growth. The wave would ‘overflow’ Italian hospitals within weeks – but with decisive action, it could be stopped. He then outlined in stark terms what needed to be done in Ireland:

The scale of the disaster is avoidable by taking the precautionary measures early. As per the WHO recommendations: ‘It’s worth trying to slow the pace of the outbreak with measures to keep the number of patients from overwhelming local hospitals’. I would recommend all of the following immediately, on a daily basis the longer we wait the worse it will be:

• Ban all mass gatherings immediately

• Close all schools and universities – helping people to stay at home (there is a theory that young kids are spreading it without) immediately

• Advise the public to work from home where possible

• Close the airports and ports to ordinary passengers

• Inform supermarkets (maximum spend of 50 euro per person per visit)

I know the damage this will do to the economy but I also know the damage that delaying will do. Imagine Wuhan without a strong government. It will be lawless.

If we don’t do this I believe people will start taking things into their own hands.

Varadkar did not respond to the email. Nearly twenty months later, he had moved jobs. Sitting in the last office on the left of the Tánaiste’s ground floor corridor in Government Buildings, he looked through the paper sent to him by Cunningham. ‘I remember Kevin Cunningham being in touch with me about it,’ he said. ‘There were a few people very early on who were warning that this could be a big thing.’

Before working in politics, Cunningham had spent time at the United Nations, building statistical models of human migration for its population division. He gained experience of working with messy data on people and populations – similar to that used when modelling disease outbreaks – on how large groups of people change and behave over time, and how rates of change work in the real world.

When he was doing his undergraduate degree at Oxford, swine flu was seen as a significant threat to global health, and he became interested in epidemiological statistics. His great-grandmother and her baby died of the Spanish flu in 1918, and so he took an interest in the area whenever it came up in his studies.

He also understood exponential growth, a phrase commonly used to describe something growing quickly. In statistics and disease modelling it has a narrower definition. It means that a single infected person might infect another two on day zero. If those two infected people infect another two people, who in turn infect another two people, the scale of the infection will double rapidly – and continue to double.

Coronavirus was highly infectious and would make a small percentage of people sick enough to require hospitalisation. Exponential growth in this context would mean disaster. In late February and early March 2020, Cunningham crunched numbers, examining the relationships between testing and cases, reading deeply, and becoming more worried.

While still in his twenties, he had risen to a senior position in the British Labour Party, and after leaving the UK, he was briefly involved in helping to set up the Social Democrats in Ireland in 2015. He worked closely with the then Independent TD Stephen Donnelly until the two fell out when Donnelly asked Cunningham to decant into one document his entire approach to political polling and strategy. Cunningham felt he was being bypassed. Being asked to, in effect, turn his job into a document would make him redundant. He lost all faith in the Wicklow TD and quit the nascent party before it was launched.

He applied unsuccessfully for the role of general secretary of the Irish Labour Party. During the process, he struck up a relationship with Ed Brophy, Tánaiste Joan Burton’s chief of staff. After Labour was nearly annihilated in the 2016 general election, both men were in need of work. They founded the Ireland Thinks polling company, which carved a niche for itself with punchy, topical polls. Cunningham had featured heavily in RTÉ’s coverage of the general election, parsing results as they came in, providing a statistical and thematic backbone to the uncertain election outcome.

Brophy, meanwhile, went back into government, as an adviser to finance minister Paschal Donohoe. That meant that Varadkar was not the only person inside government with whom Cunningham was able to burn his political capital, as his concerns mounted.

He watched the government prevaricate over what travel advice to give to punters bound for the Cheltenham horse racing festival, and the debate over whether St Patrick’s Day festivities should proceed. All that clearly told him one thing: ‘No fucking way they were on top of this.’

Cunningham had a little more purchase with Brophy than with Varadkar, and was more willing to strafe him with texts and emails. So on 26 February, the day after he first discussed his concerns about the virus as part of a panel discussion on RTÉ Radio 1’s Late Debate, he texted Donohoe’s adviser, ‘Nobody will blame the government for taking too many precautions on coronavirus.’

‘Totally,’ Brophy responded.

In the days that followed, Cunningham besieged Brophy with more texts and phone calls. The longer the government delayed, he argued, the more people would die. Brophy was increasingly irked by the volley of WhatsApps. ‘Translating the “something should be done” narrative into reality raises 100s of questions,’ he wrote back.

But the message was landing. Early in March, the pair spoke at length on the phone while Brophy paced the sidelines at his son’s football game. Afterwards, Brophy was nearly in tears. Hundreds of thousands of people were going to die, he thought; people would not be able to see their parents and grandparents in their final hours. In the days after that conversation, Brophy texted the Taoiseach with his view that it was time the government acted. ‘We really need to fucking move on this,’ was how Brophy would later characterise his text to Varadkar.

Brophy urged Cunningham to take his concerns offline and directly to the Taoiseach, and offered to circulate them in government. ‘Send me a few reasoned/evidence-based paragraphs & I will bring it to the attention of those making decisions,’ he told Cunningham. When there was no response to his first email, Cunningham wrote to the Taoiseach again on Tuesday 10 March:

Please undertake these measures today. Tell people how serious this is. People will find a way to work and for the economy to continue to function. Real disaster is if hospitals were overwhelmed. France will be the same as Italy in a week. Spain the week after. Please don’t wait.

Brophy approached Varadkar with his concerns. ‘Do you really think so?’ the Taoiseach replied. ‘This isn’t the advice that we’re getting from our public health people at the moment. They’re not saying cancel the parade. They’re not saying stop the flights from Italy.’

It’s not unusual for a taoiseach to receive conflicting advice on a big issue. Varadkar was being told, on the one hand, that this was SARS or MERS or swine flu all over again; and on the other, that it was a very different type of pandemic.

Varadkar was inclined to take his counsel from the chief medical officer (CMO). ‘It seemed kind of sensible to me.’ The advice of CMO Dr Tony Holohan and his National Public Health Emergency Team (NPHET), set up in late January 2020 by Holohan himself, was not to cancel the St Patrick’s Day festival and not to impose major public health restrictions.

Not yet anyway.

—

That view – ‘not yet’ – was based on the orthodoxies of public health, a division of medical practice that is almost like a mix of medicine and social science and involves its fair share of subjective judgement. When the medical advice is for a whole population, part of it is about holding steady, striking at the right time, ensuring the public’s buy-in and compliance.

In the early days of Covid-19, even as it became increasingly inevitable that the country would shut down, this view spread across government. ‘Part of “not yet” was the view at the time that people would only be able to tolerate very strict restrictions for, you know, twelve weeks,’ Varadkar later recalled. ‘Yes, we could shut down the schools or yes, we could do a “stay at home” order. But you could only do this for a certain number of weeks, people would only tolerate it for so long.’

The corollary of that strategy is that it allows the virus time to spread. In Ireland, the pandemic response was split into three phases: Delay, Contain and Mitigate. It involved tracking the growth of the disease before imposing harsh restrictions if it looked as if it was getting out of control. But Ireland’s nascent testing system was picking up only a small fraction of the cases in the country. Early testing criteria focused on travel from an area of concern or close contact with a confirmed case – and on being symptomatic.

On 25 February, a man was brought by ambulance to Cork University Hospital (CUH) with a headache – he had previously been diagnosed with a brain tumour. He had no travel history, hadn’t had contact with a Covid case, and didn’t fit the criteria for testing for Covid. He was, in any case, tested for Covid on 2 March and notified as positive to regional public health on 5 March. Later testing of a swab that had been taken when he was admitted showed he was already infected. In the interim, he had been shuttled around the hospital, infecting people on at least three separate occasions, a subsequent public health report found. Eventually, he was transferred to another hospital, where he later died.

That report identified three ‘transmission events’: one when he was in the emergency department, where he was on a trolley for two days; another in a medical short stay unit he was transferred to; and another in the ICU itself. The report also found that he had been recently discharged from another hospital in the city, and concluded that he had most likely acquired Covid-19 there. The other hospital was contacted, but medics there concluded, after reviewing case files of patients who were contacts of the case, that none of them was likely to have carried Covid-19. But these patients were never swabbed or tested for Covid-19.

The public health report into the CUH case would eventually find 780 close contacts of the patient, 405 of them in the hospital, where 64 cases were later diagnosed during an outbreak – 9 had been close contacts of the patient. The outbreak control team in CUH brought the disease under control, but it caused significant staffing issues in the ICU, requiring an exemption for asymptomatic staff who were close contacts to continue working. It was an early and jarring warning of what Covid-19 could do. Public health doctors concluded that the man had probably had the virus for around a week before he checked into CUH, meaning he likely acquired it in mid-February.

Dr Cillian De Gascun, the State’s top virologist and a member of NPHET, later said that the CUH case (and one more death from around this time later shown to be a Covid-19 infection with no travel history) showed something else. ‘It would seem that the infection was seeded far more widely than certainly I appreciated, or we appreciated at the time,’ he said. ‘Looking back, we have to assume that the pockets of infection we identified in near real time were in fact being replicated all over the country.’

Using a case fatality ratio – the proportion of people with a disease who die from it – it can roughly be determined how many cases are present in the community based on those two deaths alone. Rather than the six cases that had been detected by 4 March, De Gascun believes the two community-acquired Covid-19 deaths by early March meant that people were being infected on a greater scale than was being detected. ‘We can presume they acquired their infections in February, so unless you are very unfortunate and two of the first three cases just happen to be susceptible to infection and die, that suggests there were at least a few hundred cases circulating in the community in February 2020,’ he said.

It will never be possible to tell just how widely Covid-19 was spreading in Ireland before the first public health restrictions came into force. The 2019/2020 flu samples in the National Virus Reference Laboratory (NVRL), which could have retrospectively indicated the prevalence of undetected Covid-19 in people with flu-like symptoms, were discarded in the second half of 2020 as part of a routine space-saving protocol. There was just no room in the freezers.

In the UK, an academic study later found around half its first-wave deaths could have been avoided by locking down one week earlier. Ireland did move faster than the UK and many other countries, introducing a lockdown that just about contained the first wave of the virus and prevented the health system collapsing. But it is also the case that it did so after the virus had been afforded a chance to spread, unobstructed. As the pandemic took hold in spring 2020, the words of Irishman Dr Mike Ryan of the World Health Organization (WHO) became a maxim in Ireland: ‘Speed trumps perfection.’ The first wave of Covid-19 still hit a country that was mentally, politically and medically unprepared.

—

The consultant oncologist and former Independent senator John Crown was another person warning the Taoiseach to move early. He contacted Varadkar in early March and told him that he must cancel the St Patrick’s Day festival. The danger, he said, was not the parade itself but people congregating in pubs afterwards. ‘Leo from day one really did take this seriously,’ Crown later said. ‘But I think there were some people around him who were not taking it as seriously. I worried that he was getting other advice that was not taking the public health aspect of this seriously.’

On 10 March, Crown appeared on The Tonight Show on Virgin Media Television. He would later reflect on how anxious he was to sound the alarm on everything from restrictions to face masks – and how he thought it made him unpopular. But that night, Crown sat in the middle of a crowded five-person TV panel with Dublin City University (DCU) academic Professor Anthony Staines and De Gascun to his right, and Fine Gael TD Jennifer Carroll MacNeill and Stephen Donnelly, who was then Fianna Fáil’s health spokesperson, to his left.

‘The real danger is that we’re going to be doing battlefield-level triage here if the extrapolations from Italy are correct, and the stories that we’re hearing from Italy are horrific,’ Crown said with a sense of urgency.

Matt Cooper, the co-host, asked what this would mean in practice.

It would mean turning people away from hospitals, Crown responded.

So what could be done?

‘Adopt the extreme measures now,’ Crown insisted.

‘Close everything?’ asked the other co-host, Ivan Yates.

‘Yes.’

‘Stop travel?’

‘Yes.’

Cooper and Yates were visibly taken aback, as were some of the panellists. But within 24 hours it would become a reality for everyone in the studio.

It was only the beginning. Across 2020 and 2021, Ireland would be locked down three times, with less onerous public health restrictions constantly in place, even when lockdowns were eased. It was unprecedented – the future would not be like the past.

CHAPTER 1:

THE PHONEY WAR

24 January 2020

Cases: 0

Deaths: 0

Seven-day average of new cases: 0

Paul Reid was on the second hole at Carrick-on-Shannon golf course in Leitrim and his phone was hopping. There were cases of coronavirus infection associated with travel in Paris and Bordeaux. ‘This was here and it was in Europe. It had reached us and it was for real,’ he would later recall.

The chief executive of the Health Service Executive (HSE) soon had to give up on golf. ‘Lads, this just isn’t working, I have to pack it in.’ He was getting nowhere, and, in any case, his golf buddies had already moved forty yards ahead of him.

It would be a long time before Reid would get back out on the course. A small group within the HSE – the High Consequences Infectious Diseases Group – had been meeting since early January, but now the decision was being taken to elevate the response.

Reid pulled together a National Crisis Management Team (NCMT). Much like its counterpart in the Department of Health – NPHET – there had been NCMTs before, periodically formed in response to disease outbreaks in hospitals, severe weather events, or other unpredicted threats. This would be different.

—

The first ripples of Covid-19 reached Ireland in early February. Passengers on a flight arriving from Moscow late on the evening of 1 February were greeted with the unexpected sight of public health doctors in hazmat suits, who had scrambled after being alerted that a passenger could be carrying the virus. Passengers were told to ‘avoid contact with other people as much as possible tonight’. The person suspected of carrying the virus was taken to the Mater Hospital, tested negative, and released.

In early 2020, the official position in Ireland was that the State was ready for whatever might be coming. On 28 January, the Cabinet was told of the Department of Health’s view that ‘Ireland is adequately prepared to address any potential cases of the novel coronavirus (2019-nCoV)’.

A full two weeks later, a briefing note by the Health Threats Coordination Group, a high-powered gathering of officials from across government departments, the Defence Forces, the HSE and elsewhere, said there were ‘advanced plans in place as part of its comprehensive preparedness to deal with public health emergencies such as novel coronavirus’. They were, the note said, the plans that had previously been used for pandemic influenza, SARS and MERS. ‘Ireland is, therefore, well-positioned to detect and respond to any case of the novel coronavirus (2019-nCoV) that might arise here,’ it concluded.

Through January and February, diplomatic cables from China detailed the advance of disease, but it was not a headline on the dispatches. It was there if you looked for it, but it ‘wasn’t up in lights or anything like that’, a source in the Department of Foreign Affairs later said. As days turned into weeks, no single urgent communiqué received in Iveagh House, the Department of Foreign Affairs headquarters on St Stephen’s Green in Dublin, sounded alarm bells about Covid-19. But a drumbeat was beginning to signal trouble.

On the eve of the general election, 7 February, it was confirmed that an Irish couple were passengers on the Diamond Princess, a cruise ship that would become a real-life petri dish for what the virus could do in an enclosed setting. Fourteen deaths would eventually be linked with 712 infections on the ship. In fact, six Irish passengers were on board the cruise ship, two of whom caught the virus. Nine more Irish citizens were later caught up in an outbreak on the Westerdam cruise ship in Cambodia. Irish people were being flown out of Wuhan, which had been placed under a severe lockdown on 23 January, but in small numbers. The Chinese city was the epicentre of the coronavirus outbreak and had by this stage reported more than 10,000 cases and nearly 550 deaths. Gradually, the virus was moving from being stock content in diplomatic cables to something more substantial. Something was out of step with the normal hubbub of activity and intelligence gathered from across the globe.

Early NPHET meetings were small gatherings of experts who were usually called upon in the face of public health threats. The meetings were held in person in room 631 on the sixth floor of the Department of Health, a sprawling complex of buildings at Miesian Plaza in the heart of Dublin 2. The first meeting was chaired by Tony Holohan, who had served as chief medical officer for over a decade. There were ten people there, largely drawn from the HSE and the Department of Health.

In addition to what one participant later recalled as an ‘optimism bias’ in the wider health system at the time, members of the team were unsure how reliable information emerging from China was. In early February the Health Protection Surveillance Centre (HPSC) began engaging with the Chinese embassy, which shared documents on the characteristics of the new virus, including one that said that, to date ‘there is no reliable evidence from the field investigations that the disease is contagious during the incubation period’. This assessment would later prove to be devastatingly wrong. Equally, documents suggest the Chinese didn’t always get prompt responses from the Irish side. On 11 February, the first secretary of the embassy emailed the HSE to say that a ‘Chinese patient’ had been trying to get in touch with their local Department of Public Health in Ireland. The embassy said, ‘We are also concerned that the phone calls made […] were not answered after 13:00 on Saturdays and Sundays.’

The first meeting of NPHET on 27 January discussed how supplies of personal protective equipment (PPE) were ‘sufficient’, with contracts in place to access more ‘as required’. While the European Centre for Disease Control’s assessment of risk to the EU was ‘moderate’, the threat of onward transmission of the virus was rated as ‘low’.

On the evening of 26 January, the first messages began to flow out from HSE headquarters to the hospital network. ‘The CEO is calling an emergency meeting in the morning about the Chinese coronavirus,’ a senior HSE official emailed an executive in the Dublin Midlands Hospital Group. ‘Can I check if there’s any major red flags or gaps in your hospitals around PPE or preparation levels that we need to be aware of?’ the official asked, before almost casually pointing out that this was landing amid the chronic chaos of winter in the Irish health system: ‘Apart from the obvious that your [emergency departments] are likely out the doors and isolation facilities are full up already. Thanks.’

In the Department of Health, Holohan’s team were working on pandemic preparedness plans based on old models for other diseases, in a vacuum, with limited information about the new threat. They were looking back at work done for influenza, as well as SARS and MERS. Holohan would later admit to being ‘troubled’ by the lack of real disease modelling as he began to assemble a larger team in early March. But in February it was, one senior department official later recalled, still a ‘phoney war’.

The parts of the State apparatus that were nominally supposed to plan for and react to medical threats were gradually warming up. Holohan, his deputy, Ronan Glynn, and their small team worked away in Miesian Plaza, as did the HSE in its Dr Steevens’ Hospital headquarters in Dublin 8. But the brain, the heart and the soul of the system was elsewhere – because, in late January and early February, everyone else was off having an election.

—

Faced with a motion of no confidence in Minister for Health Simon Harris, Leo Varadkar called a general election in mid-January just as the Dáil had been due to return from its Christmas recess. In so doing, he called time on the confidence and supply agreement with Fianna Fáil, a deal that had spanned the previous four years. It involved Micheál Martin’s party abstaining on Dáil votes in return for the delivery of certain key priorities, which were laid out in a short document that the two parties had agreed in summer 2016.

For the two parties that emerged from the ashes of the Civil War nearly a century earlier, the 2020 general election was a period of intense pressure. Their leaders had to make good on promises not only to the electorate, but also to their own parties.

For Varadkar, the thrust of his leadership campaign in 2017 had been that Fine Gael seats were safer with him in charge – and that he could deliver more of them. His allies believed his reputation as a straight-talking politician who was not afraid to be blunt and to court controversy, who would transcend party lines and win new voters. Alongside this was his compelling backstory as the son of an Indian doctor and an Irish nurse, who grappled with his sexuality before publicly revealing in 2015 that he is gay.

But the local and European elections in 2019 had been the first, and unconvincing, test of his pitch. Varadkar then hesitated over calling a general election when, on the crest of a wave after helping to secure a Brexit deal in late 2019, he stood to benefit. Yet in early 2020, the post-Brexit shine had worn off and Varadkar’s hand was being forced by the political vulnerability of his health minister.

His government was also deeply unpopular, a position compounded by a disastrous attempt to hold a commemoration event for Ireland’s pre-partition police forces. After the emergence of the plan caused widespread anger and claims that Fine Gael were in effect commemorating the brutal regime of the Black and Tans, the idea was abandoned in early January 2020.

The damage was done in the minds of an electorate who were already deeply frustrated with Fine Gael’s handling of seemingly intractable housing and health crises. It hammered home a deeper Fine Gael vulnerability: the sense that it did not understand the electorate, and that it was remote, detached from them after nearly a decade in power – a well-trodden path for many political parties after two terms.

Meanwhile, Micheál Martin, the only true veteran of government in the senior echelons of Fianna Fáil, faced being the first leader of his party not to occupy the Taoiseach’s office. The local and European elections had been largely positive for Fianna Fáil. The party retained its position as the largest in local government, taking back council seats ceded to Sinn Féin five years earlier and making gains in Dublin, where its fortunes had nosedived since 2011, including winning a European Parliament seat.

But large swathes of the Fianna Fáil parliamentary party and the wider membership had been unhappy with the confidence and supply arrangement. They fumed at Martin’s unilateral decision to extend it in December 2018 – without consulting the party – because of his concerns about creating political instability as Brexit loomed. But as the election dawned, it still seemed Martin stood a chance of leading the next government and closing the book on one of the most remarkable recovery stories in Irish political history.

On the campaign trail, ministers were briefed to expect questions on Covid-19, but it didn’t feature. Instead, the election was dominated by housing issues. Health featured, as always, but it was the stock barrage of issues around waiting lists, clinical outcomes and the fallout from recent scandals like that surrounding CervicalCheck, the State’s screening programme for cervical cancer. Countless debates, interviews and doorsteps with leaders, frontbench members and ministers came and went, but coronavirus received scant attention.

While out canvassing in Dublin towards the end of the campaign, Micheál Martin told a group of young Fianna Fáil members, ‘Watch out for this, there’s not much comment on it now, but this could be something.’ He had read a newspaper report about the new virus emerging from China and had what he later described as ‘a hunch’. Martin had been health minister when SARS emerged in 2003. It had left an impression on him.

To most others the new virus was something that was ‘over there’ – in China. ‘Everybody in the West did not pay enough attention to what was going on in the East,’ Professor Mark Ferguson, the government’s chief scientific adviser at the time and a future member of NPHET, later said. ‘I would say that’s collective Western arrogance. We didn’t look carefully enough at what was happening in China and elsewhere.’

Both Fine Gael and Fianna Fáil failed to capture the public appetite for change. There was a surge of support for Sinn Féin, and the two Civil War parties’ bitter and personal attacks on each other continued, while they also expanded into the familiar territory of targeting Sinn Féin’s murky links with the IRA.

Their stuttering campaigns led to dramatic setbacks on 8 February when Sinn Féin surprised itself by gaining 15 seats and winning the popular vote. ‘Mary Lou for Taoiseach’ became a popular refrain among its buoyant supporters. The party proceeded to hold a series of post-election rallies across the country that would soon have to be curtailed.

After the election there was no clear route to power for any party, while the caretaker government was shattered. The ranks of Cabinet were depleted – Shane Ross, Katherine Zappone and Regina Doherty had lost their seats – but they retained their Cabinet seats until a new government could be formed. Finian McGrath was a lame duck minister who had not sought re-election. Housing minister Eoghan Murphy, once the architect of Varadkar’s successful campaign to lead Fine Gael, was an opposition hate figure and although he had clung on to his Dáil seat, he would resign it a year later. Varadkar’s demeanour after the election, Cabinet colleagues thought, ranged from despondency to acceptance that Fine Gael would be going into opposition. Most of his parliamentary party demanded Fine Gael get out of government. It was just about the worst time for an identity crisis, given what was coming over the horizon.

Worldwide, the virus was stealing a march on governments and healthcare systems that failed to grasp its insidious nature. The election compounded this in Ireland, creating a political vacuum.

CHAPTER 2:

‘AN EXPLOSIVE EFFECT’

13 February 2020

Cases: 0

Deaths: 0

Seven-day average of new cases: 0

Simon Harris, his adviser Joanne Lonergan and Dr Colette Bonner, one of Tony Holohan’s deputy chief medical officers, boarded the government jet at Casement Aerodrome just outside Dublin. They were bound for Brussels and a meeting of EU health ministers, known by the acronym EPSCO. Three days earlier, on 10 February, Harris had been re-elected as a TD for Wicklow on the fifteenth count without reaching the quota. At the age of 33, the Minister for Health was embarking on his third Dáil term, having been just 24 when he was first elected in 2011, but the election outcome meant this could be the last time he was on board the Learjet 45. Some of the party took selfies to mark the occasion.

At the EPSCO meeting, Croatia’s health minister Vili Beros confidently told journalists that there was a ‘high degree of preparedness’ within the EU for the emerging Covid-19 threat. Briefing materials circulated to journalists afterwards focused on information sharing and co-ordinated action to avoid shortages of medicine. There were presentations from the WHO and the European Centre for Disease Prevention and Control (ECDC), which brought home the growing seriousness of the emerging situation surrounding the virus. Harris’s public comments mirrored the bravado of his colleagues on the continent. He told the Irish Times that he was satisfied Ireland had a ‘significant level of preparedness’ for the virus.

But on the plane home, the mood was darker. At the summit, EU member states had wrangled over the wording of a joint declaration. For all the affirmations about common cause, health was not a core EU competency, with member states retaining autonomy; in a pinch, some countries could go it alone. ‘We were having all these meetings, but Europe didn’t act as a cohesive bloc; that had devastating consequences,’ Harris later said. ‘We were suspending normal rules in our own country and everywhere else, we didn’t seem to suspend the normal rules in Europe. We left ourselves really exposed as a geopolitical bloc.’

On 20 February, Harris signed an order designating Covid-19 a ‘notifiable disease’, meaning that doctors would have to inform the HSE when a case was diagnosed. There was a growing acceptance that Covid-19 would come to Ireland, but the view remained that it would be controlled, and perhaps only a few cases would be reported.

‘Even public health officials thought this was something we could kind of weather,’ Harris would later recall. ‘There was a period from January to mid-March where there was a sense of “this is a pandemic, we’ve had lots of difficult times before, Minister – SARS, whatever else – we got through it, we’ll get through it, [even though] we’ll probably see cases”.’

But before a case was even diagnosed in Ireland, the power of the virus to stop life in its tracks would be vividly illustrated.

—

Late on the night of Sunday 23 February, Austrian authorities stopped a train from Italy crossing the border through the Brenner Pass on suspicion that two passengers might be infected with Covid-19. Later that evening, the authorities stopped all services crossing the border. Deaths from the virus were now being reported in Italy, and 50,000 people were quarantined across the Veneto and Lombardy regions.

The Department of Foreign Affairs would soon issue advice against travel to northern Italy as the virus began to strike at the commercial and industrial heartland of the country. The north of Italy is the centre of much of the country’s power and wealth, home to its fashion and automotive industries. In Milan, the biggest city of the region, the Borsa Italiana saw billions wiped off its publicly quoted companies as panic took hold. It was also home to a lot of Italian rugby fans.

That Sunday evening in Dublin, Tony Holohan called an emergency NPHET meeting. Just eight members attended via teleconference, but there was a clear shift in tone and emphasis. Events in Italy made the threat of the virus tangible, and Holohan told the meeting of his concerns. The ECDC had just published a threat assessment on Italy which reported that there was ‘third generation’ transmission of the virus across multiple towns, cities and regions. The report highlighted that, ‘once imported, the virus causing Covid-19 can transmit rapidly. This may emanate from cases with mild symptoms that do not provoke healthcare-seeking behaviour.’

Holohan told the meeting that Ireland now had to consider how to deal with high levels of infection. The current model for dealing with cases suggested that all patients would be hospitalised, but they needed to think about home testing and self-isolation. The subtext was obvious: if there are a lot of cases, only the sick ones could be hospitalised. What was happening in Italy could happen in Ireland, even though not a single case had yet been detected. For the first time, the group discussed cancelling mass gatherings. ‘In general terms experiences had an effect on actions taken,’ Holohan would later recall. ‘Northern Italy had an almost kind of explosive effect.’

In his own mind, Holohan had already formed the view that the forthcoming Six Nations rugby match between Ireland and Italy in Dublin could not go ahead on 7 March as planned, but a larger meeting of NPHET two days later would be needed to formally adopt the recommendation. Simon Harris was anxious to get in on the act and promptly turned up at the meeting in the Department of Health that Tuesday, 25 February. Holohan did not like this because he doesn’t like politicians at his meetings. It was an article of faith for him that the formulation of advice needed to be separate from the consideration of that advice. Holohan had always been of the view that ministers in meeting rooms have one of two effects on officials: either they don’t want to disclose things; or they try to show off in front of their political master. In either case, it becomes more challenging to ascertain clear advice. Officials speak more freely when there is no minister present. So on that day, Holohan made it clear, either Harris would leave quickly, or he would.

Members of Harris’s team recalled feeling intensely uncomfortable. Nonetheless, Harris was allowed to address the meeting on the understanding that he would depart before NPHET got down to business. TV cameras were brought in for the show. Some amused NPHET members furtively took photos with their phones of Harris enthusiastically addressing the room with a cranky-looking Holohan beside him.

After Harris left the room, the discussion about cancelling the match was straightforward. There was little debate or dissent, given that Holohan had flagged concerns to a smaller group the previous Sunday. Paul Connors, the HSE head of communications and a huge rugby fan, was somewhat horrified. As he pointed out of the window in the direction of the Aviva Stadium, he said that the Irish Rugby Football Union (IRFU) would have to be briefed. His nephew Will Connors, a tearaway flanker who plied his trade for Leinster, was in line to win his first international cap against Italy.

Outside the room, Harris was booked to appear on RTÉ’s Six One that evening, and he and his team grew anxious as the meeting dragged on. ‘I got messages to say that the outcome was awaited from the minister’s team, [on] pieces of paper as I am chairing NPHET,’ the CMO later recalled. But Holohan was not running the NPHET meeting so that Harris would have a result in time for the evening news. ‘In the course of the kind of work I do, I’d often get messages from the minister of the day – and I’ve had many of them – and they’re looking for something and I am not in position to give it and I don’t get too worked up about that.’

Nonetheless, the meeting adjourned just before 6 p.m. There was a scramble to tell the IRFU of its decision, but the Department of Health’s communications chief Deirdre Watters could not raise her counterpart in the IRFU, Stephen McNamara, or its chief executive Philip Browne, who was on a plane. Sarah Bardon, Harris’s press adviser, tried unsuccessfully to contact Varadkar’s staff, and Harris texted the Taoiseach. But it was too late. Harris’s announcement during a live interview on the main evening news caught everyone cold. The IRFU released a terse statement seeking a meeting with Harris. Sports journalists were pointedly briefed on how the IRFU was caught unawares by the announcement.

Later that evening, Harris rang Shane Ross, the Minister for Transport, Tourism and Sport, to apologise and acknowledge that the affair should have been better handled. Ross recalled speaking with Browne about the cancellation. The IRFU boss does not do effing and blinding, but Browne made clear in a measured way his displeasure at what had happened. ‘He’s not the type of guy to fly off the handle,’ Ross later recalled, ‘but he was very cross.’ At the same time Ross, so often a thorn in his Fine Gael Cabinet colleagues’ sides over the previous four years, was in total agreement with the decision. Early on he had become very concerned about the threat Covid-19 posed. ‘Lives, lives, it’s simple human lives,’ he would later say. Ross duly went on Morning Ireland the following day to defend the cancellation.

But that was not the end of the matter. Later that week, Holohan, Harris and his team were summoned to the Department of the Taoiseach where Leo Varadkar rounded on his health minister. He was furious that Browne hadn’t been notified, and told them that there could never again be a situation where a decision was made involving a key sectoral body that wasn’t told in advance. ‘Leo tore a new one for Simon and Tony for cancelling it,’ one person in the room later recalled.

Varadkar queried whether the match could have gone ahead with Italian fans told not to come and their tickets resold. Could it have gone ahead behind closed doors? Holohan would later be described by one participant as bemused by these suggestions, while Harris’s team wondered whether Stephen McNamara, the IRFU communications chief and a friend of Varadkar’s, had been in the Taoiseach’s ear.

The following Sunday a story in the Sunday Business Post outlined how the Taoiseach had ‘reprimanded’ his health minister over his handling of the matter. Harris’s team blamed Varadkar’s team for leaking the details of the entire meeting.

Even though the match was cancelled, there was never a substantial discussion about stopping Italian fans coming to Ireland. The travel advisory for Irish citizens against going to Italy did nothing to stop Italians from landing in Dublin. ‘I don’t know how many [came], but I’d say a lot did,’ Varadkar later said.

Around this time, on NPHET’s recommendation, HSE staff were sent to Dublin Airport to review the steps they were taking to police the advisory. Very little, it turned out. At one point, a senior HSE executive literally walked around the airport with a member of DAA staff pointing at spots on the walls where posters with advice for arrivals from Italy could be put up. In retrospect, it seemed futile – but this was the playbook from previous pandemics.

On the week the rugby match would have taken place, 3,585 people still flew in from Italy, and 7,640 had preceded them the week before.

—

On Saturday evening, 29 February, the Department of Health confirmed Ireland’s first case of Covid-19, diagnosed in a teenage boy who had come home from a school trip. Within hours of parents being told, the name of the school became public knowledge. Scoil Chaitríona, a gaelscoil in one of the leafier parts of the Dublin Central constituency, was attended by children of, among others, Sinn Féin president Mary Lou McDonald. The boy concerned had just returned from a skiing holiday in northern Italy, and therefore was eligible for testing.

Testing had been under way at the National Virus Reference Laboratory for weeks, and its director, Cillian De Gascun, was quietly unnerved by the fact that nothing had yet been found. Just one case was detected from 460 tests carried out between 7 February and 2 March. There was almost a sense of relief in the lab when the first positive test was returned because it meant the kit was working.

But the situation in Scoil Chaitríona was complicated. There had been discussions about testing the contacts of confirmed cases, but with four hundred students in the school, that was discounted. Instead, contacts identified by public health doctors were asked to restrict their social interactions, and the school was closed for 14 days. The student was never seriously unwell – the hospital told senior HSE managers he was ready to be released, but he was kept in isolation because they didn’t know how contagious the disease was.

At a hastily arranged meeting held in Croke Park a few days later, several senior HSE staff fielded questions from a packed room of parents. Paul Connors chaired what turned out to be a highly volatile event. Concerned parents demanded to know the identity of the student so they could assess their own and their children’s levels of risk and exposure. Many of those present wanted to be tested even though they didn’t fit the criteria for testing. Some complained about having to cancel or delay weddings because of concerns about the virus, which was then seen as a major and unusual imposition. But the large indoor gathering did not itself appear to set off alarm bells, even among those from the HSE at the top of the room, showing just how little was known at that stage.

As a parent, but more relevantly as a political and community leader, Mary Lou McDonald was not going to remain silent. She read the riot act to the HSE executives, telling them that she wanted absolute assurance that her family and the families of those in the room were safe; and she had heard nothing in their presentations that provided that assurance.

Connors called on Professor Martin Cormican, the HSE’s head of infection control, to respond to McDonald from the stage. Based in the small village of Clarinbridge in south Galway, Cormican, softly and precisely spoken, has a black belt in karate and would frequently practise by himself in his back yard late at night. Or he would go out running, finding that physical activity of whichever kind helps take his mind off the pressures of the day job. In 2019, at the age of 57, he completed the Dublin City Marathon in a time of 3 hours 36 minutes. Colleagues observe that he has an almost monk-like discipline and is congenitally unable to tell a lie.

On that tense night in Croke Park, Cormican calmly but firmly told the Sinn Féin president that he would love to give her absolute assurance that everything would be all right. But that isn’t the way medical advice works, he said. She and her family would probably be okay, but in a pandemic, total guarantees could not be provided. He was unfazed by what he later described as a ‘confrontational sort of manner’ from McDonald. It was just her style, he concluded. Cormican’s view on this was clear. He used to tell his students, ‘Never promise patients the sun will come up in the morning.’ Certainty is not the business of medics – ‘Our business is managing uncertainty.’

The Croke Park meeting was, a participant later recalled, a harbinger of things to come. People were upset, disoriented, seeking reassurances that they and their families would be protected from infection, that someone, or something, would stop the disease. One HSE participant later recalled thinking, ‘I hope there’s not too many more cases, because if we’ve many more meetings like that, we’ll be fucked.’

—

The HSE was not just trying to address growing public concern about the virus. In early March, Paul Reid had begun to warn the Taoiseach more explicitly about the need to protect the health service. ‘My concern was growing, that something was needed to protect the health service,’ he later said.

Over the course of the months that followed, Reid’s approach would, at times, divide and frustrate others involved in the pandemic response. Some on NPHET, a body rammed with PhDs, medical doctors and university-educated civil servants, would mischievously call the HSE chief executive – who left school at 16 without a Leaving Certificate – ‘Professor Reid’. Others who observed him closely as he settled into the role he had been appointed to in April 2019 on a pay and pension package of over €420,000 a year, felt he struggled initially with his lack of a clinical background.

Reid’s reporting structure was also far from straightforward. In addition to the HSE board, he had effective reporting responsibilities to the political system – Taoiseach, Tánaiste and Minister for Health – and relationships to manage with the Department of Health, its secretary general, and the chief medical officer. The fate of his predecessor, Tony O’Brien, who had been forced to resign over the CervicalCheck scandal, showed how exposed the position could become. ‘I think he was pulled in a dozen different directions,’ observed one HSE source who interacted with Reid across the period.

Later in the pandemic, there was a feeling in some quarters of the HSE and NPHET that Reid would exceed his brief as chief executive of the health service, his responsibility being solely to protect healthcare provision in the State. He would often appear in the media, much more so than his predecessors. He was fond of referring to how the HSE existed within a society and an economy, and how the welfare of the health service would be impacted by all these elements. While undoubtedly true, this provoked the ire of some, who felt Reid should stick to the knitting. ‘He’s the head of the HSE, he’s not the head of a multi-agency organisation cross-checking the economy,’ an HSE contemporary later remarked.

Reid’s style frustrated some. He would speak in generalities, both in public and in private, saying that the health system was ‘coping’ and referencing conversations with clinicians as evidence for his position. Members of NPHET were particularly irked – they felt they were held to a higher standard than the HSE chief executive; they had to be more precise, and if they were wrong, the criticism was unbridled. Meanwhile, they felt, Reid got away with a communication style that was one part sloppiness and one part an elaborate manoeuvre to avoid being pinned down, or aligned too closely with any one policy response, lest it prove politically unpopular. In the months ahead, NPHET members would form the impression that Reid was a domineering presence in the HSE, looming over his senior team, and that at key points, he didn’t identify threats from Covid-19 coming down the tracks. ‘Paul “Everything-is-going-to-be-all-right” Reid’ became another moniker.

However, for all that some people chose to criticise him – and rarely to his face – there was a steeliness to Reid. HSE veterans believe he galvanised the organisation within months of taking over, simplifying top-heavy reporting structures and ruthlessly cutting out unnecessary feedback loops that perpetuated the HSE’s speciality: inertia. He also knew how, and when, to fight his corner, and had an assertive leadership style. He is a ‘pugnacious street fighter [who] operates on the principle that the only way of avoiding being weak is to attack’, observed a senior HSE source.

True to this characterisation, in the early days of March 2020, Reid was warning the political system that something needed to be done. ‘This is getting really serious, we need to do something, there needs to be some restraint put on it, we need strong messages,’ he told Varadkar in one phone call. The HSE chief executive was reflecting the growing anxiety at board level around the planned St Patrick’s Day festival but also the risk associated with the Cheltenham festival, which thousands of Irish racing fans flock to every year. Board members had asked Reid that their concerns about mass gatherings be passed on. Reid was concerned that NPHET was ‘maybe not as strong’ on the mass gatherings, with St Patrick’s Day a particular cause for concern.

Around 500,000 people were predicted to flood into Dublin for the parade. The Department of Arts was ‘panicky’, one source later recalled, and had argued that if a cancellation wasn’t decided by a certain date, it could not be cancelled. St Patrick’s Day was the showpiece event for the State for the entire year and to cancel it would be tantamount to declaring Irish tourism closed.

On Friday, 6 March, Tony Holohan stood next to Leo Varadkar in the courtyard of Government Buildings as the Taoiseach told reporters that Ireland was still in a containment phase, that decisions would be proportionate, and that at this stage, major events, including St Patrick’s Day, were not being cancelled.

Watching the footage at Dublin Airport was Simon Harris and his team, who had just returned from another meeting of health ministers in Brussels – this time flying Ryanair. The meeting had heard more of the same urgent messages about the EU needing to act together. The ECDC warned ministers there had been a hundred-fold increase in cases since their last meeting, and that this trend would continue. Cases were being reported without links to affected areas or cases that had already been diagnosed, which signalled that the virus was likely far more prevalent in the community than testing was picking up. The WHO warned EU ministers that the measures being taken now would determine the course of the outbreak.

Harris and his team were, at that stage, firmly of the view that ‘Paddy’s Day’ could not go ahead. Sweden had cancelled its parade and the Irish permanent representative in Brussels had cancelled its St Patrick’s Day gathering. Harris’s special adviser Joanne Lonergan relayed the minister’s concerns to Varadkar’s chief of staff, Brian Murphy, and another of the Taoiseach’s advisers, Clare Mungovan, including his belief that a call should be made that Friday afternoon to cancel St Patrick’s Day.

But the message that came back from Murphy was to hold tight through the weekend. He believed the decision would be best made the following Monday at the inaugural meeting of the Cabinet subcommittee on Covid-19, which had been set up a few days earlier. Although agreeable to waiting a few days, Harris wanted to join a press conference being organised for Varadkar and Holohan later that day once he returned from EPSCO. But coming off the plane he saw Varadkar and his chief medical officer signalling that it was all systems go for St Patrick’s Day. He wasn’t happy that the event had happened without him, and that night Harris told the Taoiseach as much in a phone call.

Within 48 hours, however, Holohan had brought forward a NPHET meeting to discuss the St Patrick’s Day festival originally slated for the following Wednesday to that Sunday night, 8 March. The only people physically present at the ad hoc meeting in the Department of Health were him and Dr Colm Henry, the HSE’s chief clinical officer, with every other member joining via teleconference. The official minutes record a ‘robust’ discussion on cancelling the festival. However, participants remember it as a straightforward call to cancel that came from Holohan. The broad shape of the decision had been emerging for some time. NPHET had discussed whether just the Dublin parade could be cancelled, with local festivities going ahead, but the fear was that the congregation due to take place in Dublin would just spread outwards, with attendance at regional parades swelling and the risk of mass transmission increasing.