Leaks, renegades, rows and reason – Inside Ireland’s Covid response

The lockdown players
The lockdown players

December 2, 2021 Cases: 578,064; Deaths: 5,707; Seven-day average of new cases: 4,451

It was a cold, wet December night. Laura Casey, a principal officer in the Department of Health working for Nphet, hopped on her bike and cycled the eight-minute journey from Miesian Plaza on Baggot Street to the Department of the Taoiseach on Merrion Street.

In her possession was a printed letter signed by the chief medical officer with the latest recommendations from Nphet, which had met earlier that day.

The uncertainty over Omicron had prompted  Tony Holohan and his team to recommend a series of new restrictions.

Nightclubs were to be closed, strict social distancing reintroduced in hospitality, capacity at indoor events cut to half, the Covid pass extended to gyms and hotels, and household visits kept to a maximum of three other households.

Inevitably, such measures would not be popular with the Government or the public, but things were still so finely balanced between government and its advisers that Holohan, Robert Watt and others in the department were determined that the recommendations not leak.

They knew that if the Government felt bounced into action — again — the backlash could be destabilising.

Throughout the pandemic, politicians steadfastly believed that Nphet would brief the media about its recommendations in order to box the Government into a decision. Dozens of times, the media would document the path from a Nphet meeting to Holohan writing a letter to Stephen Donnelly that would then go before the cabinet subcommittee before the full Cabinet agreed what- ever measures were deemed necessary.

Every step was riddled with leaks and briefings — and they came from both Nphet and Government, who blamed each other.

Leaks became a cipher for the tensions within the wider relationship. When restrictions were being recommended, this tension had the potential to go nuclear.

So on that December night, to avoid leaks, a letter was printed off and Casey cycled through the rainswept streets.

She took a copy to the Taoiseach’s department, where it would go to Martin Fraser and  Micheál Martin. She also gave one to Stephen Donnelly’s driver, who made sure it was handed to the Health Minister in the Dáil chamber.

'Pandemonium - power, politics and Ireland's pandemic' by Jack Horgan-Jones and Hugh O'Connell is published by Gill Books
‘Pandemonium – power, politics and Ireland’s pandemic’ by Jack Horgan-Jones and Hugh O’Connell is published by Gill Books

Donnelly had already been briefed orally by Holohan earlier that day and was before TDs that evening dealing with legislation to give effect to new travel restrictions, including the reintroduction of hotel quarantine. Holohan had himself become increasingly exasperated by the leaks — and more specifically that Nphet was being blamed for them.

However, even though they felt unfairly targeted, the chief medical officer and other senior Nphet members had come to the conclusion that at least one person on the team was consistently leaking from key meetings. They viewed it as entirely counter-productive to Nphet’s aims, which were ultimately to secure government agreement to their recommendations.

Though the identity of this person has been discussed privately by senior Nphet figures, they were never confronted. The person in question categorically denies briefing the decisions from Nphet meetings.

Ahead of the Nphet meeting earlier that day, Holohan and others on Nphet, including Ronan Glynn, discussed how to smoke out the mole.

It was decided that Holohan would put up a slide displaying on screen the measures that would form part of his letter, including a proposal to cut capacity on public transport to 50pc. But that proposal never made it into the letter. In fact, it was never under consideration.

The question was, having been shown to the meeting, would the bogus recommendation be leaked?

Paschal Donohoe was sitting alone on the front bench of the government side of the Dáil chamber, surrounded by binders and sheets of paper, as he undertook his most complex and hardest legislative job of the year — the Finance Bill, which gave effect to measures announced in the budget.

As TDs streamed into the chamber to vote on amendments, Donohoe was approached by several backbenchers who had seen a tweet from RTÉ’s Paul Cunningham just after 9pm about Nphet plans to limit household visits, as well as much earlier posts indicating that it was considering reimposing hospitality restrictions.

Donohoe was furious, believing the Nphet letter had been made available to RTÉ before it had been given to ministers. If there were new restrictions on hospitality, he should have known about them — given that he was responsible for the financial supports underpinning the sector. This view became widespread among cabinet ministers, as did the assumption that the leak had come from Nphet.

The truth was more complicated.

In fact, a government source had been briefing the likely outcome of the Nphet deliberations to some political correspondents that evening, including lines strikingly similar to those reported by Cunningham which caused such consternation on the government benches.

But more was to come. John Lee, the political correspondent, appeared on Virgin Media Television’s The Tonight Show just after 10pm with a scoop: the full rundown of the Nphet recommendations.

But his story, which appeared in the Irish Daily Mail the following day, contained one measure that wasn’t actually in the letter: the 50pc reduction in public transport capacity.

Lee’s story could ultimately only have emanated from someone who had been shown the slide with the bogus recommendation to cut public transport capacity by 50pc — which strongly suggested the Nphet ship was leaky. But it was also the case that government, or at least one person within it, was briefing on the expected public health restrictions from Nphet.

Taoiseach Micheál Martin speaking from the steps at Leinster House

Taoiseach Micheál Martin speaking from the steps at Leinster House

The careful steps taken to avoid a leak had failed spectacularly, and the stage was set for a confrontation that would only be paralleled by the ugly meeting on October 5, 2020.

Anger on the political side had not subsided by the following morning when, in a rare move, only Holohan and Philip Nolan, Nphet’s head of modelling, were invited to the cabinet subcommittee meeting via a text from Liz Canavan in the Taoiseach’s department. Ronan Glynn was excluded, while Paul Reid from the HSE and Brian MacCraith from the vaccine task force were not invited either.

It was a virtual meeting, the politicians and their advisers sitting in the Sycamore Room in Government Buildings, with the secretaries general of their departments also on the call. Holohan and Nolan were beamed on to the screen from their respective homes.

It became clear almost immediately why the list of participants was kept shorter than usual. After the Taoiseach opened, he departed from the custom of allowing Holohan to present the Nphet assessment and recommendations and instead invited the Tánaiste to speak.

Leo Varadkar was furious.

He let rip, accusing Nphet of acting in a ‘political’ manner. He said it was unacceptable that the Government had been put in a position where it had no alternative but to do what the public health officials recommended.

It was clear to those in the room and on the screen that Varadkar was angry and annoyed that decisions were out in the public domain before they had been discussed. He said Nphet had undermined and disrespected the Taoiseach.

To Holohan and Nolan, the clear implication of those words was that someone on Nphet had leaked the recommendations.

Furthermore, Varadkar questioned the need to tighten restrictions when the public health situation appeared to be improving. Government and Nphet, he argued, should listen to the doctors on the ground in South Africa, who were at that stage saying that Omicron was not having a severe impact on hospitals.

He also pointedly told the meeting that the public health team and ministers should have listened to the Indian doctors who said that Delta was serious — while, in his view, Nphet was still waiting for evidence before acting.

CMO Tony Holohan, Nphet chair Philip Nolan, and Ronan Glynn, deputy CMO

CMO Tony Holohan, Nphet chair Philip Nolan, and Ronan Glynn, deputy CMO

He then criticised Philip Nolan’s models, saying that they would be overly pessimistic again, as they assumed Omicron would convert to hospital/ICU admissions and deaths at the same rate as Delta, which, the Tánaiste believed, was unlikely to be true. It was a scathing assessment of Holohan and the Nphet team.

Eamon Ryan, the Green Party leader, was next up.

He said he largely agreed with the Tánaiste. Ryan, who throughout the pandemic was viewed by government colleagues as a libertarian when it came to restrictions, talked about the deep anger among younger people about the effect of the pandemic on their lives.

Catherine Martin, Ryan’s deputy and the minister with responsibility for the hospitality sector, asked whether Nphet’s proposals had been “mental-health proofed”. She queried the science behind the six- to-a-table rule in hospitality and the 50pc capacity limit for indoor events. She asked where the evidence was to back up the rules Nphet were recommending for the sector she represented.

Helen McEntee, the Justice Minister, was not pleased either. “It’s not helpful that I am talking to you and I haven’t seen the letter,” she had told Morning Ireland earlier that day, when faced with questions about the new recommendations.

As he had been the night before, Paschal Donohoe was livid.

“Why was I, a member of government, finding out about this in the Dáil chamber after RTÉ?” he asked.

Nolan and Holohan furtively communicated about how to handle the onslaught as it was in progress. Holohan even sought advice from Robert Watt as the meeting was in progress. It was agreed that the chief medical officer would go ahead with his presentation outlining the rationale for the measures.

But when it came to the politicians again, Donohoe wasn’t finished, interrupting Holohan to ask him to address a question he had raised about the leak.

The CMO denied that it came from Nphet or at the very least from its senior membership.

“It’s not in our interest and I’ve no idea where it came from and I have no explanation for it,” he said. “Any investigation of any kind, I have absolutely nothing to hide, I am quite willing to be part of that.”

At that point, Varadkar interjected and said it would be a pointless exercise unless phones were going to be examined and, in his view, that wasn’t going to happen. It was not considered a serious remark by those in the room — rather it was indicative of the Tánaiste’s level of anger.

Some later noted Varadkar’s own predicament over leaks. His own phone had been seized earlier that year by gardaí investigating his leak of a confidential document.

The meeting was, in the words of one participant, “carnage”. There was a sting in the tail when it came to addressing the row over leaks. Watt told the politicians after Holohan and Nolan had left the meeting that he would deal with the leaking matter.

Before that could even happen, at the full Cabinet later that day ministers agreed that all communications would now be managed and run centrally through the Government Information Service, which would be “coordinating all media by civil and public servants and members of advisory bodies in respect of Covid-related matters”.

It was unusual, to say the least, that communications strategy was the subject of a full cabinet decision, which was seen, in effect, as a gagging order on the public health team.

The leak, and the meeting itself, had had a profound effect. The Nphet team was taken aback at the level of anger in the room and in particular from Varadkar. People who dealt with him felt Holohan was personally shaken by it. Senior figures said that in its aftermath, relations were worse (“way worse”) than at any time in the pandemic.

Some among the senior echelons of Nphet felt that Holohan and Nolan stood accused of being subversives who had actively sought to undermine the government and bounce ministers into making decisions.

An accusation that civil servants have attempted to subvert the democratic power vested in the government is a serious matter. It would have been anathema to Nolan, the son of two civil servants, and Holohan, the son of a guard who served along the Border during the Troubles.

The politicians, meanwhile, were genuinely angry and upset. However the news emerged, they were again being hit with advice to impose new restrictions at high speed, again on the back foot, reacting rather than leading.

The mechanism for making pandemic decisions was wearing out. How long could this be sustained?

Yet, despite the acrimony, it was not October 2020 all over again. The Government accepted the public health advice in full and the Taoiseach later announced the measures would come into effect from the following Monday.

The gagging order in particular caught the public’s attention, with broadcasters struggling to secure interviews with Nphet members. However, in the background, Micheál Martin was quietly working to defuse the situation. The following day, Saturday, December 4, he called Holohan to discuss the decisions made the previous day.

During the call — which the CMO later briefed colleagues on — the Taoiseach told him that he appreciated and supported Nphet’s work, notwithstanding the acrimony that had spilled out the previous night. It was a deft intervention. Martin had poured oil on troubled waters.

Queues outside a vaccination centre

Queues outside a vaccination centre

The surge in cases caused by the more transmissible Omicron variant created massive pressure to get more booster vaccines into arms.

While none of the mass vaccination vaccine centres was closed, some were effectively mothballed, running part-time, a few days a week. The number of vaccinators available for work dropped significantly, from around 1,350 to circa 750, as people drifted back to other parts of the health service.

The style of the vaccine programme had shifted from carpet-bombing to laboriously targeting small groups where uptake was low — among migrant communities and marginalised populations.

Towards the end of September, the HSE began rolling out boosters to nursing homes and to some immunocompromised people, but when Niac cleared the way for the over-60s to be boosted from the middle of October, there were hundreds of thousands of people eligible again, on an age-based approach.

The public’s appetite and enthusiasm for the booster shot was less than it had been with the original vaccination. Across October and early November, with society largely reopened, it was not seen as urgent for many people. There was a spike in no-shows, but there were logistical and technological quirks that frustrated people. Someone could be boosted by their GP, but still receive several appointments via text for a vaccine centre.

The HSE had been planning to run the entire booster programme in about 20 weeks, around the same timeframe for the winter flu vaccine programme. But Omicron changed the game and the health service was now being told it had to be done in about six weeks.

In mid-November, Martin Fraser called Brian MacCraith and asked him to reconvene the high-level vaccine task force, which was rechristened the booster oversight group. The message landed with the HSE.

“That was the week where they were getting f**king pissed off,” one senior official later recalled.

The urgency to boost meant that, once Niac had cleared the way for everyone over 16 to receive a booster, towards the end of November many of the barriers that had existed during the first rollout were dispensed with. The entire programme was condensed into a single fast phase, with GP surgeries and pharmacists brought into play.

Vaccine delivery effectively shifted from a constrained and planned rollout to open access in the run-up to Christmas. Instead of tightly planning how many vaccines would go to each setting, the attitude, characterised by one source, was “How many do you want? No problem. Here you go, we’ve got loads of it. Use as much as you can.”

Stocks were pushed so enthusiastically that, by early 2022, many hundreds of thousands that had been sent out to fuel the pre-Christmas rush went out of date and had to be destroyed by the HSE’s national cold-chain service.

In mid-December, with much about Omicron still unknown, Nphet met to consider more restrictions. While there was some evidence that it was milder, there was not enough that Nphet felt it could rely on.

At a meeting on December 16, modelling scenarios were shown with cases in excess of 20,000 per day. If Omicron spread faster but made people just as sick, it could be as bad as January 2021 or worse.

Nphet’s most draconian recommendation was to close all hospitality, sporting, theatre and cultural venues at 5pm. During the meeting, some questioned the necessity of the measure several times. Nonetheless, the meeting ended with a consensus.

As had happened two weeks previously, news of the recommendation leaked that night. There was a predictable backlash from the hospitality sector and government backbenchers began to line out against the early closing measure. But within the senior ranks of the coalition there was little resistance, given the potential danger of Omicron and fears of another nightmare Christmas.

With Holohan’s backing, pub closing time was extended to 8pm, but all the other advice was accepted. It was all geared towards driving down socialising in the run-up to and the period over Christmas.

“None of this is easy,” an exhausted-looking Micheál Martin told the country. “The level of concern is the highest that I have ever seen.”

Antigen tests were quick and simple to use

Antigen tests were quick and simple to use

On Christmas Eve, the previous record for daily case numbers was smashed, hitting 11,182. On Christmas Day, there were 13,765 cases of Covid-19. Omicron meant Covid was spreading like wildfire among the population.

The positivity rate — the percentage of cases detected from testing — shot up as demand also spiked.

This meant that there would be lots of cases, but those positivity levels also meant there were simply unprecedented levels of Covid-19 in the community, and much of it wasn’t being detected. Nphet estimated there might have been 500,000 cases in the run into Christmas, many more than had been diagnosed.

By the early weeks of January 2022, the public health team estimated there may have been 500,000 infections in a week — around 20 times the number diagnosed in the entirety of the first wave in 2020. Barely a family around the country was untouched by Covid over that period, with Christmas plans upended by a positive test or close-contact notification.

With so much virus circulating, Nphet advised even greater use of antigen testing. So much so that by mid-January 2022, anyone aged 39 and under was advised not to seek a PCR test and to rely on antigen tests instead.

Nphet’s fresh advice on antigen testing was widely viewed as a U-turn after a year and a half of resistance. But Holohan and other senior figures felt that high case numbers— that a PCR testing system alone could not cope with — was always the point at which the rapid tests could be used.

But while cases were spiralling to record levels, Covid-19 hospitalisations remained relatively stable over the Christmas period — and a growing percentage of admissions were people with other health issues who had subsequently tested positive for the virus.

Just as important, ICU admissions were also steady. Many of the people in ICU were infected with Delta, not Omicron. Vaccines meant that those who became infected did not become seriously ill and ICU admissions fell below 100 on December 22, and remained below 100 into the new year.

Early in January, Holohan began to quietly form the impression that the Omicron wave would not threaten the health service. There was vaccine protection from an accelerated booster campaign, and the enormous case numbers meant that hundreds of thousands of people had acquired immunity.

On January 4, the CMO met the Taoiseach and told him no further restrictions would be likely. Two days later at a Nphet meeting, some of the more liberal-leaning members could already see no reason for keeping the restrictions. Towards the end of the second week in January, the data on Omicron became irrefutable. Donnelly was briefed by Holohan and his team that the peak had passed.

By the time Nphet met again on Thursday, January 20, there was talk of reopening pubs that weekend. However, there were still some unknowns. Caution and precedent suggested there could be a phased reversing out of restrictions — a view some members of the team argued for at the meeting. But in the end, consensus was once again reached around the viewpoint Holohan had when he entered the meeting.

Nphet advised that all restrictions be dropped at 6am that Saturday. It was a remarkable turnaround.

The pandemic was not over, ministers were warned: “The emergence of new variants with increased levels of transmissibility, immune escape and/or virulence remains a risk both nationally and globally,” the Cabinet was told in a memo the following day.

But the public’s response over Christmas had been extraordinary. Even without a lockdown, survey data showed that the change in public behaviour from mid-December to early January “was the largest recorded since the study began a year ago. People socialised less and were more careful when they did,” the memo stated.

Ordinary people, not politicians, were responsible for much of the positive difference compared to a year earlier, by virtue of both their caution and their willingness to buy into the vaccination programme. In the four and a half days leading up to Christmas Day, 470,000 booster doses were given.

By the time the Cabinet met to consider unwinding nearly all remaining public health restrictions, on Friday, 21 January, a total of 2.6 million booster doses had been given.

That same day, the Cabinet was told there had been 66 Covid-related deaths up to that point in January 2022. It was way down on 196 the previous month, 246 in November and 224 in October. Given the scenario in front of them, and the advice from their medics, the Government pushed ahead with reopening.

For what all concerned hoped would be the last time, Micheál Martin addressed the nation from the steps at the front of Government Buildings.

“I have stood here and spoken to you on some very dark days,” he said. “But today is a good day.”

He spoke of how trust in the State had enabled the most extraordinary response — and how repayment of that trust now demanded the rapid removal of restrictions on personal freedoms. Spring was coming, he said; it was time to see each other again, to smile and sing again. “It is time to be ourselves again.”

Ending the lockdowns was largely all about getting jabs in arms

Ending the lockdowns was largely all about getting jabs in arms

February 17, 2022
Cases: 1,260,329; Deaths: 6,402; Seven-day average of new cases (PCR confirmed): 3,538

In almost every other way, it was a normal Nphet meeting. There was a detailed review of the epidemiological situation and a discussion of the public health measures. Then, at the end, Holohan spoke.

He had told Stephen Donnelly, the Health Minister, that Nphet, in its current form, was no longer necessary.

In many ways, this chimed with the entire spirit of the meeting — which came to the conclusion that many of the interventions that had become part of daily life were no longer necessary.

Mass testing should be scaled back and targeted at the over-55s and the vulnerable. Symptomatic people would no longer take a test, but would be asked to isolate themselves.

The entire regulatory apparatus, with legal enforceability, of mask-wearing should be dismantled. Masks, the most visible and omnipresent reminder of the disease, were no longer mandated.

The reality — even if it might prove to be only fleeting, before vaccines waned, or before the next variant, or the next pandemic — was that there could be 20,000 cases of Covid-19 per day, and the hospitals and ICUs could handle it.

There would be disease, and death, but the costs of interrupting it with restrictions and even lockdowns would be too great.

Omicron had crystallised a reality that had been slowly forcing its way into pandemic policymaking over the previous six months.

Variants were becoming too transmissible to be contained without the strictest lockdowns. But the strictest lockdowns were also becoming politically, economically and socially unacceptable, particularly since the vaccines were reducing harm enormously.

The disease could be tolerated, even at massive levels, without overwhelming the HSE.

The point of lockdowns had never been to save every life. It had been to avoid catastrophe — and now catastrophe was not coming.

That being the case, the realisation among Nphet members that day when they discussed masks and testing was, as one participant later recalled, “There’s no reason any more for all of this stuff, including us.”

There had been no forewarning for members that this could be their last meeting. It was the 103rd full meeting of Nphet, just over 750 days after its first. Holohan imparted the news imperfectly. Some felt it was hard to discern exactly what he was saying — his speech was so full of subordinate clauses, conditionals, complexity and nuance that even immediately afterwards some people couldn’t quite grasp what had been said.

He was eager to ensure that people knew that whatever happened next was not up to him; it was up to the minister, who would review his proposal.

Allies of the chief medical officer were of the view that the approach outlined should be tightly adhered to — but Donnelly was, as ever, anxious to put his own stamp on things.

He had already been working on his own list of people to advise him directly, rather than providing advice to Holohan to impart to him. But that was a battle for another day.

The last Nphet meeting was light on sentimentality.

Holohan said there would be a time to properly express gratitude, but given that it could be the last meeting of the group in its current form, he thanked the members for their service. Máirín Ryan, the acting head of Hiqa, thanked Holohan for his leadership, mentioning Glynn and the other members as well.

It was imperfect, and undramatic, and in some ways unclear. But the important message got through. The emergency phase had largely passed, there was a need to normalise and hand over to a group of people whose day-to-day job would be pandemic management.

Covid was not gone. The pandemic was not over. Disease doesn’t end neatly. But it was an ending of sorts. Whatever had happened in the last two years, it was as over as it was ever going to be.

Immediately afterwards, one member of Nphet said simply, “We’re done.”

Source – https://www.independent.ie/irish-news/politics/exclusive-extract-leaks-renegades-rows-and-reason-inside-irelands-covid-response-41604332.html