Home Lifestyle Northern exposure: the case for an all-Ireland Covid response

Northern exposure: the case for an all-Ireland Covid response

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The headline on the front of the Irish Independent on March 1 could not have been more stark. “The plague is here,” it read. A nation braced itself.

This was not from 2020, announcing the arrival of Covid-19 in this country. This was 2001. There was huge concern then about the havoc that foot-and-mouth disease would cause. Human life was not at stake, but the disease threatened to inflict incalculable harm on the entire island’s agriculture sector.

Swift action needed to be taken — and it was. Agriculture ministers on both sides of the Border — the late Joe Walsh in the Republic and Bríd Rodgers in the North — joined forces with the island’s best veterinary and scientific teams. Events such as Dublin’s St Patrick’s Day parade were cancelled. A world-leading tracing system was brought in.

Foot-and-mouth was contained and within 10 weeks, the crisis was over. The national celebrations of March 17 were moved to the summer. Normal life resumed. By the autumn, foot-and-mouth was already feeling like a footnote.

“The north-south co-operation was crucial in bringing it under control,” the then taoiseach Bertie Ahern tells Review. “We had meetings every day. Joe Walsh and Bríd Rodgers worked very closely. There was really good co-operation with the likes of Ian Paisley and Gerry Adams. The tracing system worked really well on both sides of the Border. There was a determination to bring it under control.”

The all-Ireland effort of 2001 could not be more different to the disjointed strategies to combat Covid today.

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Former taoiseach Bertie Ahern Former taoiseach Bertie Ahern

Former taoiseach Bertie Ahern

Former taoiseach Bertie Ahern

“It really is surprising that there hasn’t been far greater co-operation,” Ahern says. “I read in the news this morning that they are talking, for the first time, about following cases from north to south. And this is mid-October!

“We were at that every day. I’m not trying to say that there were 800 cases a day [in 2001] — it was relatively small. But the tracing was meticulously followed — and there was no technology then.

“When I hear these guys, Nphet, meeting once a week or twice a week” — he pauses — “we were trying to follow cows and we were meeting every morning at 7.30. And the liaison with Bríd Rodgers and the politicians in the North was endless.”

The same cannot be said of the response to the coronavirus pandemic. Since the beginning of the outbreaks in February, both sides of the Border have gone their own distinct paths. Co-operation and co-ordination have been virtually non-existent.

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Four-week lockdown: A shopper in Belfast this week Four-week lockdown: A shopper in Belfast this week

Four-week lockdown: A shopper in Belfast this week

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Four-week lockdown: A shopper in Belfast this week

There were lockdowns in the North and the Republic in March and April that followed a broadly similar approach, but the reopenings were done differently. Northern Ireland opened quicker, while the Republic’s more cautious approach was frustrating for the business community. Rules on socialising, ‘wet’ pubs and supporters at matches were looser north of the Border.

On July 1, everything looked rosy. There was just a single case of Covid-19 detected in the North that day and four in the Republic. Although there was talk that a second wave could hit in the autumn, it appeared as though the worst was over and a sense of normality could be restored.

But recent weeks have provided sobering lessons about how quickly the virus can re-emerge and spread rapidly. For much of last week, cases in Northern Ireland exceeded those in the Republic — despite its population being 60pc smaller.

This week, on Thursday, the Republic recorded its highest number of cases in a single day so far: 1,205. The Border counties of Donegal, Cavan and Monaghan had the highest incidence per head. It was a clear sign that, in health terms, the Border between the jurisdictions is invisible when it comes to the virus.

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Escalation: First Minister Arlene Foster (left) and Deputy First Minister Michelle O'Neill during a press conference. The Stormont Executive announced this week that schools are to close for two weeks Escalation: First Minister Arlene Foster (left) and Deputy First Minister Michelle O'Neill during a press conference. The Stormont Executive announced this week that schools are to close for two weeks

Escalation: First Minister Arlene Foster (left) and Deputy First Minister Michelle O’Neill during a press conference. The Stormont Executive announced this week that schools are to close for two weeks

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Escalation: First Minister Arlene Foster (left) and Deputy First Minister Michelle O’Neill during a press conference. The Stormont Executive announced this week that schools are to close for two weeks

In an attempt to bring the crisis under control, a stringent four-week lockdown has been introduced in the North, while Donegal, Cavan and Monaghan have all been moved to Level 4 restrictions — the second-toughest strand in the Government’s Living with Covid roadmap. Household visits have been banned nationwide.

For public health physician Gabriel Scally, the lack of joined-up thinking has been a source of enormous frustration. “I think I was the first person to call for an all-island approach — and I’ve been consistent on this since the very beginning,” he says. “It has to be a cornerstone of bringing this pandemic under control on the island. There is no way around it.

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‘Abnormal times’: Dr Gabriel Scally wants an integrated effort across all Ireland ‘Abnormal times’: Dr Gabriel Scally wants an integrated effort across all Ireland

‘Abnormal times’: Dr Gabriel Scally wants an integrated effort across all Ireland

‘Abnormal times’: Dr Gabriel Scally wants an integrated effort across all Ireland

“The virus doesn’t recognise borders, as is clear from our current predicament in the Border counties. Co-operation is no longer enough: there needs to be an integrated effort to really suppress the virus.”

The Belfast native — who led an independent inquiry into failures in cervical screening in the Republic — believes our island status should have given us a crucial advantage in tackling Covid-19 head-on. But it hasn’t been taken.

“Islands are being successful in this — from New Zealand, which is the best-known example, to Taiwan and on to smaller places like the Isle of Man and Guernsey,” he says.

“But the problem here is getting the politicians north and south to have the will to do it and to have the courage to put aside some of the prejudices or age-old reservations about working together that get in the way. They can resume their normal approach to life when this is all over, but this is abnormal and it requires people to behave in an abnormal way — which means an integrated effort across all Ireland.”

Division in North

The stark contrast between the way this pandemic and the foot-and-mouth crisis was handled is not lost on him. “If this was chickens, pigs or sheep we were dealing with, there wouldn’t be the slightest problem about having an all-Ireland approach and keeping the disease out of the island of Ireland,” he says.

Scally believes the shadow of Brexit hangs over the failure to co-operate. “That whole argument about borders and the Irish Sea and so on tainted the thinking coming into this pandemic,” he says. “The fact that there was such a division in the North between the DUP — who, for once, were in the minority — and those opposed to Brexit increased the attention being paid to borders of a political and economic nature. And that’s not what anyone is talking about in terms of this pandemic — we have to think about public health controls.”

Dr Tom Black is a GP in Derry and chairman of the British Medical Association in Northern Ireland. He has seen at first-hand just how swiftly Covid can come back, having been largely snuffed out in the summer.

“Here’s a killer fact for you: on September 10 — five weeks ago — we [in the Derry and Strabane region] had 10 cases per 100,000 in the previous seven days. We now have 969 [per 100,000]. That was due to complacency and to socialising. It was due to the public letting their guard down and thinking they had it beaten,” he says.

“It came back so fast, you couldn’t believe the speed of it. They talk about exponential growth — well, I’ve seen exponential growth. GPs here would tell you that the past four weeks have been very, very busy and, of course, there’s a lag period before it gets so severe that they have to go into hospital. And then there’s another lag period when they’re in hospital before they need intensive care. The GPs are saying, ‘It’s going to hit you really badly next week’. The emergency departments are saying the same thing and the wards are already saying ‘We’re too busy with the doubling every three to four days — when’s this going to end?’”

Black says that even before First Minister Arlene Foster announced lockdown restrictions, local businesses and services had voluntarily closed their doors. “It’s more a case of them leading the politicians than the other way around. The restrictions they announced come too little, too late and they don’t go nearly far enough. Retail kept open. Why? And 25 people at weddings and funerals. Really?

“During the lockdown we had six going to funerals. It was miserable. My mother-in-law died during that time and it was miserable but, you know what, 25 people at a funeral, all hugging — because people can’t stop hugging at funerals — that’s just not strict enough.”

It is a snapshot that illustrates the difference in approaches on both sides of the Border. Under Level 4, weddings and funerals in Donegal, Cavan and Monaghan can have no more than six people in attendance. In Northern Ireland, all schools are shutting for the next two weeks. Over the Border, the schools remain open.

Illona Duffy, a GP in Monaghan town, says Border counties such as hers are taking the brunt of the rise of Covid cases. “There has always been such a huge amount of travel over and back on the Border,” she says. “And there have been very different approaches to how to manage Covid, north and south, and that can be confusing for people to remember what restrictions apply to them.

“It stands to reason that if restrictions are lesser in one area, people will travel there to do their shopping and socialise and so on — and that, of course, can present all kinds of problems. The only way to really stop that happening is for exactly the same restrictions to be in place everywhere and that’s very much the way it should be along the Border. But that hasn’t been happening.”

Duffy says this second wave of the virus has been especially tough for her patients. “People feel very fatigued by it all and they’re letting their guard down. There’s still a lot of confusion about what they should do if they’ve been in close contact with a positive case, for instance — often, they don’t understand the necessity of staying home from work.”

When the virus first arrived in the Republic, Monaghan was the last county of the 26 to record a case. Now, incidence of Covid there are third behind, respectively, Cavan and Donegal at 312 cases per 100,000. “The fact that there have been such high numbers north of the Border mean that it’s no surprise that it’s the Border counties like Monaghan that have seen so many cases in the past few weeks,” Duffy says.

For virology specialist Connor Bamford from Queen’s University Belfast, taking an all-Ireland approach in the Covid battle is a no-brainer. “Leaving aside the rights and wrongs of which policy [either side of the Border] is more effective, we’ve seen that these infections don’t respect borders. As we’ve seen, there are obvious links between outbreaks in Northern Ireland and the Republic, and it would be hard to properly contain that without a joined-up approach. What happens on one side of the Border affects what takes place in the other.”

Bamford is hopeful that the measures introduced in both the North and the Border counties of the Republic will arrest the spread of the virus.

“I think they’re quite robust. We know there’s not one just thing that’s driving this — there are a lot of things that come together to aid the spread. I think the timeframe of four weeks [of restrictions in Northern Ireland] will have an impact and I would think the rate of increase will come down. We have to use this lockdown to get on top of the problem and it makes sense that something similar is happening in those counties on the other side of the Border.

“I think there is a chance that we can get on top of this pandemic,” he adds, “and we can see that they have managed to do that in places like China without a vaccine. Being an island can definitely help with that. It makes it far easier to control the borders.”

A joint approach proved fruitful during the foot-and-mouth crisis two decades ago. Time will tell just how significant the failure of Dublin and Belfast to co-ordinate efforts for the first eight months of this pandemic will be.

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