Have NPHET lost the attention of people?

November Golf

Humilde wrote: »

The economy may not be in their remit but surely all the other patients with other ailments and conditions should be part of their decision making. But it seems they don't give a fig about the rest of the cancer, heart disease etc sufferers out there. Both my parents have had numerous essential scans etc pushed back time and time again. These included scans to monitor life threatening pulmonary embolism, aortic aneurysm and heart disease.

NPHET advice is basis on all Public Health issues. They have said time and time again that back in March their fear was the hospitals would be over run by Covid-19 cases.

In their last two letters to government (not including the most recent) they emphasised the need to reduce the spread of COVID-19 so that they could protect hospitals and non-covid health care.


https://www.gov.ie/en/collection/ba4aa0-letters-from-the-cmo-to-the-minister-for-health/

Turtwig

Humilde wrote: »

The economy may not be in their remit but surely all the other patients with other ailments and conditions should be part of their decision making. But it seems they don't give a fig about the rest of the cancer, heart disease etc sufferers out there. Both my parents have had numerous essential scans etc pushed back time and time again. These included scans to monitor life threatening pulmonary embolism, aortic aneurysm and heart disease.

They have said over and over and over and over and over and over and over again that non covid healthcare is a priority. The only way for this to function is to keep covid out of hospitals.

Your suggestion they don't give a fig is disingenuous. Even people who advocate herd immunity style approach give a fig. The vast majority of people want the best health outcome for their society. To suggest the group you disagree with doesn't is just toxic laziness for what is a really serious complicated issue.

Can you please outline in detail the steps by which non covid health care can function like normal because every country not just Ireland is grappling with this problem.

Melanchthon

mouldybiscuits wrote: »

NPHET don't take into consideration the preservation of our economy. If we keep locking down we'll damage our economy beyond repair. If we don't have a working economy then nobody will have healthcare.

This is true but it highlights something, NPHET don't take the preservation of the economy into account but why do they seem to take preservation of the schools into account when making their calls, both sectors are outside their competence but only one, education and schools staying open seems to influence their suggestions. The economy and social well being are at least as important as schools being open for a few months but those factors don't get taken into account.

Dravokivich

mouldybiscuits wrote: »

NPHET don't take into consideration the preservation of our economy. If we keep locking down we'll damage our economy beyond repair. If we don't have a working economy then nobody will have healthcare.

A healthy economy requires a healthy populace. You can't put economy first.

November Golf

Happydays2020 wrote: »

I am not missing the picture. This is about having a dedicated COVID unit with full time officials closer to the centre of power rather than the current situation where advisors to NPHET are there in their capacity regarding other roles. In effect many of the same people will be involved but it will not be double jobbing and it will need to have a wider remit.

We have successful precedence for this type of structure notably re Northern Ireland.

NPHET consist of officials and representative of a wide range of public health, including:

Dept of Health Health Service Executive NVRL Laboratory Health Information and Quality Authority Health Protection Surveillance Centre Irish College of General Practitioners and a number of Hospital Consultants

And Of course the chairs of the

Irish Epidemiological Modelling Advisory Group (IEMAG) Expert Advisory Group on Virology (EAG)

NPHET is to provide advice and recommendations to government on Public Health, its up to the government to balance that advise with the views of the Senior Officials from the other government departments.

I would also say, that is how government normally works. The government take advice and recommendations from a variety of departments and make a balance decision (i.e: the Budget).

Happydays2020

Mike Foxtrot wrote: »

NPHET consist of officials and representative of a wide range of public health, including:

Dept of Health Health Service Executive NVRL Laboratory Health Information and Quality Authority Health Protection Surveillance Centre Irish College of General Practitioners and a number of Hospital Consultants

And Of course the chairs of the

Irish Epidemiological Modelling Advisory Group (IEMAG) Expert Advisory Group on Virology (EAG)

NPHET is to provide advice and recommendations to government on Public Health, its up to the government to balance that advise with the views of the Senior Officials from the other government departments.

I would also say, that is how government normally works. The government take advice and recommendations from a variety of departments and make a balance decision (i.e: the Budget).

Government does not work on the NPHET model. It is a permanent civil service. And you do not get situations whereby a group of officials give off and on the record Briefings to the media to bounce the Government into one course of action.

The senior officials group was introduced last month to try to bring this into the normal decision making process but it is still not optimal.

I don’t see why anyone should have a problem with having a permanent team in place as we will be living with this for the next two years.

Also I do not believe the membership is independent- they are compromised by their existing roles and the failures therein which means there is an inherent bias towards lockdown measures. I would rather that the HSE experts are fully focused on addressing these deficiencies.

November Golf

Melanchthon wrote: »

This is true but it highlights something, NPHET don't take the preservation of the economy into account but why do they seem to take preservation of the schools into account when making their calls, both sectors are outside their competence but only one, education and schools staying open seems to influence their suggestions. The economy and social well being are at least as important as schools being open for a few months but those factors don't get taken into account.

NPHET advise on public health, In March they objected to schools being opened as they believed schools would drive up viral spread. They withdraw their objection when the evidence abroad proved otherwise.

Of the schools with a positive case, the tests within classes show a positivity rate of 1.9%. If children were passing onto others in school that number should be raising rapidly but its not.

They have said and said again, If the virus levels in the community raises (which it is) to a high level the risk to school goes up and they may object to school being opened again.

Until then, its up to the Department of Education to decide if they can implement Infection Prevention and Control measures.

Mike Foxtrot

Mike Foxtrot wrote: »

Until then, its up to the Department of Education to decide if they can implement Infection Prevention and Control measures.

And/or the teachers unions

MelbourneMan

Melanchthon wrote: »

This is true but it highlights something, NPHET don't take the preservation of the economy into account but why do they seem to take preservation of the schools into account when making their calls, both sectors are outside their competence but only one, education and schools staying open seems to influence their suggestions. The economy and social well being are at least as important as schools being open for a few months but those factors don't get taken into account.

The economy is outside the remit of NEPHT. Their role is to provide epidemiological information and advice to the government.

November Golf

Happydays2020 wrote: »

Government does not work on the NPHET model. It is a permanent civil service. And you do not get situations whereby a group of officials give off and on the record Briefings to the media to bounce the Government into one course of action.

The senior officials group was introduced last month to try to bring this into the normal decision making process but it is still not optimal.

I don’t see why anyone should have a problem with having a permanent team in place as we will be living with this for the next two years.

Also I do not believe the membership is independent- they are compromised by their existing roles and the failures therein which means there is an inherent bias towards lockdown measures. I would rather that the HSE experts are fully focused on addressing these deficiencies.

Yes a permanent civil service but they regularly advise and make recommendation to government. Other departments offer alternative opinions and views but the Cabinet makes the final decision.

Its a public health emergency! They didn't take it upon themselves to start the briefing, they were instructed to do so by the government. Both NPHET and the Dept of the Taoiseach give briefs to the media on covid-19, they use to do it on a daily basis now they do it weekly.

The main different is that NPHET briefing allow reporter to ask questions about public health and the information that NPHET are considering. They have always held that their recommendations to government were confidential.

They membership is matter of Public Health, which is why they are based in the Department of Health.

Even if you were correct (which I don't believe you are), and they were bias towards lockdowns measures, Do you not understand that the final decision is made by the Cabinet?

Melanchthon

Mike Foxtrot wrote: »

NPHET advise on public health, In March they objected to schools being opened as they believed schools would drive up viral spread. They withdraw their objection when the evidence abroad proved otherwise.
.

How have they narrowed their literature review though, take a look at the schools thread here, plenty of examples of proper Reports showing that schools are an issue, are they being considered? It's easy to carry out a selective lit review to return the answer one wants.
Remember this is an organisation that when asked for evidence about the risks of pubs/restaurants provided a handful of links too media articles.
https://www.thejournal.ie/pubs-demand-nphet-evidence-5169305-Aug2020/

That's a worrying example of them not following a rigorous scientific methodology in making their assesments.

In relation to the change in attitude since march back then the government wasn't pushing for the schools to be open.

Mike Foxtrot wrote: »

The evidence
Of the schools with a positive case, the tests within classes show a positivity rate of 1.9%. If children were passing onto others in school that number should be raising rapidly but its not.

When is that figure from and does it seperate between primary and secondary as that's a significant difference due to the way the disease displays by age.

Remember as well the numbers, a positive case and contact tracing of the entire class of 30 persons with a positive return of 1.9 percent is considerably worse in terms of viral spread than a positive test and contact tracing of six persons in a private home with a positive return rate it 6 percent.
Basically school kids currently have close long term indoor close contact with a significantly higher number than of individuals than the average now so the positive return rate from contact tracing doesn't give the whole picture even leaving aside issues with the age profile.

Mike Foxtrot wrote: »

They have said and said again, If the virus levels in the community raises (which it is) to a high level the risk to school goes up and they may object to school being opened again.

Until then, its up to the Department of Education to decide if they can implement Infection Prevention and Control measures.

They object to other settings being open at much lower levels of virus levels despite significant social and economic costs. For example when they released the initial 5 level scheme schools may have been open when literally nearly everything else would be closed, that isn't an evidence based neutral recommendation.

Happydays2020

Mike Foxtrot wrote: »

Yes a permanent civil service but they regularly advise and make recommendation to government. Other departments offer alternative opinions and views but the Cabinet makes the final decision.

Its a public health emergency! They didn't take it upon themselves to start the briefing, they were instructed to do so by the government. Both NPHET and the Dept of the Taoiseach give briefs to the media on covid-19, they use to do it on a daily basis now they do it weekly.

The main different is that NPHET briefing allow reporter to ask questions about public health and the information that NPHET are considering. They have always held that their recommendations to government were confidential.

They membership is matter of Public Health, which is why they are based in the Department of Health.

Even if you were correct (which I don't believe you are), and they were bias towards lockdowns measures, Do you not understand that the final decision is made by the Cabinet?

We are way beyond a public health emergency. We need proper structures, full time expert advice and the best governance. The final decision is made by Cabinet but the decision making process is not good, is leading to mixed messages, is being overly influenced by the media, and is quite frankly a charade.

You can keep on defending the NPHET model but it is currently not working and will not only cost lives but also livelihoods.

Divisadero

zerosugarbuzz wrote: »

How exactly do you propose to enforce the no guests in hour house rule? Would you put 24 hour Garda presence at everyone’s gate? I don’t know anyone who will be holding a house party but, all of my friends and family will be allowing small numbers of friends and family to visit.

To be honest I was thinking more of flagrant breaches like the shower protesting in Dublin the last two weekends. Are they at it again today I wonder? Just clear them by force if necessary. Another example is those post match celebrations we had a couple of weeks ago. That would send a message. At the moment those who are ignoring the measures and those thinking of joining their increasing ranks see no real consequences for their actions and are emboldened. Regarding houses I don't think there's much that can be done there. But if there is obviously a party going on it should be shut down. This business of Guards manning checkpoints with no specific means of enforcement is a waste of resources and just pisses everyone off trying to get home.

One area where I do disagree NEPHET is in leaving the schools open in all levels. I do realise that closing schools again in a hellish scenario for working parents. But in my area alone there are a lot of cases linked to schools. We should do a proper enforced lockdown to prevent a surge in our hospitals. If it doesn't work then we will know lockdowns are useless even as a last resort but doing it half assed seems pointless. I get that people are fed up and worried and some are anxious and depressed. But many in favour of the measures are frustrated too at their efforts being squandered and made a mockery of.

Let's do it properly. Otherwise we are just prolonging the pain by dipping our toe in the water rather than jumping in. Neither side of the argument is satisfied with these half measures. If the numbers don't come down so be it. We will know they are pointless. I think they will though. Until/if a vaccine or effective treatments are found temporary lockdowns from time to time may be the only way to keep our weak health service from being swamped. If they are not conducted effectively though our economy will spend more time closed than open.

greenfield21

So are we going to close the airports and border, No, and also implement a testing track and trace procedure. If not then we're wasting time. Anyway Lockdowns will not work long term. Are new Zealand airports open now?

Divisadero

greenfield21 wrote: »

So are we going to close the airports and border, No, and also implement a testing track and trace procedure. Lockdown will not work long term.

I agree. It can never work long term. It is just a last resort rolling measure to try to keep our hospitals from being swamped when cases reach a critical level. It sucks but until they can find a better way it's all we have. I think of the elderly and healthcare workers. I'm not saying I'm right but I don't see a better way at the moment. I don't want Ireland ending up like the US and our hospital capacity is one of the weakest in Europe.

November Golf

Melanchthon wrote: »

How have they narrowed their literature review though, take a look at the schools thread here, plenty of examples of proper Reports showing that schools are an issue, are they being considered? It's easy to carry out a selective lit review to return the answer one wants.
Remember this is an organisation that when asked for evidence about the risks of pubs/restaurants provided a handful of links too media articles.
https://www.thejournal.ie/pubs-demand-nphet-evidence-5169305-Aug2020/

That's a worrying example of them not following a rigorous scientific methodology in making their assesments.

In relation to the change in attitude since march back then the government wasn't pushing for the schools to be open.


When is that figure from and does it seperate between primary and secondary as that's a significant difference due to the way the disease displays by age.

Remember as well the numbers, a positive case and contact tracing of the entire class of 30 persons with a positive return of 1.9 percent is considerably worse in terms of viral spread than a positive test and contact tracing of six persons in a private home with a positive return rate it 6 percent.
Basically school kids currently have close long term indoor close contact with a significantly higher number than of individuals than the average now so the positive return rate from contact tracing doesn't give the whole picture even leaving aside issues with the age profile.



They object to other settings being open at much lower levels of virus levels despite significant social and economic costs. For example when they released the initial 5 level scheme schools may have been open when literally nearly everything else would be closed, that isn't an evidence based neutral recommendation.

There is a difference between Public Health assessments and National Priorities,

We can't close school indefinitely and NPHET view is the risk is Low. If the virus level continues to raise in the community, I can see schools closing but you can't compare schools which are essential with the likes of wet-pubs which are recreational in nature and think its a balanced argument. its not.

I accept that in some counties the risk to teachers and children are higher and I for one hope the government act quickly to deal with that.

kippy

greenfield21 wrote: »

So are we going to close the airports and border, No, and also implement a testing track and trace procedure. If not then we're wasting time. Anyway Lockdowns will not work long term. Are new Zealand airports open now?

Track and trace is pretty pointless when there are large swaths of the population ignoring the regulations and particularly where a lot of people have a lot of contacts.
It could be better but it is relying on the vast majority of the population to do what they are told

November Golf

Happydays2020 wrote: »

We are way beyond a public health emergency. We need proper structures, full time expert advice and the best governance. The final decision is made by Cabinet but the decision making process is not good, is leading to mixed messages, is being overly influenced by the media, and is quite frankly a charade.

You can keep on defending the NPHET model but it is currently not working and will not only cost lives but also livelihoods.

We are not beyond a public health emergency and there are proper structure and expert advise, your just not happy about it.

If the "decision making process" is a reference to the leaks, I would agree thats not good for anyone but I don't believe they are coming from NPHET.

All NPHET letters are sent to the Minister for Health, the CEO of the HSE, The Dept of the Taoiseach communication group and the Senior Official Group on Covid-19. Any of whom could be responsible for the leaks.

I wouldn't ask a plumber for advise on electrical issues so it makes sense to me to ask doctors for advise on public health. Thats not to say financial and economical consideration are not important, but a broad group would dilute the advise of public health before it gets to the cabinet table.

A decision cannot be made without opinions and views. Public Health have to give advise to government without interference but it will always will be the responsibility of the cabinet to decide.

karlitob

Divisadero wrote: »

I agree. It can never work long term. It is just a last resort rolling measure to try to keep our hospitals from being swamped when cases reach a critical level. It sucks but until they can find a better way it's all we have. I think of the elderly and healthcare workers. I'm not saying I'm right but I don't see a better way at the moment. I don't want Ireland ending up like the US and our hospital capacity is one of the weakest in Europe.

Yet I’d say people would be surprised that it’s better than the UK, Sweden and Denmark. Though notably not with respect to icu beds.

https://data.oecd.org/healtheqt/hospital-beds.htm

Humilde

karlitob wrote: »

Again, that’s another assertion without evidence. You don’t get the make crass assertions that senior health leaders don’t care about patients. It’s unfair and untrue. And I won’t let you do it unchallenged. If you don’t like it - I don’t care.

You’re not a doctor. Patients are treated on the basis of need depending on resource availability. That has always been the way and always will be the way. There is greater need because of Covid for resources to go elsewhere to protect all patients as best as can be done. No one promised the same service throughout a pandemic.

Sorry to hear about your parents. I’m sure you all are quite worried.

The dogs on the street can see whats going on here. Unfortunately the sheeple can't. We have 30 people in ICU, even assuming they are all on ventilators or in coma due to Covid 19, which I very much doubt. And this is the national emergency that everyone is talking about? Just ditch all the other cancer treatments and plans for other patients for this? If deaths start going through the roof for young or otherwise healthy people, then I'll eat my words. But for now, this is a complete crock.

boetstark

Humilde wrote: »

The dogs on the street can see whats going on here. Unfortunately the sheeple can't. We have 30 people in ICU, even assuming they are all on ventilators or in coma due to Covid 19, which I very much doubt. And this is the national emergency that everyone is talking about? Just ditch all the other cancer treatments and plans for other patients for this? If deaths start going through the roof for young or otherwise healthy people, then I'll eat my words. But for now, this is a complete crock.

Great Post, I am totally in awe of your intelligence.
Honest question. Would you be prepared to volunteer for a day on the covid ward in one of our large hospitals. Ppe optional, I'm sure that your answer is yes because this covid is only a crock.

Dempo1

Very odd day yesterday, felt like groundhog day all over again. Not at all sure what part of the Recommendations government don't get or understand.

This looking more like the entire levels concept has been an abject failure. Constant Tweaking, adding, taking away restrictions and yet again Government seem to be scrambling to adhere to the advice but with a Tweak, here, a Tweak there. Just get on with it.

It's the complete lack of consistent approach by government to date that has the situation as bad as it is. Blame the young, blame the pubs, jesus wept blame the households, its becoming absurd.

Like it or not, no amount of gentle persuasion is going to stop a virus spreading and the ridiculous notions about limiting contacts etc is near impossible to enforce or police. Blunt and decisive action required and whilst unpalatable, yes if it takes a short lockdown.

If all government are worried about, namely the economy & schools, surely the dogs on the street can see all this uncertainty is actually more damaging.

As for the "it's not as bad as it was in April brigade" spend a little time looking at the numbers but better still look at America, Trumps incompetence aside and with world leading hospitals 1,000 a day dying, indeed 57 nautical miles away, look at Wales and beyond.

is_that_so

Dempo1 wrote: »

Very odd day yesterday, felt like groundhog day all over again. Not at all sure what part of the Recommendations government don't get or understand.

This looking more like the entire levels concept has been an abject failure. Constant Tweaking, adding, taking away restrictions and yet again Government seem to be scrambling to adhere to the advice but with a Tweak, here, a Tweak there. Just get on with it.

It's the complete lack of consistent approach by government to date that has the situation as bad as it is. Blame the young, blame the pubs, jesus wept blame the households, its becoming absurd.

Like it or not, no amount of gentle persuasion is going to stop a virus spreading and the ridiculous notions about limiting contacts etc is near impossible to enforce or police. Blunt and decisive action required and whilst unpalatable, yes if it takes a short lockdown.

If all government are worried about, namely the economy & schools, surely the dogs on the street can see all this uncertainty is actually more damaging.

As for the "it's not as bad as it was in April brigade" spend a little time looking at the numbers but better still look at America, Trumps incompetence aside and with world leading hospitals 1,000 a day dying, indeed 57 nautical miles away, look at Wales and beyond.

So locking people away till January is the only answer and then in January if it's not, what then? Betting the house on a single solution is not planning at all. We are all frustrated but we do need more options to hand.

meeeeh

How do people know that lockdown will work? It dragged on forever in April and May and considering compliance will be lower (fatigue, Christmas) we will be in it probably till sometime in February.

I find it funny how people think closing everything will work so much better. 6 weeks is suggested but nobody actually said it will only be 6 weeks. What is the next step? Army on the streets to check if the Christmas shopping people are carrying was done more than 5km away from their home.

Dempo1

is_that_so wrote: »

So locking people away till January is the only answer and then in January if it's not, what then? Betting the house on a single solution is not planning at all. We are all frustrated but we do need more options to hand.

Did I say lock people up till January?? Read my post again, I specifically said Short lockdown. Can we seriously continue on with this pretence lower levels actually working, Seriously?

My main point is the current approach clearly not working, yes I understand the pain, I understand the stress, I've many friends working on the high street and they all say uncertainty is seriously damaging business. I know teachers who are terrified, I know people working in health and they are alarmed.

I live in the Midlands and the level 3 we went through a few weeks ago was a farce, it just didn't happen, I travel through 3 counties to work, saw Zero compliance, Zero change, Zero anything.

karlitob

Humilde wrote: »

The dogs on the street can see whats going on here. Unfortunately the sheeple can't. We have 30 people in ICU, even assuming they are all on ventilators or in coma due to Covid 19, which I very much doubt. And this is the national emergency that everyone is talking about? Just ditch all the other cancer treatments and plans for other patients for this? If deaths start going through the roof for young or otherwise healthy people, then I'll eat my words. But for now, this is a complete crock.

It’s hard to know where to start with this ignorance. I suppose we should all be thankful that despite your incredible intelligence and ability that you didn’t bother to become a politician, doctor, nurse or senior civil servant.

No one needs you opinion of whether a patient is vented or not. While a lot of patients are, not all patients are. It’s not a defining criteria for admission, treatment or discharge. I presume your conspiracy theory is that everyone working in icu is in on some scam - including highly trained healthcare professionals all over ireland and the world - that they’ve all agreed to admit patients who don’t need icu to make the whole situation seem worse.


Your point about only 30 being admitted and that this doesn’t constitute an emergency is incredibly ignorant. It’s only 30 because of everything we’re doing to keep the virus at bay. March April and May shows how many could be in an icu. The problem with Covid is it’s infectiousness - a point that seems to escape your enormous intellect. It can exponentially rise which means that 30 can climb quickly. Very quickly. Sure Lombardy has one of the best health services in the world and it was overwhelmed. You’re ignorance here suggests that we should get rid of all road traffic protections - seat belts, kids car seats, speed limits - because only 230 people die each year.

Deaths haven’t gone through the roof. I wouldn’t expect you to know that. Details below. Though I doubt you know how to read it.

https://www.euromomo.eu/

Dempo1

meeeeh wrote: »

How do people know that lockdown will work? It dragged on forever in April and May and considering compliance will be lower (fatigue, Christmas) we will be in it probably till sometime in February.

I find it funny how people think closing everything will work so much better. 6 weeks is suggested but nobody actually said it will only be 6 weeks. What is the next step? Army on the streets to check if the Christmas shopping people are carrying was done more than 5km away from their home.

Fair points but to be honest, the only time I've seen any compliance and the reduction in cases was evident was the main lockdown. I do think it went on too long but it's hard to argue it did not make a difference.

Yes there is the worry of how long a new one would take but my feeling is, we'll be stuck in a perpetual level 3 indefinitely or Level 4 if a new and serious approach is not taken and yes, I believe it may take a short a strict complete lockdown but this time absolutely no ceasing of any Hospital activity or services

is_that_so

Dempo1 wrote: »

Did I say lock people up till January?? Read my post again, I specifically said Short lockdown. Can we seriously continue on with this pretence lower levels actually working, Seriously?

My main point is the current approach clearly not working, yes I understand the pain, I understand the stress, I've many friends working on the high street and they all say uncertainty is seriously damaging business. I know teachers who are terrified, I know people working in health and they are alarmed.

I live in the Midlands and the level 3 we went through a few weeks ago was a farce, it just didn't happen, I travel through 3 counties to work, saw Zero compliance, Zero change, Zero anything.

There is no such thing as a short lockdown. If we go to Level 5 that will be 6 weeks+, then we'll have another 3 weeks at least to get through Level 4 back to where we are now. That's January. Level 3 a month ago is not where we are now and if Level 5 didn't work we'd be right back to this uncertainty you're talking about.

Happydays2020

is_that_so wrote: »

So locking people away till January is the only answer and then in January if it's not, what then? Betting the house on a single solution is not planning at all. We are all frustrated but we do need more options to hand.

Yep. I agree with you on that.

Vieira82

Is this the third time NPHET has advised level 5? TBH at this time, as a question of principle if I was anyone on that team I would say to simply resign in block and declare, we take no further responsibility in this.