One-stop thread for my sanity on how I view certain issues that crop up, as opposed to Groundhog Day rehashing the same points in 30 different threads.

(-Wash your hands + Social distancing.)

Debating the top 5 most-cited criticisms of the (IMO v. good) Irish Response:

1. "We closed schools too late and only due to public pressure".

Hard to be definitive but we likely closed our schools *too early.*

School closures are effective in containing influenza outbreaks, because flu has low transmissibility and high attack rates in children.

Covid19 is diametrically opposed to flu - it has high transmissibility and low attack rates in children. A detailed study on the 1957 Asian Flu epidemic (a virus with a similar R0 to covid19) found school closures reduced the epidemic size by less than 10%.

At the time we closed schools, R0 was high.

Possible if we held tight another 7-10 days, the closures would have had a bigger reductive impact on the size of our epidemic peak.

Detailed study on ineffectiveness of school closures on covid19 is here: https://www.thelancet.com/journals/lanchi/article/PIIS2352-4642(20)30095-X/fulltext

Probably true we closed schools partly due to public pressure.

"Common sense" and "intuition" leads most people to believe closing schools can only help and can never be too soon.

Both are false premises:

School closures can negatively affect death rate and can be too soon.

School closures often result in a reduced healthcare workforce (i.e. forced to stay at home minding kids) and it can cause a rise in death rates. Moreover, when schools reopen, they can prompt a surge in transmission of the virus.

It's a delicate balance to get the timing right.

2. "We should have banned flights from Italy".

Travel bans, generally, don't work.

In this particular epidemic, Spain, France and Germany were hot on the heels of the Italian outbreak. So you're essentially arguing we should have banned flights from 4 countries, not just Italy.

In the meantime, Italian, Spanish, French and German citizens were roaming around Europe. You ban flights from one hotspot, another one pops up.

So the theoretical argument that originated with "Italy" in practice becomes "should have just closed Dublin airport".

The best study on the effectiveness of closing entire airports in pandemics is below. The baseline conclusion is closing an airport would only reduce infection rates by 18%.

Moreover, even that effectiveness would depend on something out of our control:

https://arxiv.org/abs/1205.3245 

....Which is the simultaneous closing of Belfast Airport and a patrolled hard border. Closing Dublin airport without a conjunctive closing of Belfast airport wouldn't do much - if anything - in reducing the infection rates, it would just delay & shift the initial point of attack.

New Zealand implemented this quasi-airport-shutdown (85% reduction in flights). They could because they had complete control of their borders and were willing to bail out the national airline to the tune of $900m.

It's not certain to work for them medium term (I hope it does).

3. "We should have had enough reagents for testing".

I wrote a long thread that I won't rehash. Bottom line is the global shortage began in late January and Ireland suffered the same fate as 110 other countries in not having enough to test.

Stockpiling them early was impossible.

Ireland might not be the richest country in the world, but we had the money to buy as many as we wanted - the supply just wasn't there. A fist full of tenners is no good to you for buying groceries if every shop is closed or empty shelves.

4. "PPE shortages".

Much like the testing situation, the PPE shortages are affecting mostly everywhere. Stockpiling them would seem the answer but most PPE have short shelf-life's. Just-in-time supply chains are wiser but as we see, in unprecedented demand, it causes problems.

I refuse to believe the solutions to the PPE and testing crisis were easy-peasy and simply overlooked by almost every Government west of Beijing.

There are far too many countries in the precise same boat to conclude anything other than -

Historic demand vs limited supply.

5. "Nursing home outbreaks are a result of not enough PPE".

Contributory factor yes - but the reality is nursing home outbreaks are devastating Europe & North America, w/ many affected nursing homes in Canada, Germany and Belgium having the PPE. So why are they getting infected?

The first misconception to tackle is there are only 2 ways to cause an outbreak - via healthcare workers or visitors.

There's actually 4 ways:

-HCW
-Visitors
-New residents
-Transferred residents

The latter 2 are particularly difficult to defend against.

Many nursing home residents cannot wear a mask due to their health. Many don't have the mobility in their arms to cover their mouth when coughing or sneezing. Residents frequently attend hospitals or outpatients and come back to the nursing home.

The virus spreads so rapidly in these settings because the elderly are less able to protect themselves or other residents.

PPE for healthcare workers completely omits these considerations - the residents themselves can seed the outbreak and it's not simple to quarantine them.

There's a greater failing in all this, not unique to Ireland - western societies don't place the elderly on a pedestal like Asian societies do.

Quality of nursing homes in the west, often old buildings w/ outdated facilities, is low down list of priorities. It should be higher.

~50% of seasonal influenza outbreaks in Ireland occur in nursing homes & kill our old people - and those sort of numbers are replicated throughout the West.

That should be a point of outrage each and every year but it just isn't.

I hope now it will be.

My own criticisms:

1. Social measures didn't go far enough.

Pandemics disproportionately affect poor people and that is universal the world over. A temporary base-rate social welfare increase, with added protection to renters, would have mitigated the impact on them.

There are also questions to be asked on the conditions facing asylum seekers and whether we have done enough for the homeless (no).

The step-down facility in CityWest was a great proactive initiative but we need similar/more high-class facilities to protect the vulnerable.

2. Gardai deployed too late.

This is really a criticism of society and government. We shouldn't have needed the gardai everywhere to cajole us to do the right thing but in hindsight, more Guards on the streets earlier would have been better.

3. Government not done enough to counter online misinformation.

None of us want to live in a police state but when the likes of Jim and Gemma are promoting batshit crazy ideas like "take chloroquine" and "ignore social distancing, it's a hoax", doing nothing is untenable.

/end.