Northern Irish health staff sign letter demanding tighter coronavirus controls

16 Mar 2020 Ryan Miller    Last updated: 16 Mar 2020

The Royal Victoria Hospital
The Royal Victoria Hospital

Hundreds of health officials have already signed up to the open letter calling for Stormont to implement major social distancing measures immediately.

 

UPDATE (7pm): following Prime Minister Boris Johnson's televised address providing new guidance, the letter outlined below has stopped registering new signatures, with an expectancy that measures in NI will soon move closer to those in RoI. Per an update to the letter: "Following the UK government announcement this afternoon (16/3/20) of a significant increase in social distancing measures, signatures will no longer be registered and the letter will no longer be actively pushed to the press. Measures in Northern Ireland remain less stringent than those in the Republic, but government policy has altered substantially in the last number of hours and it seems likely that the policies will soon be aligned."

Northern Irish clinicians are calling for stricter measures to tackle coronavirus – warning that current policies “may leave our critical care capacity overwhelmed within a fortnight.”

Northern Ireland currently has 45 confirmed cases of coronavirus but the medics state this could be “hopelessly inaccurate” pointing out the actual number could easily be 900 at this time and 3,600 by the end of the week.

NI only has 100 critical care beds – most of which are already taken up by people who do not have coronavirus. If critical care provision does become overwhelmed, the knock-on effects go far further than dealing with coronavirus.

Per the letter: “Any patients who becomes critically ill thereafter, whether that be with Covid-19, a heart attack, a car crash or complications of childbirth, will only have access to critical care facilities at the cost of someone else losing out. And this is likely to be the very beginning of a period of crisis lasting for months.”

Stormont’s current light-touch approach is slated in the letter, with signatories stating that delaying implementation of distancing measures because of a belief that a bored, inconvenienced public will not stick to them “is an insult to the people of Northern Ireland and irresponsible leadership of the worst kind.”

The letter, dated yesterday and addressed specifically to the First Minister Arlene Foster and Health Minister Robin Swann, already has hundreds of signatures and is being shared right now on social media by local doctors and other health professionals who say they are “deeply concerned about the failure to introduce social distancing measures to slow the spread of SARS-CoV-2 in line with the Republic of Ireland.”

It tells our political leaders that “right now, it is in your gift to take the decisions that will save many lives in the coming weeks.”

At the time of writing the letter claims to have “over 400 signatures, including from 50 consultants and GPs, over 100 non-consultant doctors and over 50 nurses within HSCNI.”

Social distancing

Social distancing is a plan being followed in many other countries around the world. Broadly speaking, it involves everyone having the fewest possible physical interactions with other people thus reducing the number of chances coronavirus has to spread through human-to-human contact.

Although the virus seems too infectious to prevent its spread and, ultimately, massive numbers of people getting it, social distancing could significantly lengthen the amount of time it takes coronavirus to move through the population.

This means fewer people would have it at any given time, meaning it would leave a smaller number of people in critical condition at any given time, therefore giving the health service a better chance to cope with demand and save as many lives of possible.

Medics signing the letter are critical of ministerial claims that the current policy, which is far more relaxed in terms of social distancing than most other countries in Europe (including the Republic of Ireland), is based on good science.

“Stormont politicians are reassuring the public that current policy is based on “expert scientific advice”, but as clinicians and scientists we strongly disagree.”

The health professionals say NI is not like the rest of the UK because it has an open border with another jurisdiction – and also the local health system is on the brink of collapse and far more poorly prepared to face a crisis like this than NHS services in Great Britain.

Clinical point of view

The letter states:

At the time of writing, there are 45 confirmed cases of Covid-19 in Northern Ireland, 174 across the whole island. Community transmission has been evident since 10 days ago, yet our testing policy remains extremely limited: until very recently we were only testing those with a known travel history or contact, now we are only testing those requiring hospital admission.

This may be a sensible use of limited resources, but it also means that estimates of early cases within the community are hopelessly inaccurate. We must, therefore, assume the worst rather than take false reassurance from flawed data.

If we look to other countries who are ahead of us in this particular journey, it is very plausible that cases are being underestimated by a factor of 20. In truth, there may very well be over 900 cases in NI at present, over 3,000 cases on the whole island.

The doubling time of cases from other European countries before the introduction of strict distancing measures has been as short as three days. If this holds true for us, we might be looking at 3600 cases by the end of the coming week.

So far, it seems that approximately 5% of patients need critical care beds, about half of those go on to need mechanical ventilation. Allowing for a period of approximately a week before illness severity peaks, another week without strict social distancing measures will very plausibly result in 180 Northern Irish patients needing critical care beds a fortnight from today.

We would remind you that we have approximately 100 critical care beds in Northern Ireland, most of which are currently occupied by non-Covid patients. In summary, a further week without meaningful social distancing may leave our critical care capacity overwhelmed within a fortnight.

Any patients who becomes critically ill thereafter, whether that be with Covid-19, a heart attack, a car crash or complications of childbirth, will only have access to critical care facilities at the cost of someone else losing out. And this is likely to be the very beginning of a period of crisis lasting for months.

Response to the response

The letter continues:

The UK government is delaying social distancing measures with the intention of building “herd immunity”. Quite aside from concerns expressed within the scientific community regarding this approach (see the open letter from Professor Arne Akbar, president of the British Society of Immunology), the approach hinges upon Britain being an island nation with a significant capacity to limit immigration during the current crisis.

On the island of Ireland, we have an open border and high levels of population mixing. The suggestion that we can achieve controlled herd immunity in isolation of the Republic is at best ill-considered, at worst profoundly irresponsible…

The temptation to fall into line with Westminster is surely strong. We are, after all, part of the UK rather than the ROI, the NHS rather than the HSE. But we are not in the same boat as Britain on this occasion. In addition to the situation outlined above, we must remind you that the state of HSCNI is very different to the rest of the NHS at the outset of this difficult period.

Within the last four months, we have experienced the first and only Royal College of Nursing strike (which you will be aware was about inadequate staffing levels in addition to pay inequality) and the following evaluations have been made of our healthcare system:

  • “…without change, the system will deteriorate until services collapse under pressure.” Westminster Northern Ireland Affairs committee, November 2019.
  • “Northern Ireland's healthcare system is at the point of collapse.” Mark Jones, deputy director of the Royal College of Surgeons Northern Ireland, November 2019.
  • “Parts of Northern Ireland's health care system have already collapsed.” Nuffield Trust, November 2019.

In short, we are in the worst shape of any part of the NHS going into this. Needless to say, we will do our absolute best for our patients, as we always have. But right now, it is in your gift to take the decisions that will save many lives in the coming weeks. Namely, we believe it is of the utmost importance that strict social distancing measures in line with the Republic of Ireland are implemented without delay to avoid large scale, avoidable loss of life.

Failing to do so on the assumption that the public will not tolerate such inconveniences long enough to avoid a rebound wave of cases is not an excuse: it is an insult to the people of Northern Ireland and irresponsible leadership of the worst kind. In the words of another leader faced with extraordinarily difficult times, “It is a mistake to try to look too far ahead. The chain of destiny can only be grasped one link at a time.”

We know we cannot prevent Covid-19 becoming endemic to the human population, but we also know that social distancing is the only intervention likely to slow the spread and allow our healthcare system a better chance of coping.

This is why other European nations and the WHO are advising immediate action, and why we trust that our own leaders will make the right choices under these most testing of circumstances. We also trust that the government of Northern Ireland will not want to undermine the intensifying efforts of the Republic to control the outbreak that is not only theirs, but also ours.

There are well founded concerns about the impact of school closures on the ability of those in essential professions (including ourselves) to work. This should not be a reason to defer measures that will slow the spread of infection and save lives, but rather to make urgent state-provided childcare arrangements to ensure the continuity of professional services. We urge you to address this as a matter of high priority.

Over to Stormont.

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