Is Dr. Tony Holohan taking the Irish people for granted?

As you all probably know, the tsunami that is Covid-19 has been belting at Irish shores for a few weeks at this stage. Fortunately, we seem to be managing the outbreak reasonably well, despite the tragic loss of over two hundred people to the virus. We can however take hope that this could have been much, much worse: by last Tuesday, we were predicted to have 15,000 confirmed cases, but a week later we have not even reached 40% of that figure, and at the present growth rate, we will reach 15,000 in just under two weeks. If the rate continues to fall, we may not even reach 15,000 confirmed cases at all (though in all probability we most likely will if we have not already done so). Nevertheless, we must continue to keep up our efforts to ensure that will be the case.

That's the good news. Despite this however, the Government has seen fit to lock down the country for at least two weeks (and at the time of writing this is probably going to be extended), even though the fact that the virus only manifests itself two weeks after contraction suggests that the curve has already been flattened to just above replacement level (which the growth rate needed for new cases to be offset by expected recoveries; the two-week incubation period suggests a rate of c.5%) with only the first tranche of measures announced on April 12th. The probable extension comes at a time when many countries of a similar size on the continent, such as Norway and Denmark (both which had a similar-sized outbreak to ours) and Austria (which was more badly affected than we were, lest we forget) are tentatively beginning to ease their measures. This begs the question as to why the lockdown was even necessary in the first place, let alone why it is about to be extended. The fact that the stated pretext for the lockdown (that demand for ICU beds would exceed capacity if we didn't do so) has not come to pass (we are now being told that the number of active ICU admissions has stabilised at 139, given that it was at about 75 two weeks ago, and our total ICU capacity was 250 before the crisis and is now well in excess of this) even without the impact of the lockdown fully manifesting itself should raise even more questions as to whether we are inflicting more damage on our society than is necessary to defeat the pandemic. 

It has been suggested to me that the official figures given by the Department of Health may not necessarily reflect the true picture of what is going on, given the well-publicised difficulties with testing and the asymptomatic nature of much of the virus' transmission. I'm not necessarily sure that is the case: people are usually hospitalised, transferred to ICU or die a number of days after the onset of symptoms. If the trajectory given by the figures was inaccurate, we would expect to see a significant difference between these rates and the rates of the illness itself, and the data so far suggests that this is not the case, so the official figures can be seen as reliable as regards to the trajectory of the virus, if not its actual extent.

I believe that one reason for the Government's unduly robust reaction is the undue weight they are giving to the advice of the National Public Health Emergency Team, and in particular the Chief Medical Officer, Dr. Tony Holohan. Now certainly, both the NPHET and the CMO have important roles to play in defeating the virus and their advice should be seriously considered. However, what appears to be happening is that the Taoiseach and Minister Harris are basically rubber-stamping decisions advocated by the CMO with little apparent regard for the non-medical implications of these interventions, to the point where Dr. Holohan is now for all intents and purposes the de facto Taoiseach of our country despite never having ran for political office, never mind being elected. 

Now the argument can certainly being made that technocracies such as the one that we effectively have at present are more effective than ordinary democracies in handling crises, especially where it concerns the technocrat's area of expertise. There is something to be said for that, I accept, and Dr. Holohan is certainly very well qualified in matters of public health such as this. The problem with technocracies though is that the technocrat's area of expertise is usually rather narrow and specialised and this therefore consequently leads them to underappreciate the consequences of their decisions that lie beyond the scope of their expertise.

One rather stark example of this would be General Erich Ludendorff, the German military general who despite having no formal political power, effectively ruled the German Empire single-handedly in the second half of the First World War. Now Ludendorff was undeniably a military genius who won the war in the East for the Central Powers and triggered the collapse of the Russian Empire. However, Ludendorff felt that in order to win the war outright, the military, and by extension himself, needed total control of Germany's war making potential and to this end, sidelined the official government by threatening to resign his commission and had the prime minister replaced by a figurehead. Once Ludendorff had consolidated power, he had the German economy prioritise military needs to the detriment of the German home front, to the extent that serious food shortages began to develop and German civilians began to depend on the black market to supplement their rations. Unsurprisingly, morale deteriorated severely and almost certainly contributed to the Empire's collapse shortly before the end of the war. Ironically, if Ludendorff had taken a more measured approach to winning the war (for instance not making the Treaty of Brest-Litovsk as harsh as it was, or not neglecting the home front), the Central Powers would almost certainly have won the war, so the robust approach he took was a case of snatching defeat from the jaws of victory.

General Ludendorff is admittedly a rather extreme example, but I believe that his actions illustrate the point I am trying to make, that technocrats often undermine the goal they seek to achieve by biting off more than they can chew. A more recent, and indeed relevant considering the situation in Italy, is the technocratic government of Mario Monti in 2011-13. Mr. Monti implemented a series of unpopular austerity budgets which among other things, reduced spending on healthcare. These measures did succeed in stabilising the Italian economy at the time, however they also contributed to the rise of populism in the country and may have left the healthcare system in the country less able to cope with events like the coronavirus. Admittedly, hindsight is a wonderful thing and it is easy to throw stones after the fact, but decisions made now could have serious negative consequences in the long run that would exceed the problem the decisions set out to rectify. Personally, I think Dr. Holohan is closer to Monti then Ludendorff for what it is worth. 

But even now, one has to question some of the decisions that he has made, like asking nursing homes not to prevent visitors at a time when public concern was growing about the virus. Given the amount of clusters that have sprung up in such institutions, it is fair to say that this decision undermined the efforts of the Irish people in containing the virus. Likewise, he has made statements such as saying that a lockdown would be excessive and then went on to request exactly that, or saying that we will have recovery figures next week that we are still waiting for two weeks later, which lead me to question whether he is being entirely truthful with the Irish people about what is going on.  Ultimately, defeating this virus and getting buy-in from the public requires a degree of trust, which is being undermined by the contradictory nature of many of Dr. Holohan's statements thus far. It is not unreasonable to ask that if you place heavy burdens on the Irish people that you be honest and truthful with them in return. Otherwise, it comes across as taking the support of the people of Ireland for granted and that they are being asked to compensate for the mistakes made by the HSE around testing, nursing homes and the availability of information. If the lockdown goes on for months, that support could easily dry up, and at best Dr. Holohan could face protests of the type that greeted Dr. Monti in Italy. In an extreme case, it could lead to a collapse in morale and revolution like that which greeted General Ludendorff.

In any case, a crisis such as this requires a measured and proportionate response and care must be taken that the cure does not cause more problems than it seeks to solve. If you are of the praying persuasion, pray for Dr. Holohan, and indeed for all decision makers at this time: they need them.