The approach taken by Ireland in trying to contain the coronavirus is coming under increasing scrutiny as public concern mounts.
Understandably, given what is happening in Italy and elsewhere in Europe, the worry that we may have been slow to act in the early stages of the Covid-19 outbreak is growing.
So have the Irish authorities done the right things, at the right time, that will enable the State to contain the threat posed by the virus? Or have we set up the conditions for an explosion of cases similar to what has been seen in Italy?
These are difficult questions to answer. In the fullness of time, there will be answers, some imbued with the perfect vision that is hindsight.
As of Tuesday evening, 34 cases had been discovered in the State. That compares with 65 in Iceland, 40 in Finland and 227 in Norway, to take three European neighbours whose reporting of figures can be regarded as reliable.
By that yardstick, Ireland is at, or below, the European average for cases relative to the country’s size.
Yet you may have noticed the reference to having “discovered” cases. Some international experts say we should refer to “newly discovered” cases rather than “new” cases, because there may be many more cases of Covid-19 in the community than have been revealed through tracing.
There is a strong case for widening the criteria further to allow for sample testing of people in the community
Irish authorities cannot say with confidence how widespread the virus is because not enough testing for it has been done. For too long, only people who came from specified, limited at-risk areas and had symptoms were tested.
It is only in recent days that a decision has been made to cast the net more widely, by testing people with severe, unexplained respiratory symptoms but no travel history. There is a strong case for widening these criteria further to allow for sample testing of people in the community.
Community transmission
To date, there has been one case of community transmission of the disease, as opposed to travel-related acquisition. Yet almost a week after this case was identified in a patient at Cork University Hospital, it remains shrouded in mystery. This is a big worry.
It appears the Irish system lacks the technical ability to carry out genetic detective-work on confirmed samples that would enable scientists to make links between different cases and explain the routes of transmission of the virus. This kind of work helped in the investigation of a large outbreak in Seattle in recent weeks.
For too long the travel advice applied to just 11 towns in Italy, when it was clear the problem there was more widespread
It might also have helped if Ireland had drawn up a national plan to deal with the crisis before now, though Taoiseach Leo Varadkar has indicated one is due to be published shortly. However, the single biggest thing the Irish authorities could have done to stem the spread of the disease was to critically examine travel relations with Italy at an earlier stage.
For too long the travel advice (not restrictions) applied to just 11 towns in Italy, when it was clear the problem there was more widespread. For too long Irish healthcare workers coming back from the rest of northern Italy were able to return to work without any quarantine or testing.
Most critically, no restrictions were placed on travel back from Italy or, failing that, no required period of self-isolation.
Barriers up
These kinds of decisions are made at European level, one suspects, among ministers in Brussels or at the European Centre for Disease Control in Sweden. There was only so much public health doctors in Ireland could do, even if some other EU states were quicker to get tough on travel from Italy.
There are plenty of excellent arguments against imposing unilateral travel restrictions: that it impedes the free movement of people, that it might lead to tit-for-tat responses, that you would end up having to do the same for other countries, for example.
Yet it is remarkable how quickly the barriers have gone up, and how quickly the flights have been grounded, once Italy belatedly realised the depths of its own crisis.