‘Institutional inertia’ and a breach of duty, HSE in the suspect list

Health authorities have been accused of ‘institutional inertia’ and a breach of duty of care because they neglected to improve our test-and-trace systems in recent months.

Dr Tomás Ryan, leading Trinity College scientist, said that they could have prevented a second wave if they have taken timely action to improve the test and trace systems. ‘I was expecting this to be sorted out through the summer. We knew how to do this. We knew.

‘And I feel like we had our head in the sand for most of the summer,’ he told to a newspaper.

Dr Ryan, a neuroscientist and an associate professor in the School of Biochemistry and Immunology at Trinity College Dublin, said it should have been a ‘reasonable expectation’ for the HSE to act to meet its ‘duty of care’ over the summer.

He described this failure as an ‘institutional inertia’ that saw test-and-trace systems call to a halt gradually.

Dr Ryan said that he naively assumed that they were doing that, but many heard nothing and it turned out they were doing nothing.

‘If we had done that we could be in a very different position now,’ he continued. Hecalso noted that testing alone would not decrease the virus rates.’ he said

‘We’re maxed out now at 15,000 tests a day and we’ve got an exponentially growing case load. It seems that testing needs to be combined with our new restrictions to suppress transmission,’ Dr Ryan said.

Dr Ryan said he could not understand why the authorities did not act sooner.

‘It doesn’t make sense. It’s not excusable that they wound down the system and that they were caught off guard. I don’t think that’s okay and I don’t think enough of that entered the public narrative. I’m not sure people see how much we dropped the ball,’ he said.

The white paper submitted to NPHET by Dr.Ryan and other academics, calling out for a better system was virtually ignored.

Similar concerns which warned the authorities to act were expressed again during hearings at the Oireachtas Special Committee on Covid-19 in June. One such warning came from Paddy Mallon, professor of microbial disease at UCD and consultant in infectious disease at St Vincent’s Hospital.

‘We need to avoid complacency and ensure that this time is used wisely to improve our infrastructure,’ he told the committee on June 24.

He also indicated the committee about a new testing model ‘with a target implementation of August.’

‘It will focus on building a fit-for-purpose, sustainable testing service that will deliver short turnaround times, maintain long-term capacity, effective contact tracing and be flexible for any potential surges that may come,’ Dr Henry said.

But the August deadline was not met and the new system is not yet in place. Instead, new commitments for testing formed part of the Government’s Living With Covid document, published this week.

While welcoming the new commitments, Dr Ryan described them as ‘a statement of intent’ that was ‘making all the right noises rather than a concrete plan’.  According to him more lives could have been saved if a suitable testing had been set up during the summer.

‘I think that with a faster and more streamlined test/trace infrastructure we could well have stopped these outbreaks. I think we just dropped the ball, partly because of not taking on board diverse scientific advice,’ he said.

Dr Ryan said he could not understand why the authorities did not act sooner. ‘It doesn’t make sense. It’s not excusable that they wound down the system and that they were caught off guard. I don’t think that’s okay and I don’t think enough of that entered the public narrative. I’m not sure people see how much we dropped the ball,’ he said.

‘We need to avoid complacency and ensure that this time is used wisely to improve our infrastructure,’ he told the committee on June 24.

While welcoming the new commitments, Dr Ryan described them as ‘a statement of intent’ that was ‘making all the right noises rather than a concrete plan’.

‘We’ve missed opportunities. We definitely missed out on an easy opportunity for zero Covid (elimination of community transmission) in June. We missed our opportunity for South Korea-style suppression in early August. If we had just jumped on it then, we could have been able to take care of it.’

Dr Ryan said he is hopeful that Level 3-type restrictions would allow time for a new better trace-and-test system to prevent a third wave.

‘With Level 3-type restrictions in Dublin and in other places where necessary for a few weeks, we could get things down again without a heavy hammer lockdown. We need to reinvent the testing infrastructure to make sure it’s ready for next time and face the reality that it looks like it will be restrictions of some degree that is going to get this suppressed from here.’

Dr Ryan also raised concerns at the delays in introducing restrictions and the NPHET recommendations to get approved by the Government.

‘I’ve seen one analysis that said to go from NPHET to the Covid Oversight Group to the Cabinet sub committee to Cabinet to be acted on is itself a process of four days. This is worrying. I don’t think the Covid Oversight Group should exist,’ he said.

But he is anxious to remain positive and believes science will help us find a way out of the crisis. ‘If we don’t get a vaccine, then I hope with new technologies we’ll be in a position test our way out of this with rapid at-home testing, but that is not on the table just yet,’ he said.