Listening to Michael McGrath (FF Finance) this morning he was asked whether his party, if in government, would make face masks mandatory in enclosed spaces such as transport and shops. His answer was interesting. He said that his thinking is that if the key influencers including medical experts, government and media got behind the idea, then just as the public has overwhelmingly supported and complied with the Covid19 restrictions, mask wearing would quickly become the norm.
McGrath made the point that, there will always be a small number of people that simply cannot wear masks for a variety of reasons including their age or specific medical conditions. And we should avoid stigmatising individuals. In this short conversation McGrath summarised the differences and opportunity for Ireland – that without talking about green jerseys as a nation we have proven we can collectively act in the national interest. There will always be a small minority who don’t, but the experience of the past two months is that the overwhelming majority can act in the national interest.
It is perhaps easy to look at New Zealand and observe that they do the same. An island state with similar size of population they have, through national unity of purpose, effectively killed the virus and are on a course to establish a bubble comprising New Zealand and Australia. Unfortunately, Ireland can never copy New Zealand. Our island has a porous international border and will never be able to close that, or establish a virtual bubble with the North because they are governed by a different national entity. There is also a very high level of dependency upon international tourism and trade and keeping borders open is going to be an economic necessity.
The answer for the Republic of Ireland to achieve something like normality is almost certainly to establish an effective automated contact tracing system. If the tracing system is working well and is downloaded and used by a high proportion of the population, any outbreak of the virus would be rapidly identified and managed. Ireland has made some good decisions in this area, choosing to implement the Apple/Google API which is a distributed architecture that protects individual privacy. Unfortunately, there are various actors who are already briefing against the app, even though they clearly don’t understand the architecture. I note today that Iceland, another small country like us, who have moved rapidly to implement an app, report they only have 40% of the population using the app and have pretty much discounted it as a potential game changer. For Ireland, because of our open borders, the app must be the game changer. It is the only way that we will achieve anything like normality in the next few months and through 2021 as we wait for a possible vaccine.
Returning to Michael McGrath’s comments, we need to see the use of the app in a similar way to the use of masks in enclosed public spaces. We need to see at least 80% uptake not just of the app but also in individuals self-isolating when they have been in close proximity to a confirmed case for 15 minutes. This will require a concerted effort by the key influencers to explain why this is another area where we need a huge effort and compliance by the entire population. Perhaps we should start by explaining that the contact tracing app is actually just one key component in our virus suppression system. The system is so much more than the technology, it’s the buy-in of the entire population in the process that starts when an individual believes and reports that they have symptoms through to managing the isolation of their contacts and the prevention of outbreaks.
This will need, just like over the last two months, everyone to put their shoulders to the wheel. But the prize is a return to normality.
Perhaps Kerala is the place to look and although a tool may be useful it’s the overall design of the process that is just as important. The key is the the right granularity. What’s missing isn’t a tool, it’s political will and a non-ideological, pragmatic imagination. Lets do an imaginary design
Get as much of the economy is working as possible = keep income streams
Keep keep the outbreak under control = minimise spread/deaths
The process would look something like this:
– a 4 hour turnaround on testing, we know that’s doable – it seems that in the early days just a temperature check would have sufficed
– local recruitment and training of volunteers – we’ve wasted 6 weeks if not more
– use of local resources and organisation capacity for delivery
– testing done in several ways
— large employers do their own staff staff, all clear go to work, not all clear, isolate the positive and stay closed for a further week
— clusters with testing spots by geography on the scale of polling stations for smaller employers and self employed people to use – (libraries, schools,health centres)
— testing at other specific places to fill in gaps
– certification of all clear to go back to work
– as well testing in hospitals and care homes, homes, sheltered housing etc
– delivery of PPE to care homes
Build on the remnants of Public Heath stop ignoring them and trying to do one size fits all centrally.
Contract tracing and specific (mandatory and punishable if ignored) quarantining of individuals based on contacts but also by exception for specific workplaces or street areas based on outbreaks
The phone app can have a place in this, but only a place, remember – No Silver Bullets (Fred Brooks) and a saying A fool with a tool is still a fool.
Volunteers with immunity would be drafted to help with deliveries and other services to the vulnerable
Introduction then becomes a technical problem – not a political on – and it isn’t based on a timetable where becaus R is ok in London relax occurs in NW where it’s still over 1. When R is suppressed to the level at which contract tracking tracing and selective isolation can cope that’s when it happens.
This virus is particularly contagious/infectious and people can be asymptomatic so even the above is tricky. It’s also just on the boundary of lethality which is why some say just let it run and why the concern was about overwhelming the NHS. We have escaped but only by moving the problem (to homes, and in collateral damage of delays to other treatments).
That’s why the testing turnaround is a key – you have to do everyone who wants to go about their normal business.
If you think my process is/would be expensive we are seeing the alternative,we have a double whammy (fail on COVID and crash the economy) so I’d hazard a guess I’m on the right track.
It looks like ideology, combined with over centralisation, and an I’m in charge mentality is proving a disastrous combination (this is not limited to the Tories).
What we get is broad brush guidelines, and they seem to be making those up as they go along. A tool without a process to go with it, and outsourcing to large Companies, like Serco, Sudexo etc. (cronyism?). Remember a fool with a tool is still a fool
The government has consistently ignored requests for help from smaller companies precisely because, as they see it “they cannot scale”. But, if it it was organised locally the small companies don’t need to scale. Example: Gateshead – 40 miles for some to drive to a single testing centre at an IKEA site, meanwhile a local laboratory with capability – ignored. We still don’t know how local health organisations are to be used, except for the hospital-pass they have been given making them responsible for the care home fiasco.
The local, granular regime I envisage needs a government to enable, to state the governing principles and then step back by empowering local government. It doesnt have to be on the TV night after night at a press conference – it chooses to be because it thinks it can manage public opinion.
What can be done locally is amazing. The Yorkshire scrubs hub has delivered over 12100 pairs of scrubs (c. End May). Thats an under estimate because there are local informal groups like Kate’s that delivers to order, direct. Small companies who cannot scale have supported this effort with delivery of fabrics at cost or for free – our local B&M Fabrics in Leeds Market have been amazing. This effort has all local networked people using social media – imagine what,could be done with power of local government behind it.
We need people to be responsible, engaged and part of the solution. One size doesn’t fit all and breaks the fragile consensus. We are the worst in Europe, there are reasons for that.
I agree – I said, “the contact tracing app is actually just one key component in our virus suppression system.” I think the app is important because it reduces the time to trigger. I have also looked at the UK contact tracing and wondered why the UK continually chooses to give mega contracts to multinational companies, rather than distribute and decentralize. They never learn.