It’s - yet another - crucial day for the Government’s Covid policy. But what are the main factors that will influence decisions to be taken on Tuesday?
What is happening?
Two key meetings took place on Monday: a long meeting of the National Public Health Emergency Team (Nphet) and then later, senior members of Nphet briefed the Cabinet subcommittee on Covid, consisting of party leaders and key senior Ministers, who were briefed about the potential for relaxing restrictions from April 5th, Easter Monday.
Hospital Report
The key message from Nphet was that not enough people have been vaccinated to take risks when it comes to easing Covid-19 restrictions.
Another two weeks off school? How to keep children and teenagers entertained over Easter
Nphet gives stark warning that lifting restrictions too early could cause fresh Covid wave lasting into summer
No evidence to support ban on partners for maternity appointments, says forum
Covid-19: Belfast’s SSE Arena opens as mass vaccination centre
Today, the Cabinet will meet to discuss potentially easing restrictions on a gradual and phased basis, potentially week-by-week or fortnight-by-fortnight.
Some in Government believe the Coalition has little room for manoeuvre and will have to heed the warnings by Nphet.
What’s up for discussion?
The main moving parts haven’t changed since the Government published The Path Ahead document on February 23rd.
The three areas flagged for potential relaxation then were construction, outdoor activities and the 5km “exercise limit”.
Alongside these three areas, a parallel process has been underway around the resumption of education. The most recent “big” day on that was March 15th, when most primary school children resumed classes alongside 5th years.
How likely are changes?
Very. But that shouldn’t be confused with the changes being very substantial. In reality, whatever is announced won’t massively change people’s day-to-day lives.
The Government will also on Tuesday consider allowing two households to meet outdoors in a place that is not a private garden, and allowing non-contact sports training in pods for children. Ministers will also discuss potentially allowing people to play golf or tennis, although no decisions have yet been made. The 5km limit is to be expanded, but it has not been decided how ambitious this will be, however opening up travel to within county is looking likely from mid-April.
Ministers are likely to consider phasing the restrictions in over April, giving time to assess the impact of each step.
If that happens, some suggest the first relaxations could focus on activities for children, due to the Easter holidays being underway.
Why the hesitancy?
The problem is that since early March, there’s been a flatlining, and even slight growth, in the daily case figures.
While the trajectory in hospitalisations and intensive care admissions has been more encouraging, increased movement associated with schools reopening and some slippage in compliance with distancing rules has been blamed for the stall.
The increased transmissibility of the B117 variant of coronavirus means small changes can have outsized impacts on the spread of Covid.
What about construction?
It seems to be in the balance.
Some Ministers are expected to push for a phased return to construction, although there are fears among health officials that this could result in travel between counties which could pose an infection risk.
Many Ministers are concerned about the impact on the housing crisis of a prolonged closure, as well as the politics of “hard cases” - people awaiting completion of a home or improvement works, who have been left stranded by the shutdown.
Against that, the Government is balancing the risk of allowing tens of thousands of workers back on site at the same time it is trying to preserve plans to resume classes for all children on April 12th.
A phased return has been mooted, with a focus on private home building at first. It may be the case that construction comes back later than April 5th, but before the next “big” step, which is likely between four and six weeks later.
What about vaccines?
Notwithstanding substantial recent controversies around improper administration of doses, and the stop-start nature of the vaccination programme, there is now a reasonable level of protection among those most vulnerable to infection and death or serious disease.
However, it’s understood that internal modelling done by Nphet shows while this is likely to seriously depress deaths, the effect is less pronounced on hospitalisations and ICU admissions, as many of these occur in parts of the population that are as yet unvaccinated.
So despite vaccination, the fear is that another surge could put the hospital system under severe pressure again, even without the same level of death.
There’s also fears that widespread transmission could result in a wave of long Covid or serious infection in younger people, as even if a smaller percentage of younger people fall seriously ill, if transmission is more widespread, it could still be a big gross figure.
What is the Nphet advice?
Fairly conservative. The view among senior members of Nphet is that the much-vaunted “ramping up” of vaccination in the second quarter will make things substantially less risky in four to eight weeks’ time than they are now.
Ministers were told last night that if the State lost control of the disease now there could be a substantial wave of infections until the middle of the summer, whereas a cautious approach for the next four to eight weeks could cut the risk by between 50 and 70 per cent.
But several factors underpin the caution: namely, the transmissibility of the variant, the legacy of Christmas still playing out across higher case numbers and elevated pressure on the health system, and the danger of these two factors to goals of keeping schools open and continuing the resumption of non-Covid healthcare.
As one senior public health source put it last week: “If Government do something in April that triggers a wave, they have a disaster on their hands. If they hold off until May or June, it’s a completely different risk profile.”
What does this say about the overall strategy?
The strategy since Christmas has been one of incremental reopening, followed by measurement and assessment of the impact. The fact that cases plateaued after the first really meaningful changes undermines that strategy, and may herald another subtle but important shift in stance.
Many in Government believe 500-600 cases per day is as low as things can go, due to the prevalence of the variant and increased mobility associated with even minor reopening and slippages in compliance.
If that’s the case, it seems that getting the disease down to the levels seen last summer through lockdowns alone is off the table, and this suggests chips are now basically all on vaccination.
But there is still much uncertainty over how B117 and the vaccination programme will impact the relationship between cases, hospitalisations and deaths.
There is massive uncertainty, with Nphet not even fully confident on where the R number - which measures how fast the disease is spreading - is.
The estimates are between 1.0 and 1.3, but the different outcomes depending on where in that range the R number is, is huge. As one well-placed source put it recently: “you could be shot in the head or shot in the arm. There’s not much distance between them but it makes a big difference to the outcome”.
What are the politics of this?
Tricky, to say the least. Ministers acknowledge their room for manoeuvre is limited, but fret over waning political and wider public support for ongoing restrictions.
So, the approach is expected to be twofold: alongside some minor tweaks next week, there will be a push at Cabinet to indicate the kinds of things that might be considered in the next period.
“What will May and June look like is the big thing,” said a Minister last week. Signalling some movement on non-essential retail, perhaps further concessions on outdoor gatherings or commercial activities. Some in the Coalition think it’s time to start outlining what benefits will accrue to vaccinated people in the weeks ahead, in terms of mixing and social activities.
The difficult task facing the Government is to offer some meaningful hope of better times in the not-too-distant future, but simultaneously do very little that will make a tangible difference immediately.
