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Coronavirus – could it be safer to re-open schools in NI?

It is essential to read all my posts on the subject of the coronavirus in the recognition that I am not a virologist, nor an immunologist, nor indeed a biologist of any sort. They are designed to pose questions on the basis of the information available.

Today’s piece is written to try to open some kind of informed debate about how we answer what is an increasingly pressing question: might it, in fact, be safer to send pupils back to school in Northern Ireland, than have youths (and even families) congregating in an unmanaged way across various beauty spots?

On all the issues around the coronavirus, I am absolutely certain about only two: firstly, we have to test a lot (and with a purpose) to understand the virus; and secondly, there is no point in (effectively) closing schools if you do not proceed immediately to lockdown (i.e. universal curfew). The second point is relevant here, because as we come out of the lockdown in Northern Ireland, we are opening things up but we still have schools (effectively) closed.

From the very first Imperial model, but also through pure common sense, as soon as you raise curfew but do not have pupils at school, you are creating for yourself in practice an unmanageable problem. Families with older children essentially have two options – either they stay off work and find ways to entertain the children, which on a sunny day probably means heading out to a beauty spot with lots of other people who have made the same decision; or they go to work and leave the children to do their own thing, which on a sunny day probably means heading out to a beauty spot with lots of other people who have made the same decision…

In terms of the virus itself, this is unlikely to be a significant problem, although it is not ideal. The key is to avoid the three ‘C’s – closed spaces, contact, and crowds – and gatherings at beauty spots are a worry only for the third of these (maybe in some cases the second). Nevertheless, the situation is unmanaged and, at least to some extent, practically unmanageable – once drink is added to the equation and inhibitions are reduced, as we have seen, outcomes include police officers being assaulted, drunken anti-social behaviour, and mass littering; alongside, it has to be said, the unlikely but certainly possible careless further transmission of the virus.

Assault, anti-social behaviour and littering are not excusable but, realistically, they are a predictable consequence of the restrictions as they stand. There is nowhere else to congregate but beauty spots (i.e. beaches, parks etc); and working parents and care givers are now faced with unenviable choices in terms of balancing their professional and family lives as work re-starts but schools remain effectively “closed”.

As I have written before on these pages, there is in fact no “safe” option here. The status quo is not safe – it leads to crowds, albeit of people not particularly vulnerable to the virus gathering outdoors; it also leads to general disturbance (not least for residents nearby who may be shielding or otherwise feel vulnerable who then face further stress).

So the question must arise: would “re-opening” schools, if only for three weeks and even if part-time, in fact be the safer option? It would mean that at least some young people would have somewhere to go; parents would have space to work (and indeed sort other things); and the danger of crowds would be less apparent.

In terms of the virus itself, we are finding increasingly that the task is to avoid “super-spreading”; if we can do this (and we are increasing our knowledge in this regard), we may find the virus has been eliminated in Northern Ireland by the end of this month.

In Hong Kong, for example, studies now show that half of those infected became infected at just six events. In fact, seven out of every ten people infected with the virus there did not infect anyone else at all. In Germany, a single church service accounted for nearly a quarter of all new infections in the entire country on 10 May. Now that we understand better where the real dangers are, we will soon understand better how to manage the virus.

It should be emphasised that, with just 14 new cases confirmed yesterday on the entire island of Ireland despite testing being available to anyone with symptoms, realistically any further “wave” will have to be imported.

Remember, this is not ‘flu – failing to realise this was the core error in the UK’s and Ireland’s response. With a coronavirus the odds are probably against a further wave, but it is of course wise to be prepared.

There are other options too, of course. For example, many German States have an effective night-time curfew (the exact times vary, but 11pm to 6am would seem reasonable), meaning that outright lockdown is in effect re-applied at night. As case numbers continue to decline, perhaps organised sport could be re-started faster than initially intended as a managed diversion. Certainly there is a case for re-opening caravan sites and holiday homes well before 20 July, with the benefit of broadening the spaces in which people may spend time safely.

As the virus moves out of circulation (across much of the island of Ireland at least), these are the sorts of questions which need to be raised. The answers are, of course, best left to the experts.

Coronavirus – podcast

Last Thursday evening I recorded a podcast with Mick Fealty from Slugger O’Toole, outlining some of the issues to consider in Northern Ireland.

The context in Northern Ireland is a peculiar one – a recently re-assembled Executive finds itself charged with managing the response to the pandemic, taking account of its position in the UK but also on the island of Ireland, and being scrutinised by MLAs who had not been working on legislation for three years. Northern Ireland also has the peculiarity of being governed for domestic matters not by a single “Government” but by legally separate “Departments”, making coherence something which has to be worked at. At the very time they get back to the work, a virus is spreading beyond China and within weeks is clearly set to become the most significant pandemic for over a century.

There is as ever the issue of myth-making. We are having a lot of information thrown at us, some of which is based on demonstrable expertise, some of which is educated guesswork, some of which strays into assumption, and some of which is politically motivated nonsense. We are now at the stage in the pandemic where a lot of people, from government to academia, are involved in defending their reputations rather than learning and adjusting. No one will get this right all along – so beware anyone who claims that!

Northern Ireland has made mistakes in common with other jurisdictions – it focused too much on “protecting the NHS” at the expense of the wider issues of protecting the most vulnerable (most obviously in care homes) and of understanding the virus, not least through tracing (which it gave up too early, effectively by its own admission). Nevertheless, we do not notice the things which go smoothly and, when you count them, up, there is a fair argument so far that Northern Ireland’s response has been the most effective in the UK. Decisions in Northern Ireland, for example on steps to raise lockdown and the specific implementation of them as the numbers show the virus may be deemed “under control”, are in fact close to exemplary in terms of evidence-based policy-making.

The major challenge now is to adjust to research which shows increasingly that the issue is not just who gets the virus but how. Danger is increased by age and by being someone with a particular underlying condition (most obviously diabetes or COPD); but also, it increasingly appears, by receiving the virus at close quarters indoors. This danger is not just of death, but also of the development of chronic rather than acute needs.

Coronavirus – UK Government’s plans look dangerously clueless

The fundamental point of the “Cummings Saga” is that the Prime Minister is outrageously hypocritical but, worse still, also dangerously clueless.

We have seen this again this week. His evidence to Liaison and his media appearances have demonstrated his fundamental ignorance of the basic issues around how the virus behaves. He has even admitted that he does not read scientific papers (as noted before on these pages, he is also just plain lazy), and he is now blatantly ignoring warnings from scientific advisers that infection rates are still too high to raise lockdown in England.

In his desperation to “re-open”, he has asked SAGE to review the 2-metre rule while ignoring it on everything else. In itself, the question is not unreasonable – yet it is designed to enable the re-opening of hospitality with no functioning 24-hour tracing system in place, absolutely contrary to SAGE advice and when indoors is increasingly being demonstrated as much more dangerous than outdoors. Meanwhile thousands of people are still being infected every day in England (with deaths likely to number in the hundreds per week on an ongoing basis of rates are not slowed).

If you ask limited questions to suit your bias, you get limited answers to suit your bias – that has been the crux of the UK Government’s failings from the very start.

Looking at the figures in any part of Great Britain, with many multiples more infections and deaths each day than in comparably sized Italy, it is obvious there should not be the remotest consideration of re-opening indoor hospitality before the autumn. Testing, which takes 72 hours from referral to result typically, is too slow for a functioning tracing system to be put in place. We are seeing – in Korea, in Germany and (as revelations of an event in February have shown) even in Scotland – that crowded indoor events can all too easily lead to mass infection.

Hospitality may not like that, but that is the penalty for the UK Government giving up “test, test, test” and then focusing on pointless targets rather than useful outcomes in the first place.

Remarkably for a functioning cabinet in the UK we need to look to, er, Stormont. Here, of all places, the requirement for a tracing system was understood for longer and indeed tracing has already restarted on a scale capable of covering every positive test; the difference between indoor and outdoor is understood so that the next steps of restriction raising are also focused primarily on outdoor retail and sport; and indeed Northern Ireland is being cautious to ensure that its much lower comparative fatality and infection rates stay low. Bar an early further wave imported from elsewhere, Northern Ireland can as a result look forward to the resumption of something approaching normality from about August. It is hard to see how the numbers and the plan would justify any such optimism in England.

Ultimately this is why the Cummings debacle matters. The Prime Minister, a clueless charlatan who himself lies compulsively about everything from his eyesight to his children, relies on an elite hypocrite whose judgement is at a level where he thinks sixty-mile round trips to check for eye-sight are a sensible story. As a result, they are aiming to re-open things based on populism rather than science. This cannot but lead to further infections and deaths. It is remarkable and perhaps even alarming that the population is so relatively calm about this.

There are no easy choices here but it is now beyond obvious that these idiots’ ignorance (and their refusal to learn even the basics about this virus) is blatantly leading to lots of people dying.

Why do so few care? Why are they still in post?

Coronavirus – R-number has value, but it is limited

The news in Northern Ireland, as it does in many other jurisdictions, focused in on the R-number yesterday – but it did so in a way which is not entirely helpful, and indeed which Northern Ireland’s own Chief Scientific Adviser, Prof Ian Young, warned against last week.

R, as commonly presented currently, is essentially the average number that each person who is infected goes on to infect (this will typically take place over 4-5 days, but maybe up to a week). There are significant problems with it, however.

Firstly, we simply do not know what the number is. Despite wider testing, we are still probably missing (but by definition we do not know) over three quarters of those infected across the UK. We are having to run with the assumption, therefore, that testing is picking up the same proportion day after day – that assumption is not outrageous, but it is a stretch.

Secondly, even if we did know what it is, it is of limited value. For example, if Northern Ireland had a run of exactly 100 new infections for four days and followed that with a run of 95 new infections for a week, R would be calculated (all other things being equal) at 0.95. However, if Northern Ireland had a run of 2 new infections for four days followed by 2 for the next seven except for one, in which there were 3, all other things being equal R would be 1.07. Yet, obviously, the latter is much preferable to the former – and indeed that type of discrepancy is likelier the lower your total infections go.

Thirdly, and perhaps most importantly of all, R merely marks an average across an entire population, but in fact there is significant variance within the population. This is where focusing on it too much can become part of the problem, rather than a solution. This is not just to do with regional discrepancy or whether you count care homes; it is a much broader problem than that, to the extent that R may in fact be a significant barrier to finding out how the virus is behaving.

To use an example from German virologist Christian Drosten’s latest NDR podcast [in German], if you take ten infected people and nine infect one other person, you are looking set for R=1. But if the one remaining person infects 10 more people, that means that between them 19 people have been infected and suddenly R=1.9!

It would be ludicrous, where R=1 in all bar particular and probably identifiable instances, to close down an entire population when in fact only one person has caused the rise in infections – and this is what is known as a “super-spreader” [even in German!]

As discussed before on these pages, the fundamental key to enabling us to restore something like normality is to identify these “super-spreaders” – are there particular people or groups of people who are prone to “super-spread” (is there even some underlying medical reason); or, more likely, is it to do with particular locations where those people spend time?

There is a natural inclination to focus in on the R-number because it gives us something apparently straightforward and understandable with which to judge progress. However, as with everything that looks straightforward and understandable with this virus, while not without its uses it is in fact extremely limited (and sometimes outright flawed) as a means of understanding behaviour of the virus and how to move forward with raising restrictions safely.

Perhaps as a guide, it is probably best to treat R a little like an opinion poll. It gives you an idea, particularly in terms of the trend, but it does not give you the whole picture – and, on occasions, it will be outright misleading…

Coronavirus – podcast

Was good to join Slugger O’Toole for a podcast on the Coronavirus, the Northern Ireland Executive’s response and some international comparisons on YouTube.

Coronavirus – what to learn from restaurants re-openings in Germany

Germany’s federal system offers an interesting parallel as the 16 states go slightly different routes with regard to easing lockdown, but they do give us some hints at how this may proceed in the UK.

From Monday, hotels, restaurants and cafes re-opened across Germany except in Saxony-Anhalt and Bavaria – in Bavaria outdoor opening is allowed (Biergaerten and so on may re-open, therefore). In all cases, a 1.5m distancing rule applies.

Hamburg, Hesse, Rhineland-Palatinate, the Saar, Saxony and Thuringia had already opened hotels and guesthouses before Monday; Bremen, North Rhine-Westphalia and Schleswig-Holstein joined the club on Monday; so does Lower Saxony, but with a strict requirement that hotels may only be half-capacity (the Saar intends to do something similar). In Mecklenburg-West Pomerania hotels and holiday homes have already re-opened but, curiously, there was still a prohibition on entering the state until Monday (and here too, hotels may only be at 60% capacity). Brandenburg has only opened holiday homes.

Some states require reservations with an address, but the largest state North Rhine-Westphalia does not. Even in pubs and cafes, prior reservations are generally recommended and, in Bremen, required. Hesse has a guideline that any location should only allow one person per five square metres.

In Rhineland-Palatinate and Brandenburg there must be hand sanitisers available and use is obligatory before entering; in the former, nose-and-mouth covering is compulsory other than when at the table and cutlery must be washed in a dishwasher at over 60 degrees. Saxony also requires menus to be disinfected; Mecklenburg-West Pomeria even salt cellars (in Hesse these, alongside pepper mills, are simply not allowed). Buffets are not strictly prohibited, but self-service is not recommended (most strongly in Hesse).

Even in its outdoor eateries and beer gardens, Bavaria requires a mask for anyone standing up.

Most states do not allow restaurants to open after 10pm; but again, North Rhine-Westphalia is a liberal outlier here.

Pubs, in a British or Irish sense, and bars must, however, remain closed across the country. It is reckoned that it is impossible to maintain distancing in them, and it is unclear when they will be allowed to re-open.

Germany is not immune from politics either. The First Minister (Ministerpraesident) of North Rhine-Westphalia Laschet and of Bavaria Soeder are reckoned to be candidates to replace Chanceller Merkel, but are taking markedly different positions. Certainly in Laschet’s case, this looks like a political choice.

What can we learn from this in the UK and Ireland? Firstly, it does not look good for pubs and clubs; the rule of the three ‘C’s (no close contact, no crowds, no closed spaces) applies and makes it difficult to see how they will be viable for the foreseeable future anywhere. Secondly, restaurants will have to prepare for lower capacities, with tables 2m apart (though expect the lobby to reduce this to 1m as per WHO guidance, or 1.5m as in Germany, to become more vocal); the question, of course, will be how to make that viable.

In terms of the potential for re-opening at all, this will vary from location to location. If trends in new infections and deaths are maintained, it is possible to imagine that restaurants in St Anne’s Square in Belfast may be able to open, viably, a month or so from now (as they literally have the space in the Square to move out into). In the Cathedral Quarter, however, this looks altogether more difficult – the structures of the buildings themselves and the limited space even outside them will unquestionably make things difficult, particularly given the reliance on crowded weekend trade.

As ever, there is no easy route forward, sadly.

Coronavirus – Sweden’s “special route” has failed

Sweden‘s approach has failed. We need to call it, so we can learn from it.

The principles behind the Swedish Public Health Agency’s approach to managing the coronavirus were probably sound. The intention was to set out a series of restrictions with which the population could live for some years if necessary.

However, the country’s authorities’ unwillingness to understand the virus at a national level, and to adapt the approach to new international understanding, has proven its undoing. It is a considerable error and will likely lead to a serious reconsideration of Sweden’s unique system of government whereby, constitutionally, issues like these are left to the experts with barely any interference from politicians.

Last weekend, there was one death from the coronavirus registered in Denmark and none at all in Finland, Norway or Iceland – yet there were 127 in Sweden. In fact, the previous week, Sweden had the highest death rate in the world.

The response of the Swedish authorities to this has now to be called out as either arrogant or ridiculous. They claimed that “per capita” figures did not matter; having previously claimed that their response was working well “except that more people died than expected”. This is because the whole public health response was based on blind assumptions – and we all know what assumptions are.

Fundamentally, the Swedish response relied on the death rate from the virus being just 0.1%, as with most cases of influenza; yet already, 0.25% of the population of New York City has died from this coronavirus (and, given city populations are in fact younger in profile than the general population, this means the actual death rate across an entire population becoming infected must be above that, possibly well above it). That is why “more people died than expected”. Yet why did they assume 0.1%? There is literally no reliable study anywhere which puts it much lower than 0.4%, and as high as 0.8% remains possible.

It also relied on peculiar claims that studies showing 11% of the population of Stockholm had antibodies meant that 30% (subsequently revised to 26%, but that made it no less baffling) had had the virus and were immune. These differentials were never explained; nor is anyone yet sure about the nature of immunity with this virus.

There was a third baffling assumption too – having initially ruled out any danger at all, the country then relied on experts who claimed that the virus had already been around for months and had infected lots of the population already. A survey in Northern Ireland (of all places!) has shown this is simply untrue – surveys of samples from early 2020 initially taken to test for ‘flu were re-analysed and not a single one matched this coronavirus; it arrived when we thought it arrived.

To compound the arrogance and ridiculousness is the argument that neighbouring countries are now “following the Swedish route”. Actually they can now follow the Swedish route with a tiny death toll for the very reason that they did not follow it to start with.

The certainty with which these figures and assumptions were presented to the Swedish public led to those making them becoming quite popular – in time of crisis, people crave the security of feeling they are being led by knowledgeable people who know what they are doing. When the Swedish public work out that actually it was all based on obviously flawed assumptions (and the current State Epidemiogist Anders Tegnell was as close to publicly savaged as you will get in Scandinavia by his precedessor, Annika Linde, on Sunday), it is anyone’s guess what the response will be.

This is of global relevance, because Sweden is the ultimate example of “government by expert”. Yet the experts have comprehensively failed.

This will immediately give a boost to the broadly pro-lockdown argument, but caution and precision are required here. As noted above, in each of the aforementioned neighbouring Scandinavian countries where deaths have been reduced to close to zero, restrictions have been raised now to about the same level as Sweden; indeed, Iceland never locked down as tightly even as Sweden. If there is a specific issue with lockdown to be learned for any future wave (or future pandemic), it is that specific aspects of it must be implemented in good time not just to apply through peak of infections but indeed to help reduce that peak – but also not maintained for too long (remember Denmark and Norway, with low infection rates and death tolls now running close to zero, opened primary schools six weeks ago).

That Denmark and Norway have re-opened schools and infections have continued to decline (to the extent that there are now scarcely any deaths at all) is an argument for re-opening schools in England, but again it requires precision. Denmark and Norway were never hit anything like as badly as England; schools re-opened there with infections at a lower rate comparatively than they are in England now (although they were about the same, in fact, than they are currently across the island of Ireland).

In fact, Sweden’s biggest flaw was its unwillingness to learn about the virus, exemplified by its remarkably low testing rate (in this sense, it is similar to the UK). With Denmark at close to 100,000 tests per person and Norway close to 50,000, Sweden languishes at barely above 20,000. However, even here, there is a note of caution. The real issue is not the quantity of testing but the quality; Finland, for example, has not tested much more than Sweden but used its testing to lock down specific localities where clusters became apparent (Norway also did this to some extent). Ultimately, either through mass testing or targeted testing with a purpose, all Scandinavian countries showed a willingness to understand the virus and how it was behaving – except Sweden, which just went with unfounded assumptions.

What can we learn from this? A few thoughts:

  • when you face a new virus, you need to adapt to understand it and its behaviour, and then target specific interventions accordingly;
  • if you go for something approaching lockdown, do it quickly and then lift it quickly – the first should enable the second;
  • with regard to testing, either do “mass” or “targeted” but do it with a specific purpose of identifying clusters and protecting/isolating them;
  • if you see something going wrong, admit it and change it; and
  • ultimately, for all their ills, decisions need to be made by elected politicians working off a range of expert advice and accountable directly to the people, while taking account of all the issues involved (not just those relating to public health).

It could yet be that in the end death rates all level up as we face wave after wave of the virus with no vaccine. Likelier, however, is that a combination of improved treatments and better understanding of what social restrictions matter will enable us to keep death rates low in future; so that those who acted quickly to keep them low to start with will benefit overall. It may well turn out that we all end up living with the same restrictions as the Swedes – but their neighbours will have suffered a much lower toll to get there.

Coronavirus – exiting lockdown requires civic responsibility

Is it ok to go camping by day? If you meet as a group of six, can you bring a football? Can my mum join us if she’s in a vulnerable group but not shielding?

Given the figures now show the virus is, by the WHO’s reckoning, “under control” in Northern Ireland, it is reasonable that the Executive moved to “Step 1” of its plan to exit lockdown this week.

Of course, the decision to do so brought into view another tricky reality – anything that is not lockdown is necessarily more complex than lockdown; and therefore exiting lockdown will be considerably more complex than entering it.

The Executive’s decision to move to Step 1 initially excepting “home family visits” was as evidence-based as a policy can get. The specific difficulty with “home family visits” is twofold – first, unlike all the other allowable activity, it involves significant numbers of people gathering indoors (which is a particular established danger with this virus); and second, it already pre-excluded “shielding” people from the permission. This would, for the first time, create a specific distinction between what “shielding” people were allowed to do (at least in the guidance) and what others were allowed to do – creating a not entirely unjustified concern among those “shielding” that the steps out of the lockdown would simply leave them behind. People, purely because of an underlying condition, would have to watch as other families gathered together for the first time in weeks, but they still could not. This is a classic case of how such decisions require “judgement”, not just “science” – taking account of human emotion, not just reason. The Executive was spot on, in fact, to take a little longer about it.

Fundamentally what we are talking about here is risk, and specifically perceived risk (which, in terms of human behaviour, is what counts)This is where the UK Government is completely mismanaging the schools re-opening issue.

Humans are actually quite poor at perceiving risk correctly. For example, the risk to children of the journey to school is statistically higher than the risk to them of the virus.

However, in risk perception cognitive bias plays a role. We humans always regard the novel as riskier than the familiar; and remarkably we actually judge something which is voluntary as up to 1000 times less risky than something which is compulsory.

In due course, as we resume relatively normal life and we become more familiar with and knowledgeable about the virus, the perceived risk will decline. The option to head out voluntary will increasingly be taken up. But trying to force people to do things when they still regard the issue as unfamiliar and the risk as uncertain (even where scientists already know enough about the issue to determine the parameters of that risk fairly accurately) is not going to work, as we will find out in English schools on 1 June.

This is just the latest example of the fundamental lack of expertise and understanding in the small cabal which runs the UK Government currently, and it is actually why the NI Executive’s route map is significantly superior (as it is simply more in tune with our risk perception).

Ultimately, what is going to be required here is a bit of civic duty and responsible citizenship. No regulations or guidance can cover every conceivable eventuality – laws and recommendations will need to be followed (and indeed enforced) with a dose of good old common sense. As we go through the steps, there will be further exceptions and confusions, but in the end we have to take responsibility for this – ask not just what the Regulations require, but what can I justify doing as a responsible citizen?

That will make it a lot easier to negotiate what will inevitably be a more complex move out than the move in.

Learning two languages at once, or one via another

I am helping out currently with some language tuition and thought I would share a starting point, in case it is helpful.

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Firstly remember, we are not aiming to let the perfect get in the way of the good. Would all the above sentences be used idiomatically by native speakers? Not really, particularly those on the left. Would they be understood easily by native speakers? Yes, of course.

Secondly, remember, we are trying to maximise our chances of understanding input (by listening, reading or, ideally, both). If we have the advantage – as we have with Latinate languages – of a lot of common vocabulary, then we may as well use it right at the start.

Thirdly, let’s keep grammar out of it. We don’t need to conjugate “falloir” or “pouvoir” or anything like that. Just use easy phrases which we can amend slightly to give different meanings (using for example “c’est necessaire” or “c’est possible”) and we can immediately get somewhere, at least. Repeating and replication are perfectly good ways to make progress in language learning.

Notably, French and Spanish (in this case for teaching Spanish to English speakers with some knowledge of French) is not the easiest list to compile – actually Spanish and Portuguese, French and Italian and German and Dutch are easier. This only shows that using existing linkages between languages, rather than starting right at the beginning, can help.

I hope it helps you too! Remember the main thing, however – have fun!

Coronavirus – need to stop testing prioritisation based on symptoms long established

They say that the trick to a good job interview is to recognise that the panel actually want you to succeed – after a long day interviewing people, they are willing you on to be the stand-out candidate.

Health Ministers, particularly in Grand Coalitions such as Northern Ireland’s, need to realise the same. The public are willing them on. Their success is our success. We are all on the same team in the virus era.

Here, though, Northern Ireland’s Minister Robin Swann and others elsewhere do need to tread carefully to maintain that good will. There are, of course, just blatantly partisan or thoughtless attacks; but there is also legitimate constructive criticism.

The fact is back in mid April, as testing capacity was ramped up in Northern Ireland, a public case was made, including on these pages, for testing staff in all care homes. It was becoming obvious that care homes were seriously under threat from the virus because it could circulate in them very quickly and residents were in an obviously vulnerable age group.

The case was in fact remarkably straightforward. The virus can only be brought into care homes by staff or by visitors. If you bar visitors, that leaves staff.

However, if you wait only until you have symptoms among two residents within the care home (then the policy), it is already obvious the virus has not been stopped from entering and is already circulating; there is little else you can then do. To break the chain of infection you need to intervene earlier (noting that infectiousness is highest before symptoms) and you do that by testing staff regularly.

The failure to recognise the fundamental point that people are at their most infectious before displaying symptoms in the case of this coronavirus is perhaps the single biggest failing in the authories’ response across the UK and Ireland. Testing criteria need to be able to predict in advance where the particular dangers lie, to enable testing regardless of symptoms to break chains of infection. As noted here yesterday, failure to do this actually pushed the virus into care homes in the UK and, together with a backlog, rendered ongoing contact tracing next to pointless in Ireland.

The fact is the Minister did not push this case, even though it was straightforward, as he was still going off outdated advice that testing could not solve everything. Indeed testing cannot solve everything – but very little can be solved without it. So he chose to continue focusing testing only on those with symptoms and used the extra capacity for “key workers”, but remarkably failed to include care home staff among them. In little over a fortnight, the number of care homes with cases in them had doubled.

The Minister was making decisions in good faith, but he and others in his position need to ensure they are not thrown by outdated advice in future. In the case of Northern Ireland, the prioritisation now being applied to contact tracing provides some hope that lessons have been learned faster here than elsewhere.