Yesterday saw 90 Covid-19 deaths reported across Ireland - the highest number since the outbreak began. As the daily death count inexorably grinds its way towards 1,000 lives lost, it is becoming increasingly clear that many of these deaths were completely avoidable.
Covid-19 has exposed the appalling damage that decades of mismanagement and under-funding has done to Irish healthcare. In recent weeks the authorities in the Six and Twenty-Six County states have attempted, and failed, the impossible task of repairing that damage before Covid-19 hit our shores.
Two of the most important assets that were available to the Nation - time and emergency planning capacity - were squandered playing a game of catch-up, not on Covid-19, but on bringing healthcare capacity up to the level it should have already been at.
This deadly game of catch up has been played out in the full view of the public via daily press conferences, media interviews and a never-ending stream of statistics and analysis.
At the start of the outbreak the lack of Irish critical beds was identified as the most important hole that needed to be plugged - the point at which the HSE and NHS were most likely to become overwhelmed.
Before Covid-19 arrived there were less than 350 critical care beds on the island of Ireland, equating to just six critical care beds for every 100,000 people. The equivalent figure for Germany was almost five times that number at twenty-eight beds for every 100,000 people.
Throughout the month of March, the creation of additional critical care beds dominated the agenda. Ventilators and other specialised medical devices were ordered, staff were rapidly retrained and the locations for new ICU wards were identified and kitted out.
Despite these unprecedented efforts the number of Irish critical care beds is still less than 600, the equivalent of just ten beds per 100,000 people - 35% of the rate in Germany in normal times.
Even before these additional critical care beds came online, a second deadly area of shortage was identified - the supply of appropriate Personal Protection Equipment.
In both the Six and Twenty-Six Counties doctors, nurses, paramedics, carers, porters and other front-line staff were effectively sent into battle without the armour they needed to defend themselves and those that were entrusted in their care. As a result the virus was able run rampant through hospitals and other health-care settings.
A staggering quarter of all confirmed cases in Ireland now relate to health workers, somewhere between 4,000 and 5,000 individuals. The number of non-Covid patients and others that were also infected as a direct result of the failure of the state to provide front-liners with appropriate PPE may never be known.
It is known, however, that a number of our health care workers have already died as a result of becoming infected with Covid-19. And more will almost certainly follow.
The lack of testing kits, reagent and laboratory capacity emerged as a third area of chronic shortage in mid March. In the Twenty-Six Counties the plan to ‘test, test, test’ degenerated into chaos as massive backlogs developed in the system.
Without real time testing data, it was impossible to know how much and where the virus was spreading. Thus blinded, the state was left with few choices but to order a full lockdown to slow the spread of the virus.
In the Six Counties, the situation was even worse as those tasked with managing the crisis refused to recognise the importance of testing and tracking as a critical tool to control the spread of the virus.
Throughout the second half of March and well into April vast amounts of time, energy, finances and emergency planning capacity continued to be consumed in addressing the shortages of critical care beds, PPE and testing capacity, as well as many other long-term deficiencies within the HSE and NHS.
Meanwhile, the virus was rapidly spreading through hundreds of private and public nursing homes and other forms of long-term care and residential settings across the Thirty-Two counties.
By the time anyone in authority realised the scale of the coming catastrophe, it was already too late. Hundreds of the most vulnerable people in our society were already infected and they were dying at a frightening rate.
In Portlaoise, eight out twenty-five residents of the Maryborough Centre succumbed to Covid-19. In West Belfast, four pensioners fell victim in Our Lady’s care home within days of each other. In St Mary’s Hospital in Dublin fifteen of our older citizens died after contracting the virus.
And all across the country clusters of Clovid-19 clusters appeared in hundreds of nursing homes and other residential settings. By April 20th, it was believed that at least 60% of all Covid-19 deaths in the Twenty-Six Counties had occurred in residential homes.
Many of these hundreds of deaths were totally avoidable. The experience of Italy and Spain highlighted the unique and extreme vulnerability of any residential setting where large numbers of older or other high-groups lived. But in Ireland these facilities were neglected - not overseen or forgotten - but neglected.
From the outset, nursing homes and other residential settings have been deemed to be of secondary importance to the acute hospitals which it was feared Covid-19 would overwhelm. They were considered a distraction from the more important tasking of fixing the many, serious deficits within the acute hospital system.
When Nursing Home Ireland banned visitors from 400 care homes on March 6th, they were publicly reprimanded for doing so by Tony Holohan, the Chief Medical Officer heading up the state response to Covid-19.
It is only now, after the horse has bolted, that they are being given the attention they deserve - only now that PPE, testing and healthcare staff are being made available to protect our most vulnerable citizens from a virus against which they have no immunity and little strength to fight it.
The catastrophe that is now unfolding in the care home sector was not inevitable. It is happening because of the failure of successive governments to adequately prepare for a pandemic that has been predicted for decades. And it is happening because our health services have been denied the political leadership, vision and funding by the very same parties that are now responsible for coordinating the fight against Covid-19.
In the Twenty-Six Counties Fine Gael have bee in government for nearly a decade, with Fianna Fail propping them up since 2016. In the Six Counties Sinn Féin and the DUP have effectively controlled Stormont for a similar length of time.
Collectively they must be held to account for their catastrophic mismanagement of the health system during their years in power.
Those cuts left our hospitals unable to absorb even a modest increase in demand, never mind the surge in need that would accompany a pandemic. Supplies of PPE were cut to the bone and completely dependent on ‘just-in-time’ supply lines that stretched the globe and were certain to collapse during a global pandemic.
The cuts left our healthcare workers demoralised and dejected - the same healthcare workers who are now being lavished with endless praise by the people who suppressed their wages and de-funded their workplaces.
No amount of clapping for carers by the establishment politicans can change the fact that they were responsible for running our health services into the ground and leaving it critically exposed to the effects of a pandemic that was long-predicted.
When the pandemic finally arrived, a decision was taken to launch an unparalleled effort to fill the many holes within the acute hospital system that had been caused by years of mismanagement and under-funding.
That decision left little emergency planning capacity or resources for many other areas, including the nursing homes and residential sector. The consequences of that decision are now being paid for with the lives of many older citizens.