How have NPHET failed on some obvious issues?

27 comments

1. Yeah I completely agree with these 3 points. The communications on masks, antigen tests, and schools were all shockingly poor and won’t be remembered well.

2. Opposed masks, opposed antigen tests, consistently told us our schools were safe, consistently told us our pubs were bad.

3. I think their problem is making guidelines that’s are wholly dictated by AI and Data science than factoring in as bit of common sense.

4. Masks – at the start of the pandemic, everyone was convinced it wasn’t airborne and it took some time for people to accept it was.

   Antigen tests – I suspect (but can’t confirm) that the concern was that people would believe a negative result meant they didn’t have COVID and would be less compliant with regard other public health measures. I don’t think that has really changed.

   Schools – I haven’t seen the data but I do believe the data they had available to them indicated schools weren’t a major risk for spread of the virus. Could the data collection / analysis be flawed? Absolutely. Schools being shut for the past 18 months would have been a worse outcome in my opinion.

   One thing I do think is worth commenting on is whether the gov. did everything it could of regarding COVID mitigations. Spending is obviously something that has to be factored in and I think the government should have just spent money in a couple of areas instead of dragging their feet (no action is often the worst thing you can do).

5. NPHET are experts trying to make the best informed advice they can. That’s their role. No reasonable person would claim they are above criticism, but equally no reasonable person would expect them to be infallible.

6. I remember, very early days, the opposition to the general public wearing masks was because people were going out and panic buying up masks and reducing the amount of masks available for the people who needed them.

   I remember it being “we don’t know if masks are effective yet, so cool your jets” rather than “masks are not effective so no one should wear them”.

7. The only thing about masks is that I think everyone had that view, all over Europe and US too. They just believed masks wouldn’t be needed, or were trying to prevent everyone buying up PPE until all health workers were covered.

   Totally agree on antigen tests and schools though. Antigen tests before meeting up just makes sense. If you don’t have symptoms but an antigen tests is positive you’re going to cancel your plans. No antigen test and you’re going to go about your day unaware.

8. Wish they would have just admitted from the get go that there would be an increase of cases when schools reopened but keeping them closed would cause even more detriment and harm to children.

9. The only thing that really pissed me off was calling antigen tests snake oil, that was bang out of order

10. [This](https://twitter.com/gavreilly/status/1405157995068207109) will live long in the memory. NPHET – antigen tests don’t work if you rub butter on them. They also don’t work if you pour Diet Coke over them.

11. I can understand with regards to masks as they wanted to keep as much for frontline health care workers but their opposition to anti gen tests is looking stupid now considering the difficulty in getting a pcr test and the rules around close contacts. Their dogged insistence on school transmission is akin to the Soviet politburo, I’d prefer if they were just honest with the public.

12. The mask issue is complex

    – evidence base prior to and in some studies, during the pandemic, was poor. This meant that there was a slight modification of what is called the Precautionary Principle (before supply chains opened up) : that is that an intervention with good mechanistic evidence but with a poor evidence base can be employed so long as the intervention is harmless. Thus initially early on, the concerns around supply chains for masks had to be allayed and then they were recommended.

    Re Antigen testing : the utility of them has changed : Pre 2021, their sensitivity and specificity was poor. The other issue is their accuracy during low community transmission. Also, there may have be concern around behavioural aspects of people in the absence of getting a PCR. I still think thought that NPHET should have been using them by the summer of 2021, if only to establish supply chains.

    Schools were a disaster and point to the biggest failure or reason for some odd NPHET decisions. They are and were basing their decisions off a poor contact tracing system. It’s allied to the inability of government to expand testing as well, and this hurt us this time last year and is hurting us now. The one recommendation that the WHO hammered home time and time again to governments across the world was to introduce immediately a good track and trace system.

13. Could you imagine the last week without antigens? I personally know loads of people who were asymptomatic but did an antigen before Christmas to be on the safe side and came back positive. The impact they’ve had in the last week alone is surely incredibly significant and it makes you wonder how much the “snake oil” could have helped all along.

    Not a popular thing to say in this sub but I’ve no time for Tony Holohan, he’s incredibly condescending. Don’t bother with masks / antigens sure people won’t know how to use them.. condescending finger pointing tweets etc.

    The tweets etc is another thing, their messaging has been absolutely horrific from start to finish and they’ve begun to get caught in their contradictions lately.

    Finally the thing that *really* annoys me about NPHET is that they aren’t actually as impartial as they’d like you to believe. There is no way on God’s green earth that you could be just “following the science” and continue to maintain that schools are not an issue. Just look at the incidence rates in those age groups. Not only that but NPHET / HSE have deliberately manipulated the contact tracing systems for students / teachers so that they can try and keep up the facade. It’s a farce and I hope an independent review when this is all over exposes the lot of them.

    Its one thing to get stuff wrong, it’s another thing to know you’re wrong but to lie to the public.

14. I agree with pretty much all of your examples, and I’m not anti nphet. I think they’re all examples of “perfect is the enemy of good”.

    I get their concerns over the misuse of antigen tests, however, a good media campaign around them pushed by the government alongside clear messaging on it (Not Phillip Nolan getting upset on twitter) would have made a lot more sense than what we got. It may not have got everybody doing it right but it would have hopefully got to most people.

15. I’m not sure if it’s NPHET or the government or something/someone else, but I’d love if NPHET recommendations regarding restrictions were not released/leaked to the press before they are discussed by the government.

16. One thing I’d like to know is why they’re not looking at more accessible testing locations (I’m guess cost and/or logistics but still unsure). When I was in Lisbon a few months ago, they had set up portakabins in certain spots in the city centre where you could just queue up, get a test done, find out within a day or so.

17. Schools also had weird arbitrary rules like different classes being picked up at different times from different gates while totally ignoring that students had siblings

18. In agreement with you on the last two but my understanding on masks was that there was a shortage at the beginning of the pandemic and they were trying to ease supply issues in care settings by downplaying their effectiveness to the public.

19. [deleted]

20. > They held the line for a long time that masks were useless

    They never said that. [They said “masks are of limited benefit away from specialised health settings and could even be counterproductive”](https://www.irishtimes.com/news/health/coronavirus-should-everybody-be-wearing-masks-to-combat-covid-19-1.4218062). Which was back when the only masks in Ireland were ones that very health-conscious people would have. We didn’t have a huge supply. They were not in every shop.

21. I don’t blame them a ton on masks in the very early days. That position was widely held by public health officials around the world, not just NPHET.

    But yeah they really made a cluster of schools and antigen testing. At least on antigens they’ve come around, but on schools they’re still out here acting like schools are safe.

22. I think they’ve had a very difficult task, far beyond what many of the armchair experts think, so in that regard I likewise won’t expect infallibility.

    On your points mentioned:

    1) I think they were slow and too reliant on certain strands of data suggesting they weren’t beneficial. They did reverse this obviously as what they felt was the correct policy emerged.

    2) For antigen tests, the truth is their main fear was people using them and ignoring their symptoms/using the negative as an excuse to go about their business. This will vary from what sphere you’re in, but I’m in the medical world and would say, resoundingly, they were correct. I have seen hundreds of reports from colleagues of people showing up to A&E/GP practice with COVID symptoms who had been symptomatic for days and socialising/mingling because their antigen was negative and they “just need an antibiotic”. Their fear was correct. At the same time, I do think they could’ve been faster to adopt it and use them in certain controlled scenarios at the very least. I also don’t agree with their comments about them, but in the context of when they were made, there were many reported instances of COVID positive cases who were negative on antigen out and about. With the addition of media sources like Pat Kenny droning on endlessly about them as some sort of panacea while publicly declaring the Cochrane Library as peddling propaganda against antigen tests (Cochrane being one of the most reputable institutions in scientific review literature who had published a review of data available that showed the same issues with antigen testing) I somewhat understand tempers being lost.

    3) Schools are the biggest issue for me. Even if the data does show low spread in the initial forms of COVID, and maybe it does, there are so many skewing factors I wouldn’t have ever felt it truly reliable. What’s more, I think we’ve been far too slow in ventilating schools properly with HEPA filtration systems that I think we can say would make a significant difference. I think that’s been the biggest dropped ball in the response.

23. Agreed. The other major failures I can see are the slowness of approving vaccines (what do we know that the EU & US regulators don’t?), and the lack of enforcement of Covid requirements in pubs.

    We’ve done well as a community, and our government (and in fairness most politicians) and our public health bodies have done well, but that doesn’t mean we shouldn’t challenge them to do better.

    And also everyone involved, please stop treating us as morons. Give us the facts, tell us what to do.

24. Can’t believe you discussed schools and never mentioned how they signed off on ending routine contact tracing for u13s despite the disastrous and predictable outcome.

    They also ignored the recommendations of their own working group on ventilation last March, which costed HEPA filters for every classroom on the country at only €12m.

25. Quicker to say what did they get right.
    Locking down the whole country is an easy solution they went to (righthly so at first)

26. Your first mistake was assuming they are all competent and qualified.

27. As a non-irish European living in Ireland, I can say the travel restrictions were very harsh. I think that the restrictions this year were the more strict among the whole European Union. Banning all travel and forcing people from France to go through a mandatory hotel quarantine for example was something crazy coming from a fellow EU member that no other EU country did.

    I just felt like Ireland had really decided to go their own way or even follow the UK more than the EU. I know that I am not a citizen of the country and I understand totally that they make their own decision but it just felt like isolating themselves even more from the rest of the EU.