Level 5 Response to Covid-19: Statements

I call on the Minister for Health to make his opening statement. We are certainly keeping him busy today. I ask Deputies to do those of us who will be here all night the service of keeping quiet while the Minister addresses the House.

I thank the House for this opportunity to consider the measures that have been introduced in response to the recent rise in cases of Covid-19. As Deputies will be aware, earlier this week the country moved to level 5 of the Government's medium-term strategy for dealing with the virus, Resilience and Recovery 2020-2021: Plan for Living with COVID-19. I do not propose to rehearse all of the measures that are encompassed by that move. Colleagues are aware at this stage, following the address by the Taoiseach on Monday, of the primary measures that have been taken. Among the most significant is the decision to close non-essential retail outlets, to restrict restaurants to takeaway service only, and most difficult of all, the requirement for people to stay at home as much as possible, and to exercise within 5 km of their homes. I emphasise that the Government and I understand that people are extremely frustrated at the restrictions which we have all been living with since March of this year. I understand the difficulties and the anger that have been generated by the ways in which life has been altered. However, it remains the case that we are in the midst of a once-in-a-century pandemic.

As The Irish Times reports today, Europe's reported coronavirus cases more than doubled in ten days, surpassing 200,000 daily infections for the first time. Various European countries have reported their highest ever number of daily cases. Hospitals across Europe remain under strain. Covid-19 hospital admissions and occupancy rates are rising. Belgium has had to postpone non-essential hospital procedures. There have been reports that stretched Dutch hospitals are going to have to transfer patients to Germany. The Czech Government has had to seek help from the United States National Guard. Our European neighbours are also using various measures, including curfews and the closure of bars, restaurants and non-essential retail outlets to limit the spread of this virus. Germany is now grappling with more than 10,000 coronavirus infections daily, the most it has experienced since the outbreak started, while admissions to hospital intensive care units have doubled over the past two weeks.

It is important to remember that while there have undoubtedly been some positive developments with regard to improved outcomes for Covid-19 patients in critical care, and some drugs have been shown to be somewhat effective in certain circumstances, we essentially remain without any therapeutic intervention that we can rely on as a cure. I am hopeful that in the near term, that situation will improve, but that is the case today. The World Health Organization recently reported from its international Solidarity trial, which Ireland is also participating in, and concluded that a number of drugs for which many people had high hopes, such as remdesivir, hydroxychloroquine and interferon, had little or no effect on the course of the disease when examined through a gold-standard, randomised trial. That trial involved more than 12,000 patients in 500 hospital sites in more than 30 countries.

As the House is aware, there is also a major global effort to develop a vaccine for the virus. Ireland is part of the process that will be procuring supplies for the EU and has signed on to the first contracts that have been put in place. That leaves us with what are termed non-pharmaceutical interventions and the terms which we have all become very used to over the past eight months, including social distancing, cough and sneeze etiquette, wearing a mask and avoiding crowded situations. Most people have embraced these new behaviours. We all slip up from time to time. We can all forget and stand too close to someone in a shop or not wash our hands when we had planned to, but I think it is reasonable to conclude that most have demonstrated remarkable fortitude in the face of what has been an extremely difficult year. However, we also know that it has been sometimes necessary to bring forward legal instruments to ensure that public health was provided for by means of particular measures. We are not alone on this. Many countries have done the same.

I would also like to update the House on the situation with regard to testing and tracing. As Deputies will be aware, the HSE has worked intensively over recent months to put in place a comprehensive testing and tracing operation. Capacity is in place to test up to 20,000 people a day. With this level of testing, more than 111,000 were swabbed last week, and we are finding more cases than we would have previously. In recent weeks, while we have increased resources significantly as demand has increased, the numbers of positive cases and close contacts have risen even more sharply. The impact of the sharp rise in cases and volume of contacts meant that demand on the tracing system last weekend temporarily exceeded its capacity. The HSE put in place one-off temporary measures to address this situation. This understandably caused anxiety. However, as our Chief Medical Officer, Dr. Tony Holohan, said clearly, we need to recognise that in a mitigation period in a pandemic, which is what we are currently facing, when a surge on the scale of what we are currently seeing is apparent, it is clear that we cannot contact trace our way out of where we are. We need the social restrictions that are now in place and we need everyone to help us make them work. The number of cases now being detected on a daily basis has exceeded the ability of the contact tracing system. Indeed, the events of this weekend underscore the need to move to level 5 restrictions.

It is important to state clearly that we as a country continue to face a major threat from Covid-19. Its lethal potential has not been altered. We know that most people who get the virus will have mild symptoms that resolve themselves but we also know that we can expect to see a proportion of people infected with the virus require hospitalisation, a smaller percentage requiring admission to critical care, and, tragically, some people have died and more, unfortunately, will die. As of yesterday, we have seen 1,871 of our fellow citizens die from this disease. Many others have suffered extremely debilitating bouts of illness, requiring hospitalisation and, for some, assistance with breathing via a ventilator. I express my deepest sympathies to the families and loved ones of all those who have died. I also once more wish to extend my heartfelt thanks to all of the healthcare staff who have worked far above and beyond the call of duty over the past eight months in responding to this crisis.

If a situation occurs, as it has now in Ireland, where the virus is spreading rapidly among the population, the ramifications of that begin to pose an enormous threat to the health of our entire country. It is vital in such circumstances that we work to prevent the spread of the virus from moving so rapidly that it overwhelms the capacity of the health service to treat those requiring care. There is no health service in the world that has an infinite capacity to meet the level of demand that uncontrolled spread of Covid-19 would impose. We witnessed the scenes earlier this year in a number of very advanced healthcare systems - in Italy, Spain and New York, to name but a few - where the hospital network came under the most severe pressure. As I said earlier, real pressure points are beginning to emerge across Europe. This is the situation that we are working hard to avoid in Ireland.

As the House is aware, critical care plays an essential role in the provision of care to patients who are seriously ill as a result of Covid-19. Ireland has an acknowledged historical deficit in critical care capacity and we are working to address this. Deputies may wish to note that baseline permanent adult critical care capacity in Ireland at the start of 2020 was 255 beds.

Funding for a further 40 adult critical care beds and two paediatric critical care beds was provided as part of the response to Covid-19 in March. Investment announced in the recent budget will bring the overall number of permanent beds by the end of next year to 321, an increase of 25% on the numbers last January. The acute system also has the capability to respond with surge capacity if required, although not without consequences in terms of staff redeployment, curtailing other services and greater clinical risk as the number of surge beds rises. This is precisely the scenario we are working to avoid. The acute hospital system and critical care service coped with the initial surge in admissions largely due to the success of public health measures in flattening the curve and the subsequent fall-off in Covid cases and non-Covid care.

While we are continuing to work to address the deficits, it must be recognised that the development of critical care capacity is not straightforward and involves much more than simply sourcing a bed and putting it in a hospital. It is a system of care that requires trained available nurses and doctors as well as appropriate equipment. As of 21 October 2020, 247 critical care beds were occupied. There were 35 confirmed Covid patients in critical care, as well as a further 15 suspected cases.

I recognise the genuine concerns that have been expressed by Deputies about other aspects of healthcare delivery. To be clear, we are not prioritising care for people with Covid over people with, for example, cancer. We are making every effort to ensure that we retain capacity within the health service to treat all patients. My concern, and the concern of NPHET, is that we would lose the ability to respond to non-Covid ailments, such as cancer, to stroke patients and to people injured in accidents as a result of the strain that would be placed on hospitals in the worst-case scenario. There is no option available to us where we can ignore the growth in the disease and expect hospital functions to continue as normal and to be available to all who will need them in the coming weeks. This is a public health matter, first and foremost. It has economic, legal and societal ramifications that have to be mediated through the political system. However, the virus can only be suppressed if we all buy into the public health measures in place here and across the world. Social distancing and other measures, such as good hand and respiratory hygiene, remain our primary defence.

I wish to conclude by giving a message to people throughout the country for the coming six weeks. It is about non-Covid care. During the initial efforts to flatten the curve, many health services were closed, as were schools, colleges, childcare and most of the economy. What happened was a serious reduction in the number of people presenting to their GPs and, for example, being referred to the rapid access clinics for cancer. The number of people presenting with strokes and other conditions fell to a level that deeply worried those working in emergency medicine and across the healthcare system. For understandable reasons, there is still a lower level of referral and presentation by people across the country. People are scared and anxious. They want to know that their healthcare system is safe.

For example, one of the programmes we all support, and I have discussed it at great length in the Oireachtas, is the national screening services. I was informed in the last few days that 90% of women invited for smear tests or the new test are not turning up. I do not blame anybody. People have many reasons, and it has been a very difficult year for many. However, it is essential that people continue to engage in the healthcare system. We could find ourselves in a situation, through the measures we are taking, whereby we save many lives that otherwise would have been lost to Covid-19, but, on the other side, we could end up losing many more lives and healthy years for people to live as a result of them not engaging and presenting as early as they normally would.

We have moved to level 5, but it is not like the first time. It is identical to the first time in one critical way, which is in the core message from the public health doctors, the Government and the vast majority of Members of the House that people should stay at home for the next almost six weeks. There are exceptions to that, but the core message is to stay at home, where possible, so we can drive this virus back down again and reopen in early December. How it is different is that more aspects of our lives are open, such as childcare facilities, primary and secondary schools, colleges, adult disability services and, critically, the healthcare system. The healthcare system, GPs, primary care facilities, diagnostic services, emergency departments, outpatient clinics and operating theatres are all open. The doctors, nurses and allied health professionals are all going to work. I hope we all can tell the people we represent that healthcare is open. Indeed, one of the reasons we moved early to act pre-emptively against this rise in Covid-19 is to ensure we do not find ourselves in the position we were in last time, or in the position some other European countries find themselves in now whereby they are having to close down large parts of their healthcare systems to cope with Covid. That is not where we are, and it is why we are moving early and decisively.

The message is to stay at home or within 5 km of one's house. We must look out for, and take care of, each other. Essential visits are fine, just as they were last time. For visits to relatives or friends who may be vulnerable or in trouble, we introduced something I pushed hard for, the concept of the social bubble for single adult households. Nonetheless, this will be a hard six weeks. We are heading into the winter, whereas we were heading into summer on the last occasion. That made a big difference. The message is that people should stay at home if they can or within 5 km of their house. There is a set of exemptions to that which are available on gov.ie. I reiterate, as Minister for Health, that the healthcare system and non-Covid healthcare are open. The best way we can protect and keep each other safe is to ensure that everybody continues to engage with the healthcare system. That is how we will save as many lives and as many healthy years for people as possible.

I must inform Deputies that I must leave. I had hoped to stay here so I ask Deputies not to take offence. I am meeting the 221+ group and because the business ran on, I must leave now. I apologise to Deputies for leaving.

I am sharing time with Teachtaí Ó Laoghaire and O'Reilly. I accept the reason the Minister must leave. It has been a long day and we have been discussing a number of different issues. I hope the Minister listens carefully to what the members of the group he is meeting have to say. That is an important issue, and they are quite sore about the fact that the tribunal has been created and put in place, in their view without proper consultation with them. It is appropriate that the Minister meets the group and also listens carefully and acts on what the members say.

There have been a number of opportunities over the last few days to discuss the Government's strategy for how to live with the virus. We have done that in the context of different legislative measures that have been brought forward and motions relating to extending emergency powers to the Minister for Health, the sunset clauses that give him those powers for certain periods and, for most of today, the fines that will be associated with the regulations the Minister will introduce.

We have had plenty of opportunity to discuss many issues but the big question people are asking is what the strategy is to get us out of this crisis. We are now in a six-week lockdown, which could possibly go on longer. What happens when we come out of lockdown? Do we open up for a few weeks and then is it the case that in January or February we go back into level 4 or level 5 restrictions? Are we on a wheel of constant lockdowns which are then lifted and the period between the lockdowns and their lifting shortens as opposed to lengthens? That concerns people. They want to know what the plan is and what we can do to get out of this cycle.

I speak as a member of the Opposition. There is a personal responsibility on each and every one of us. When I make asks of the Government and when I criticise it for what I see as lapses in its duty of care or failures in policy, I also accept that each and every one us has a responsibility to play our part in reducing the spread of the virus. Each and every one of us has to look to ourselves and check and recheck that we are doing all of the basic things that are required of us. That includes handwashing, the cough etiquette and wearing a mask. I encourage people as best I can to do all of that and to abide by those guidelines. Equally, when we are asked to keep socially distant, to limit our interactions with people and keep our social contacts to a minimum, I also accept that has to be done and we have to abide by all of the advice. I am under no illusions whatever that a big part of this State's and this island's ability to wrestle back control of the virus rests on us as individuals, but it also rests on the Government and Government agencies have a part to play.

In recent weeks, a number of parties in this House, including my party, voiced criticism of the Government. Sometimes when the Government is criticised, its reaction is that it is always Sinn Féin. It blames Sinn Féin and talks about my party as if we are the only ones who are pointing out the Government's problems. We have an obligation to hold the Government to account, but we are not alone in pointing out the failure in the testing and tracing system. We do not do it just because we want to attack the Government, nor do we do it because we are trying to undermine the work people in the various areas are doing. We point out failures that are fairly evident, that are factual and that are coming to us from people who work within the system. In recent months, we got calls from very senior people in the system, but also from testers and tracers who told us that there were not enough staff and that there was not sufficient capacity in the system. Teachta O'Reilly informed us again today of more problems with a lack of staff in one of the testing facilities over the weekend. These are very serious issues, yet time and again, not only have our calls to the Government to act and to put the capacity in place fallen on deaf ears, but we have got pushback and been told that we are playing politics and not being honest about the extent of the problems. We are. The problems were real and the Government failed to use the summer months to invest in testing and tracing. That was a mistake and it has cost us.

We also said that we have to watch what is happening in nursing homes. We cannot prevent the virus going into every single institutional setting and of course when the virus spreads there is the possibility that it can go into nursing homes. It is a concern when in one nursing home, for example, almost all of the residents and staff have contracted the virus. There have been many more outbreaks in recent weeks because the older people who live in nursing homes are vulnerable and are most susceptible to contracting the virus. We must do everything we possibly can to ensure these people are kept safe. There were reports from one nursing home that the support that was sought did not come in time. Again, that information is not coming from the Opposition but from the people who work in the home. This is another failure on top of the failures we had in nursing homes in the past. This is another area that we have to get right.

I am not one who says that we can get to zero Covid. Others in the House have different views on that. However, from the get-go, everybody with an ounce of sense knew that if we want to get as close as possible to zero Covid, we should aim to reduce it to the lowest rate we possibly can. That is a laudable objective. To do that, one has to get it right at the airports yet, as we speak today, we still have no testing at airports. That is despite all of the promises, commitments and talk. Again, that is not the Opposition's fault but the Government's fault.

Before he left, the Minister for Health spoke about hospital capacity, specifically ICU capacity, although he did not mention inpatient beds and acute beds, which are also important. Many of the beds that were promised were not delivered or were doubly counted, as sometimes happens during the spin that goes with budgets. The Minister is correct when he says we cannot magic up ICU beds and that they require specialist staff to make sure they are operational. That is all the more reason he should have heeded the call from Sinn Féin and others in opposition and, more importantly, from those on the front line in hospitals – consultants and managers – who said as far back as May, June and July that we should plan to put in the capacity then because it takes time. However, that did not happen. That is the wasted summer and wasted opportunity that we talk about. Had the Government heeded the advice, those ICU beds would have been in place when the second surge came, which is right now, and we would be in a much better position. It is not that we want people to be in ICU because obviously the plan is to bring the numbers down. The issue was to have capacity so that if and when a second wave came, our hospitals would be able to withstand it as best they could, but that capacity was not put in place. Again, that was not the fault of the Opposition.

When the Minister referred to ICU beds, he left out acute beds. Every time he talks about additional beds, it is in the context of opening up beds in existing hospital wards in existing hospital infrastructure. The Minister of State, Deputy Butler, comes from the same constituency as me. I spoke to the hospital manager in University Hospital Waterford last week about the 1,146 additional hospital beds that were promised by the Government. I asked how many we could get in the hospital in Waterford. She said none, because she does not have the physical space to open any more beds. What we need are rapid-build modular units or more physical infrastructure. Many hospitals in this State have old wards, what used to be called Nightingale wards, that are not fit for purpose and where the space is not available. We talk about opening up beds and we provide funding to do that in current spending, but no money is provided for capital expenditure to expand physical infrastructure or even rapid modular builds. We are not really being entirely honest about what is possible and what can be delivered.

I use Waterford as an example because it is the regional hospital for the south east. I also know from speaking to the hospital manager there that pressures in the hospitals in Tipperary, Kilkenny and Wexford, due to a lack of ICU and acute bed capacity, resulted in patients being referred in record numbers into University Hospital Waterford, which put pressure on it. That is all the more reason the regional hospitals and the specialist hospitals have to get additional capacity but that did not happen.

The overall response to the crisis is that it is like baking a cake. There are lots of different ingredients, such as those I spoke about, for example, testing and tracing, doing more at airports, making sure we put capacity into hospitals and people taking personal responsibility, but the lack of an all-island approach is the one big missing piece of the jigsaw that we are not getting right. As I said to the Minister, we have a memorandum of understanding between the North and South. The Minister quite rightly put it back on my party when he said we are in the Executive in the North and we need to do more. We have done everything possible within the Executive to argue with others for more all-island responses, but the memorandum of understanding that was signed was between the Minister for Health, Deputy Donnelly, and the Minister of Health in the North, Mr. Swann. They need to make sure that what was signed up is delivered upon, strengthened and advanced because that has not happened. We did not even deliver what was signed up to and agreed, never mind trying to strengthen it. We have very little co-operation on testing and tracing and travel. How in God's name are we going to have a response on an all-island basis that allows us to wrestle back control of the virus and get ahead of it if we do not operate on an all-island basis? That is my point. All of these things are important. They are all of the ingredients.

I hope that when the Minister looks back at the Official Report of this debate he will note the wonderful presentations made and he will act on some of the advice given.

The atmosphere has changed in recent weeks and months and there is a rising concern about the incidence of the pandemic. It was clear there was a need for dedicated action, which is to be welcomed.

We also welcome the fact that the Government eventually listened to the point made by Sinn Féin and others for weeks about the pandemic unemployment payment and wage subsidy scheme. We would like the Government to have gone further. It was incredible these payments were cut in the first place and not restored in the budget. It was clear these supports are necessary to ensure people are not put into penury or put to the pin of their collar because their work is gone. That was and still is a reality facing people. I urge the Government to address that.

After announcements were made around restrictions, attention shifted to the sphere of education and schools. It is a pity the Minister for Education and Skills is not here. She may well have a good reason not to be here. One of the requests for a debate, made by Sinn Féin and the Social Democrats, was specifically on the implications of level 5 for education. The picture is unclear. Level 5 is subject to public health advice and significant clarity is needed.

Sinn Féin supports the objective of schools being open in a safe and sustainable way. We saw the damage done, despite everyone's best efforts, and the learning lost in the early part of this year. We see the benefits of children being in school. I see it with my own family. It is vitally important schools remain open. However, it must happen in a safe and sustainable way.

While it is an objective we support, regrettably, there is a rising concern about how schools are able to function in this context which needs to be urgently addressed. We raise those concerns not to create some calls for extended closures of the kind we do not want to see. We want to see these concerns addressed. We have raised them for weeks but many of them have not been addressed. It is the same for staff, unions and parents.

Schools have had enough significant issues and chaos to deal with over the past year without the fiasco of an email at 11.40 last night informing them that one of the 11 sanitiser products recommended is defective and that they should close their school if they cannot source an alternative. Principals and school leaders had to decide late last night or early this morning whether to open their schools. That simply is not good enough. I do not know how this happened or how the Department of Education and Skills only found out and informed people at that stage. I have heard many stories of parents and thousands of kids turning up to school this morning to discover the school gates were shut and schools closed for the day. Many principals only learned of the issues this morning. There are significant questions for the Department.

We now know that the recall notice stated the products were due to be recalled by Tuesday. Why did this break so late? In a recent email, the Minister's private secretary informed a member of the public that all sanitiser providers were asked to provide product samples which were then assessed and evaluated by a team with the necessary technical competencies. The product in question can apparently cause dermatitis, eye irritation, upper respiratory system irritation and headaches, as well as aggravating asthma. I have been contacted by many parents concerned by this. The product was supposed to be sampled and tested. The Department said each of the sanitisers was sampled and tested. How was this missed? What kind of tests were happening that they did not pick up how damaging this hand sanitiser is? It was being used in schools for children when it was not suitable.

Deputy Lahart earlier said people were making too much of this issue. It is not much to expect that when the Department recommends a product to schools it is safe to be used by children. How did it only come to light now? Did the Department of Agriculture, Food and the Marine not tell the Department of Education and Skills? Has the Department of Education and Skills been sitting on this information for a few days? We need to know who is responsible.

Unfortunately, this is just one of a number of debacles in the Department of Education and Skills in recent months. Six weeks ago, we sent the Minister a copy of our policy document, Keeping Schools Open, in which we set out the issues which had to be addressed in order to ensure that schools could remain open safely and sustainably in the long run. I regret many of these issues still remain. One issue we identified was testing and tracing. I am concerned about some of the reports I am receiving. There is a concern, particularly among school staff and parents, that a different approach is being taken in this area. Certainly the timelines are not adequate. The approach being taken or the criteria being adopted when it comes to tracing in schools is not of the same standard as it is generally. When the app tells teachers they have been with a close contact, it does not count and the teacher in question must go to the school principal. In recent days, because the tracing system collapsed, they got a text message instead. That has manifested in a number of other examples as well. School staff have spoken to me about it and they are concerned. It is not good enough. I want to see confidence restored in the system. We will do that with an adequate system of tracing and testing. The Minister talked about a dedicated system of tracing and dedicated school teams. She mentioned this briefly on the 1 o'clock news but we have heard nothing else about it. What will these teams do? What will their work involve? To what criteria will they be working?

If we are to have school specific teams, we need to have people involved who understand the dynamic involving schools because it is not as static as it was before, even with the pods and all the rest. I want to see schools continue to stay open but we need to do an awful lot more to ensure they do. One measure we must take is to ensure confidence in the system. Getting tracing right and ensuring school staff and parents see that it is done properly, have confidence in it and know that they will be tested when they should is essential.

We have done nothing in terms of space. It just is not good enough. Our school system was difficult to get back open because our system is underfunded, understaffed and overcrowded. Nothing has been done to create additional space to ensure an ability to achieve social distancing. That urgently needs to be addressed by the Minister if she wants to ensure full confidence in the school system and it stays open in a way that is safe and sustainable.

The Minister for Health earlier, when he was here, referred to other jurisdictions cancelling elective surgeries and other health services. That is new for them and something to which they are not used. It is not new in this jurisdiction, however, because elective surgery is cancelled all the time.

Last year, University Hospital Limerick was in full capacity protocol for over 90% of the year. When full capacity protocol is brought in, it means that elective surgeries are cancelled, people are placed on trolleys in corridors, emergency departments and in extra wards and there is aggressive discharge of patients. This might be new for other jurisdictions but it is not new for us. In fact, that is how the Government runs the health service. It is short-staffed, overcrowded and so forth. As pointed out by NPHET, we all know the reasons it was necessary to go to level 5.

It is because we do not have capacity within our health service. The NVRL will be closed this weekend due to unavoidable staff shortages. We have known for years that our hospitals are routinely overcrowded and the infection risk that poses. We have known that since the last time Fianna Fáil was in government. We represented nurses at the time. The Minister and his party knows that. It is still widely known but they do nothing about it. Other countries are probably experiencing this for the first time. In Ireland it is not news.

The level 5 plans contain a great deal of emphasis on fining individuals for individual actions. I see that the Tánaiste has released one of his wee videos encouraging people to work from home. Where are the sanctions for employers who do not let their staff work from home where they can? One example can be found in an office not far from where we are now. When the country went into lockdown in March, five laptops were ordered for the five senior managers, who then worked from home. Other staff were advised to get on public transport and come into the office to work. The Minister is very big on individual fines, individual responsibility and individual shaming, but there are no sanctions for that employer. It is all very well to encourage people to work from home. What are the sanctions for employers who do not allow it?

I welcome this opportunity to make a statement on Covid-19. The health of our nation is paramount. We have taken these measures out of necessity to protect the health of our citizens. We are facing into the bank holiday weekend. A couple of weeks ago, I suggested continuing with summer time this winter due to the scenario we find ourselves in. Unfortunately winter time will begin this weekend. That will have an impact. The Minister of State with responsibility for mental health and older people, Deputy Mary Butler, is doing a very good job in that area. However, the evenings will soon get dark at 4.30 p.m. That will bring its own significant challenges. It would have been common sense to continue with summer time and enjoy a significant stretch of light in the evenings that much sooner in February and March. That would have been of great benefit to mental health.

I would like to make a couple of points about the restrictions and what needs to be done to make them fair. First, I would like to discuss large retail outlets. During the previous lockdown, large retail outlets were open to sell essential goods. They operated their stores as normal, selling clothing, toys and other goods. We are now entering the festive season, when toys are big sellers. It is essential that retail outlets on the high streets of towns and cities throughout the country have a level playing field. The regulations signed yesterday clearly state that large retail outlets can only be open for essential items. That must be enforced. I do not say this to be a spoilsport, but to ensure fairness. If a shop on the high street that specialises in sports goods or toys cannot trade, it is only fair that large retail outlets are treated the same way. The regulations are in place. It is essential that they be enforced to ensure fair play. When we hopefully emerge from these restrictions on 1 December, the lift in retail spending will benefit all retailers alike. There will be pent-up demand and every retailer will benefit accordingly.

The second point I want to make is about a sporting issue, namely, coursing. It is a rural pastime that is hugely important in my part of the country. The season is a very narrow window of only three and a half months. Those who partake have now been told that coursing will be prohibited for six weeks of that season by Covid-19 restrictions. I received numerous calls yesterday from people involved in the industry. It is a leisure industry and does not involve significant money. People do it for the love of the sport. They cannot comprehend the fact that other sports, particularly greyhound racing, have been allowed to continue. It is hard to understand why one activity involving greyhounds is allowed to continue while another, which takes place in the open air, is prohibited. Like other Deputies, I lobbied intensively for a bit of common sense to prevail yesterday. The regulations should be interpreted to allow various greyhound activities. Unfortunately, that interpretation has not been adopted and coursing is to be halted for the next six weeks. Last year, people had serious difficulties obtaining their licences for this sport. Yesterday I was asked if practitioners should continue to breed dogs at all if obstacles will always be put in their way. They feel they are being unfairly discriminated against. They feel that their open air sport could have been treated similarly to horse racing and greyhound racing. This restriction is going down very badly in rural Ireland. Coursing is a minority sport, but it is hugely important for those involved in it.

I have also received a large volume of calls about gyms. Many people have signed petitions saying that gyms should be open. These are not used by elite athletes by any means. They are people who use the gym before going to work in the morning, or retired people who use it to maintain their physical well-being. It has a huge effect on mental health. Yesterday I received calls from two employers with significant numbers of young employees. The vast majority of these workers go to the gym before coming to work two or three mornings each week. One employer said his productivity would suffer. People need this physical exercise, especially people of a certain age. They will leave work in the dark. They need the outlet that gyms offer. Gyms were operating well under level 3 restrictions. There have been no reports of Covid-19 clusters coming from them. I appeal to the Government to consider what we have introduced and consider what can be safely amended. Some of the restrictions should be altered to ensure that people out there will be able to feel good. They are worried about the effect of the restrictions on their mental and physical well-being. Some common sense would help to get public buy-in for the level 5 restrictions.

Not everybody will agree with the Government's decision on Monday to move the country to level 5 restrictions. However, not everybody was privy to the reasoning, methodology and science the CMO and NPHET used to support their call for a six-week period of level 5 restrictions. Both the Government and society are better conditioned and prepared to meet the severe demands of level 5 than they were two weeks ago.

There are differences between the current lockdown and the complete lockdown in March. For example, it is a welcome change to have schools open. Significant progress has been made with regard to children attending school. Those attending college can take classes online. Remote working is growing and becoming a welcome trend and reality.

It is unfortunate that stricter enforcement measures are necessary to implement the various aspects of the restrictions. It may be that if enforcement powers similar to those proposed in the Bill had been in place for levels 2 and 3, there would have been greater success in curtailing the spread of the virus. In a functioning democracy, one must have respect and regard for the authority vested in the Cabinet, the Government and the Dáil.

The financial provisions introduced in March, July and the budget and the provisions brought in last Monday can, should and, it is to be hoped, will be the sort of financial measures that assist workers, retailers, businesses and industry. The €20 billion investment by the State gives the economy an opportunity to survive. It would have been regarded as unprecedented and even unimaginable by many people some months ago, but it has been a lifeline for our combined future and has the prospect of continuing to be such a lifeline.

The sense of solidarity earlier in the year and through the summer was commendable. It made us all very proud and engendered a great sense of patriotism. It has been a significant challenge to have gradually opened the economy but then have to re-enter a period of severe restriction. The challenge is great, but its success is dependent on the buy-in of all in society. Success is dependent on the right supports being provided for the economy, healthcare, education and other public services, but it is predominantly dependent on the buy-in of the public. It is also dependent on the buy-in of public representatives.

The provision of definitions of essential retail and services by the Government on gov.ie is a genuine attempt to be appropriate and reasonable while seeking to stem the rise of cases and to reduce the R-number. People need to study and appreciate those details and apply common sense to the provisions. The 5 km restriction, for example, is not a hard and fast rule. There are acceptable deviations from it. If people genuinely acknowledge, apply and live by the restrictions, we will have a chance of achieving the goals set out by the Government last week.

I expect that the promised review in four weeks' time will assess the progress that has been made. If sufficient progress has been made, then surely the Government can look afresh at variations to the protocols that have governed many of the issues about which Members have spoken this week, such as in respect of gyms, marts, golf clubs, sports other than elite sports, retail outlets other than essential retail outlets, hair dressers, spa therapies, showjumping, coursing, tennis, music schools and other matters. However, if people flout and show disregard for the guidelines and the spirit of the guidelines, we will be in trouble.

From speaking to other Deputies this week, I have garnered that there is genuine worry and trepidation. To be brutally honest, compliance with levels 2 and 3 had waned. Apathy and fatigue set in, which unfortunately created an opening that has been exploited by the virus. I am worried by conversations I have had with constituents in recent days. A draper in Tullamore rang me yesterday evening to highlight that larger stores were open because they stated they were selling workwear, for example. Today, a shop in Portlaoise was displaying two rows of fluorescent jackets, but all the products behind those jackets were also available for purchase by the general public. One must state clearly what is outlined in the legislation. It states that only essential goods should be on display and not those goods that should not be made available. Supermarkets have massively reduced the price of drink offerings, which indirectly encourages gatherings and parties. I spoke to the chief executive of Shaws department stores today. Its tagline through the years has been "Shaws - almost nationwide". It will be almost decimated if other parties flout the spirit of the law. The company has 1,000 employees and invested €100,000 in being Covid-ready. It has respected the trust of its employees and committed to the restrictions in order to make progress. The actions of certain other retailers are not in line with the spirit of restrictions. Such action is unfair and it is breaking the law. It will not get the R-rate down or bring the numbers in the right direction.

Whether people agree with the decisions made is irrelevant. The Government, in conjunction with public health experts and advice, has made its decision, as is its duty. That decision will not be reversed. Let us try to ensure it works. If it does not, the review in four weeks' time will do nothing more than add another six weeks of pain and restriction, which would have a severe and detrimental impact on business and, of course, condemn Christmas to becoming another casualty of this terrible Covid pandemic.

On 10 September, the Minister of State at the Department of Health, Deputy Feighan, announced in the House that he had approved emergency funding to offset the cost of delivering drug and alcohol services in a Covid-19 environment. Six weeks on, there have been two upward movements in levels and four Government scandals, but the funding is still not available. The only response I have received to multiple parliamentary questions I have tabled on the funding shortage is that it will be announced shortly. I have spoken to the Minister personally on this matter and I raised it in the House. The funding for these groups that badly need it was announced six weeks ago, but there is still no sign of it. How much longer must these groups wait? Will they get their money before Christmas or afterwards? Many of them have limited funding. They are expected to make their services Covid-19 compliant and to get PPE in order to be able to continue to provide services. The Minister of State announced that support would be made available, but where is it? I ask the Minister to announce today, or next week at the latest, where the support is and when people will get it. These groups badly need it.

Last Monday, I contacted the Minister to seek clarification on whether addiction groups and services and recovery groups could meet under level 5. The groups had serious issues during the first lockdown, which they got over. We have since gone through levels 2 and 3 and are now in level 5. The groups deal with people in recovery who need to meet in person. These are essential services. They are health meetings that people need. Does the Minister realise the suffering those in addiction services or recovery services are going through? Some people have asked me if the Minister is out of his depth or whether the issue is a lack of caring. I care. That is why I am standing here and again raising the issue of those in addiction services and recovery. I will continue to do my best to highlight these issues. I wish to work with the Minister on them because these people need support and clarity.

Earlier today, I raised with the Minister for Health my serious concerns regarding tracking and tracing. In early September, I attended a meeting with HSE officials for Cork and Kerry, at which I referred to their announcement to hire 60 staff for tracking and tracing. I stated that I did not believe 60 staff would be enough. Some 96 staff were originally redeployed to tracking and tracing for the area. I could not understand how 60 new staff can replace 96 staff who must go back to their original jobs by 2 November. Only 30 new staff have been taken on so far. At the meeting, I outlined my concern that if a second wave was coming, more staff would be needed for tracking and tracing.

I do not know if the work was done to plan for the second wave. What were we doing over the summer to ensure that we had all the proper procedures, guidelines and supports in place when this second wave came? Based on what happened at the weekend and based on what I went through with my own family, I do not believe it was done. Many people suffered during the first lockdown and we had a chance to build capacity and bolster our health service. Only two additional ICU beds were added in Cork since May. We are talking about being prepared for the virus and the second wave. How can the Minister stand over two additional ICU beds for Cork?

There are serious concerns about Mount Cara residential nursing home in Cork city, a facility with a bed capacity of 25. Serious issues led to it closing in January. There is an attempt to privatise it. I have written to the Minister, the Taoiseach, the board of management and the HSE. No community-based residential care centre should be privatised or sold off. Now is the time when we need to support communities. I ask the Minister to step in and ensure that happens.

I know it is late on the Friday of a bank holiday weekend, but some of us are here. It is a pity that the Minister is not here for these comments. I do not know if some excuse was given. It is unfortunate because spokespersons want to raise a number of issues and it would have been good if we could have done that with the Minister.

We have repeatedly rehearsed the reasons we find ourselves needing to go into level 5. It is unforgivable in many ways that so many elements of what we were supposed to have been doing were not done properly. The key element of the response to Covid is testing and tracing and we now see serious problems with both elements of that. Given that that is the linchpin of the Government's response, it is very hard to understand how that has not been sorted out by now. For various reasons certain things have not been delivered as promised.

We now have no choice but to take radical action to try to drive down the levels of the virus. That radical action is playing havoc with everybody's mental health, their well-being generally, their lives, their livelihoods and so many other things that we used to take for granted as normal life. It is hard to support an approach like that which entails such severe lockdown. It is doubly hard to do that while wondering why on earth we have got to this stage and why things could not have been dealt with as it had been promised they would be.

About three weeks ago I raised with the Taoiseach the question of the clocks going back. I suggested that he consider the possibility of us not changing the clocks and keeping with summer time. That is not a straightforward thing, but on balance it would have had many benefits, not least an extra hour's light in the evening, which would have been really important from the point of view of people's well-being and also people working during the day having some opportunity to get out in daylight and so on. Generally, it would have helped in a small way in lifting people's mood. Since I raised it, there has been a very strong response from across the country. Many people and particularly older people have asked why we cannot do that. The case is all the stronger given that it looks like there will be a move at European level for us to change next year. It would have been an opportunity to try that out. It is not something drastic because we may well be doing it next year anyway. This year in particular, given the major difficulties people are dealing with it is regrettable that it was not done. I think we will rue the day that suggestion was ignored as we go into the coming weeks and as the evenings get progressively darker from Sunday on. It is a pity that did not happen.

It is very hard to understand why the issue that arose today with the sanitiser happened. It is more difficult to understand, given that it came to light on Tuesday, that school principals were only told about it very late last night. That resulted in some schools closing today because they could not get organised in time to find an alternative product. I heard suggestion on the radio today that the same product, which is regarded as being dangerous, was not only used in schools but may have been supplied to other facilities including nursing homes. It is important that we get clarification on that. While I do not want to give it legs if there is not a basis for it, we need to find out if there is any basis for it.

What is the HSE doing now? The priority must be to get public health advice out to people. I am sure many parents around the country are wondering if one or other symptom their child might have is related to that sanitising product. For that reason, we need a public statement on that from a public health perspective. We also need an assurance about the product having been withdrawn from all the places it was supplied to and also whether it is actually being sold anywhere. Steps must be taken to withdraw it. We are somewhat left in the dark on this. There has been no further clarification since this story broke in the last 24 hours.

The next issue I want to raise is rarely mentioned here. I have not heard the Minister refer to ventilation. Increasingly in taking steps to drive down the rate of the virus, the role of ventilation seems to be very significant. I am not aware of any action having been taken in that respect or any minimum standards having been set down. It comes up frequently. Professor Orla Hegarty raises it frequently in terms of construction. Other experts talk about it in the media. Many machines are available, including some that have been developed in the past year, which filter air to a very high quality. It is not clear if that message has been taken on board. Has anything been done and have any standards been set over ventilation in nursing homes? That needs to happen. I would like to hear the view of the Minister for Health on that.

I have a real fear that we will repeat the mistakes of earlier in the year in high-risk settings such as nursing homes and meat factories. We had disasters in both earlier in the year, largely because both sectors have large numbers of poorly paid staff with poor conditions, in precarious employment without entitlement to sick leave. It happened with disastrous consequences with people having symptoms of Covid or who thought they might have Covid, but they could not risk taking time off work because they could not afford to do that. That greatly contributed to the spread of Covid in nursing homes with awful results and also in meat factories and the subsequent spread back into communities. I cannot see that anything has happened to avoid a repeat of that disaster in both those sectors. We will not be forgiven if history repeats itself in respect of those two issues.

That is why regardless of any commitment to do something about a national scheme next year, there must be some kind of emergency provision at this point for workers in those two settings.

I refer to testing and the type of testing that is being done. A point made regularly is that the PCR testing in Ireland seems to be done to a much higher level of sensitivity than is required or used elsewhere. That has never been explained. We often hear people with expertise in this area talk of how we use this higher standard, which picks up minute traces of the virus that may be a few months old and the person concerned is not contagious, yet we declare those people to be Covid-positive. Last week, at one of the few briefings provided for the Opposition, I asked the CMO to send the papers to me. I have not received them yet, and I hope he does send them on, but no clear explanation has been provided. It is a very basic question and I would like the Minister to respond on it.

A specific measure in level 5 is the reduction in the number of passengers allowed on buses to 25%. It is causing major problems for people who have to go to work, as many must do, including emergency and essential workers. They are being refused onto buses and are having great difficulty getting to work in the morning and returning home, sometimes waiting an hour or longer to get a bus. If we are going to do this, additional buses must be provided to facilitate essential workers to go back and forth. That is one way we can show them some bit of respect.