Covid-19: New Measures: Statements

I understand the Minister is sharing time with the Minister of State, Deputy Butler, and Deputies Cathal Crowe and O'Dowd.

I welcome this opportunity to update the House on the Government's response to the ongoing Covid-19 pandemic. The current level of Covid-19 is having a negative impact on public health, as well as placing an enormous burden across all aspects of our health service. The number of confirmed cases of Covid-19 in hospital and in ICU is high. We are seeing case numbers previously seen only in January of this year. Our situation is not unique. Countries across Europe are seeing a surge in cases. We heard the recent warning of the WHO that Europe is once again at the epicentre of this pandemic. As we have seen throughout the course of the pandemic, Covid-19 continues to adapt and create significant challenges and this pandemic is not yet over.

In its recent advice to the Government, the National Public Health Emergency Team, NPHET, has highlighted that the current epidemiological situation is concerning and uncertain. Due to the deterioration in the epidemiological situation, on 16 November the Government decided to put in place a package of additional measures to reduce the current level of socialisation across society to interrupt the spread of Covid-19 in the community. These measures include: a move to working from home unless it is absolutely necessary to attend the workplace in person; proof of immunity to be required for entry to cinemas and theatres; bars, restaurants and nightclubs to close, and patrons to be off the premises, by midnight; and, household close contacts who are fully vaccinated and showing no symptoms to restrict their movements until they have three negative antigen test results within five days.

Ireland remains vulnerable to a further deterioration, depending on a number of factors. These include level of social contact, adherence to basic public health protective measures and levels of immunity across the population. We are monitoring this situation closely. As always, our core priorities are to protect the most vulnerable from the impact of the virus and to ensure our health and social care services can continue to deliver much-needed care.

As colleagues will be aware, Covid-19 is once again on the rise across Europe, where it is putting health services under considerable strain and is challenging the provision of health and social care in many countries. We are seeing several EU countries reintroduce restrictions or introducing new coronavirus restrictions as case rates surge. Some western EU countries, which had removed the majority of public health measures, have now experienced sharp increases in Covid cases and have reintroduced measures in recent weeks. Some of these measures are more extensive than what we have in place in Ireland, including for example the lockdown reimposed in Austria. Other countries are taking similar measures to Ireland and a number have had to reintroduce basic measures such as mask wearing and use of the Covid-19 pass for entry to premises.

In Ireland, despite the current challenges, steps taken are working in protecting our population from the worst of this virus. Our vaccination programme is among the most successful in Europe, with more than 90% of the eligible population fully vaccinated. While every death is, of course, one death too many, according to the latest European Centre for Disease Prevention and Control, ECDC, data, Ireland has the fifth lowest overall mortality rate from Covid among the EU 27, plus the United Kingdom.

In addition to the essential public health measures in place, we are doing everything we can to strengthen our public health response and to bolster our health and social services to sustain this latest Covid wave. Testing continues to be an important part of the Irish Government's response to the pandemic. Demand for testing remains extremely high, with an amazing 210,000 PCR tests completed in the past seven days. The HSE is making every effort necessary to address the very significant demand arising for PCR testing, including making arrangements with private providers. The number of National Ambulance Service mobile units will double from four to eight in order to provide additional capacity in addressing high demand. The core public health message remains that anyone who has symptoms should self-isolate at home and get a Covid-19 PCR test.

Our vaccination programme continues to be one of our strongest and most successful defences against Covid-19 and the harm caused by the virus. More than 7.7 million doses of Covid-19 vaccine have been administered since the programme began in December last year. I am happy to be able to report to colleagues that between third doses for the immunocompromised and booster doses, in excess of 630,000 doses had been administered as of yesterday under the third dose and booster programme. The programme for residents and long-term residential care and those aged 80 and above is substantially complete. Most people who are immunocompromised have either received or been offered a booster vaccine. Approximately half of all healthcare workers and half of those in their 70s have now received a booster vaccine. Progress is also being made for those in their 60s. The group I was particularly keen would be offered a booster vaccine quickly is those with underlying conditions. This is a combination of cohorts 4 and 7 from the initial vaccine programme. When we look at our ICU patients, we see that the sizeable majority of them have an underlying condition. The latest advice we got from the national immunisation advisory committee, NIAC, on this cited that 98% of the vaccinated Covid patients in ICU have an underlying condition. In regard to all of our Covid patients in ICU, in excess of 80% have an underlying condition. For me, it was critical that we moved very quickly with this group. I am delighted to be able to share with the House this evening that following on from a telephone I had with the HSE before I came into the Chamber, I can confirm that we will be commencing booster vaccines for those with underlying conditions from next week. The HSE and the Department of Health are working through the details as to exactly how that will be phased. It was a very important and necessary addition to the programme and I am very happy to be able to share that information with colleagues this evening.

The booster vaccine is adding further protection and it is having a positive impact in those who have already received it. In Ireland, the impact of the recent booster vaccination on those aged 80 and older is evident in the rate of incidence no longer rising in this group. We are seeing this internationally as well. The evidence from countries like Israel and the UK is showing that the boosters are incredibly effective in preventing serious illness from Covid. I would encourage everyone, as they become eligible for a booster vaccine, to get it.

The health system is being supported at this exceptionally challenging time through significantly increased funding, with over €1 billion extra being provided in budget 2022. This investment will ensure a continued strong public health response to Covid-19, as well as a stronger health and social care service for the future.

Before the pandemic, we had just 255 critical care beds, which was an inadequate level. We are addressing this lack of capacity, with some €52 million provided by the Government in the budget for this year to add an additional 66 permanent ICU beds, or a 25% increase in capacity. The HSE has advised me that 42 of these beds are now open, bringing the baseline in critical care capacity as of today to 297. More beds will be added over the coming weeks and months and the HSE has been funded to increase capacity to 340 by the end of 2022 or early 2023. This represents a 33% increase in our base compared with the start of the pandemic.

The health service winter plan was launched last week and will provide supports to maintain Covid-19 services, account for winter pressures, provide continuity of non-Covid services, address waiting lists and enhance services in line with our goal of universal healthcare. My Department has received the national service plan from the HSE and will now finalise the measures to be implemented in 2022 to continue to ensure a strong response to Covid-19, while also ensuring the delivery of the essential range of health and social care services that are needed. I assure all colleagues that I, and the Government, will continue to do all that can be done to respond to this phase of the pandemic. We will continue to do this for as long as necessary, until the pandemic is over.

I welcome the opportunity to speak on this hugely important matter, namely, the Government's response to the ongoing Covid-19 pandemic. The current level of Covid infections, both nationally and internationally, is of concern and is placing, yet again, a huge strain on our public services, not least our health system. I would like, at the outset, to commend the tremendous and tireless work and dedication of our health staff in continuing to provide vital services across the country.

Notwithstanding the challenges we face, I will focus today on some of the most significant progress that is being made to further enhance protections, particularly for our older population and people using the mental health services, in our continued fight against this relentless and evolving virus. Significant progress is being made in the administration of booster vaccines to the population of over-80s within the community. I commend the excellent work of GPs across the country in administering these vaccines in order that our older people continue to be protected. There are some 161,000 people in this age cohort and approximately 134,000 vaccines have been administered to date. GPs are also administering additional doses to over-70s in the community, of whom there are approximately 336,000. To date, nearly 172,300 vaccines have been administered. It is expected that this group will be largely completed over a period of about four weeks before the Christmas season. This is in line with NIAC guidance, which recommended an additional mRNA booster dose for all individuals aged 60 to 79. NIAC recommends people should be administered their booster vaccine after six months or a minimum period of five months. This means the time to complete an age cohort is dependent on individuals' original vaccine completion date. The group of people aged 60 to 69 are now being vaccinated through vaccination centres, with more than 33,000 vaccines administered to date. The expectation is this group will be substantially completed by the end of December.

The Covid-19 home vaccination service to individuals who are housebound has been made available for the purposes of administering the third primary or booster vaccine. HSE community vaccination teams visit people's homes to administer the additional vaccine dose. The first phase of the programme commenced the week of 28 October and included two groups, namely, people who are immunocompromised, as per NIAC guidance, and people aged 80 years and older. I am pleased to state that, as of 18 November, the delivery of booster vaccinations through the home vaccination service has been extended to people aged 60 to 79 years. This programme will run for a period of four weeks up to 17 December and will overlap with the vaccination of the 80 years-plus age group, which is under way. To date, more than 260 doses of the booster vaccine have been administered by community healthcare organisation, CHO, teams as part of this phase of the home vaccination programme, with many more to be delivered over the next few weeks.

The roll-out of the booster vaccination programme among people aged 65 and over in long-term residential care facilities, including nursing homes, has been substantially completed since the end of last month, having commenced on 4 October. Vaccination teams were operational within all areas of the country, seven days a week, which saw the majority of care facilities complete the booster programme within a three-week period. Following extensive discussions with the Department and the relevant health agencies, I very much welcomed the expansion of the booster vaccination programme to individuals of all ages living in long-term residential care facilities.

In line with NIAC guidance, from the week of 8 November, vaccination teams extended the administration of the booster dose to people aged 60 to 65 years in care facilities. This week, in accordance with further NIAC recommendations, vaccination teams will again extend boosters to individuals of all ages within their residential setting, or will facilitate residents to attend vaccination centres for their booster dose. As of 21 November, almost 25,000 residents in long-term residential care facilities, including nursing homes, had received their booster vaccination. Community vaccination teams will continue to administer vaccines to people who were advised to have their booster vaccine deferred and in facilities where there was an outbreak of cases. The extension of the booster programme to all healthcare workers, including those in nursing homes, is progressing and will add further to the protections afforded to front-line health staff and the people under their care.

I assure the House that significant supports continue to be made available to nursing homes in response to Covid-19. The outbreak assistance element of the temporary assistance payment scheme provided to the private and voluntary nursing home sector continues to be available. A total of €134 million was allocated to the sector between 2020 and 2021. More than €1.4 million has been paid in outbreak assistance under 63 separate claims since the end of June of this year. A broad suite of other supports continues to be provided to nursing homes. These include the establishment of Covid-19 response teams, the supply of precautionary and enhanced personal protective equipment, PPE, free of charge where possible, access to staff from community and acute hospitals, a suite of focused public health guidance and training resources, including a further series of infection prevention and control webinars delivered by HIQA in September, including nearly 800 attendees from nursing home staff, and temporary accommodation nursing home staff to support measures to block the chain of transmission. Serial testing is to be reintroduced for two consecutive cycles to all nursing homes across the country and is expected to commence at the start of December.

I meet regularly with the HSE, HIQA and the Department on the evolving impact of the pandemic in nursing homes and continue to monitor the situation very closely to ensure all necessary supports and guidance are sustained and, where required, enhanced. There is no doubt that the protection of people living in nursing homes has been prioritised once again through the roll-out of the booster vaccination programme and the continuation of a broad range of supports.

An antigen testing pilot programme has been under way in residential care facilities for older people since mid-September. Over the period of the programme, a total of 4,855 tests were completed in 41 centres in CHO 2, including counties Mayo, Roscommon and Galway, CHO 9, including Dublin North, Dublin North-Central and Dublin North-West, and County Wicklow. There were four positive antigen test results as part of this programme. The pilot programme has finished in all sites and the evaluation is currently being completed.

I would like to specifically mention the progress that has been made in our mental health services to address the emerging challenges posed by Covid. The majority of people aged 60 years and over in long-term care have been vaccinated with a booster dose, with individuals who have not yet received it scheduled for vaccination this week or next. In line with NIAC's advice to expand the booster programme to people of all ages in long-term residential care, planning is under way to administer the vaccine to those in mental health centres. As Minister of State with special responsibility for mental health, I welcome NIAC's decision to offer booster doses to those aged 16 to 59 with certain underlying conditions.

The decision means that those who experience certain mental difficulties such as schizophrenia, bipolar disorder and severe depression will now be offered a booster dose. I hope the additional protection provided will bring a renewed level of comfort and reassurance. I welcome the Minister for Health, Deputy Donnelly’s work on ensuring that that happened.

Booster vaccines among all mental health staff are progressing with the majority completed as part of a six-week programme, which commenced earlier this month. While there are significant challenges posed by Covid-19 currently, we must remember the progress we have made through our shared collective efforts. The Government has moved quickly in an attempt to stabilise the situation, with work from home requirements where possible, the extension of the Covid-19 passport, new closing times for the on-license trade and greater use of antigen testing. The vaccination and booster programme are central to our response to recent developments. Thanks to the successful implementation of a world-class national vaccination programme, the infrastructure has been put into drive forward with our booster roll-out. However, it is so important for us to remember that as we roll-out boosters, vaccination alone will not prevent transmission. Mask wearing, keeping our distance, washing our hands, reducing social contacts and choosing to make smart decisions based on our immediate environment will make a huge difference in not only protecting the great progress we have made to this point, but building on it.

Now, more than ever, I appeal to those who are unvaccinated to please come forward and speak to a medical professional about their concerns. To those who are offered the booster, please take it. If we all contribute to this collective effort, we will keep our society and economy open, we will maintain our progress and we will keep people healthy and safe.

I thank the Minister of State for her impeccable timing. That was bang on cue. I call on Deputy Cathal Crowe, who has five minutes.

I thank the Minister and the Minister of State for their presence here today and for all the work they are doing in leading the Department. More importantly, I pay tribute to all of the front-line health workers. This morning I met the Acting Chairman on the 9.50 a.m. train from Limerick to Dublin. I joined the Cork train at Limerick Junction and I was appalled to see so many people not wearing masks. We have made sacrifices over the last two years. There are people who did not get home to meet their families, such as those who were been living abroad, people who did not spend Christmas with their families and people who could not move more than 2 km from their home at various times. Wearing a mask has never been a sacrifice. What is the big deal about putting two strings behind your ears and wearing a mask for the one hour and 50 minutes you are on a train? It is two fingers to society. It is an affront to our front-line health workers. It is an affront to science. It is a damn right insult to the 5,609 people in Ireland who have mourned the loss of a loved one during the Covid-19 crisis. For God’s sake wear a mask. It is a simple requirement. If you cannot do so for a medical reason, there is a certificate, but get the damned certificate, and do not go on the train from Cork to Limerick or go into shops and put up videos on social media. We see this every evening where people think they can get away with this and this rule does not apply to them and challenging others to confront them. I confronted some people on the train today. I began by handing out masks to a family. I asked them whether they had masks and I took out a bag of a masks that I had in my own bag while travelling here today. That is wrong.

The key to this - and the Minister of State, Deputy Butler, is right – is vaccination. Vaccination and the roll-out booster vaccinations are key. Some 630,000 boosters to date is very good. We must drive on. However, the key messages of mask wearing, 2 m distances, washing your hands and hand sanitising have been lost in society. We need to restamp that point.

I do not agree with the 7% who are unvaccinated. Some of them have medical reasons and that is fine, but some of them have emailed my office to tell me that honey will cure Covid-19 and that you can pour bleach down your throat which President Trump said 18 months ago. That is codswallop. Believe in the science of this. Believe the scientific community globally, which states that vaccinations are what are needed in this. We need to buy into that. That 7% who are unvaccinated are a small cohort of the population but tonight they account for 55% of those in intensive care units, ICUs, all across the country. We need to collectively reflect on that.

We need more extensive use of digital Covid-19 certification. At the moment it is largely used in hospitality and international travel. It should be used everywhere at this point, such as going to a match, going to a local barber and going pretty much everywhere. At the moment, those who are not vaccinated - some have chosen not to be and some are unable to be vaccinated - are largely kept out of that. There is a bit of inequality in all of this. We constantly get emails into our constituency office about this. If we expand the role of digital Covid-19 certification and of antigen testing, we will allow for an extra layer of testing and of assurance for people who are publicly engaged with others. We will also allow those who cannot currently benefit from their local bar or restaurant to benefit from that too. We need to expand the role of antigen testing.

Although this is a debate on Covid-19, we urgently need to get targeted supports back in place for the tourism and hospitality sector. We have seen a 60% drop-off already in bookings coming up to Christmas. I only learned what Black Friday meant a few weeks ago. Back in the 1950s and 1960s, Black Friday was the day on which the companies and large shops in America hit the black point. They were back in the profit zone coming to Christmas. They traded without profit for 11 months of the year and they made it into the profit zone of their accounts in the last few weeks of the year. It feels like that for many publicans and hospitality providers in our country. They need supports and some certainty and assurance right now that they will be supported by Government in the bleak weeks and months ahead.

On education, I was delighted to see the Minister for Education, Deputy Norma Foley, take decisive action and take on one of the suggestions I made to deploy third- and fourth-year student teachers into the front line. There is still bit of ambiguity about Professional Development Service for Teachers, PDST, teachers. They should be sent back to their base schools to teach in classrooms.

While I do not wear it quite as well as my colleague, Deputy Willie O’Dea, I am sporting a tache for this week. We are addressing the Minister for Health and Minister of State at the Department of Health and it is Movember. I hope to shave this off next week.

I do not have a face that suits it. However, Movember is important. It is important to say on the record that for those who are not tuned into the Movember debate, it is about men's health, mental health, physical health and men’s cancer. It is important in the month of November that we reflect on that.

I call Deputy O’Dowd, who has five minutes.

I welcome the Minister and the Minister of State to the House. I listened with respect and interest to what they said. Like my colleague, Deputy Crowe, I would like to pay tribute to all of the people in the health service, such as the nurses, the doctors, the healthcare assistants, the people who test and the people who get the test results and who work on them. Their commitment is fantastic. We all acknowledge that they are under extreme stress at the moment in this difficult time.

More than 5,600 people have died from Covid-19 to date. As a nation, we need to commemorate the trauma, the suffering and the loss. We need a day of national remembrance. I have said this before, and I know nobody will disagree with this. We need to have a structure in place for a national day to commemorate all of those who passed during that time.

I note the Minister of State’s comments on nursing homes. I agree with the excellent work that she is doing there. However, there is a significant absence of action in addressing the deaths in some nursing homes. The deaths in Dealgan House are of deep concern to me and my constituents. Indeed, the deaths in other nursing homes in other parts of the country need to be properly investigated. It does not appear as if that is going to happen anytime soon and I am concerned about that. I will continue the campaign in the interim. If the Government cannot or will not provide an inquiry, the Oireachtas committee should sit again to examine this issue once again. In the UK Parliament had a parliamentary inquiry. It is time to have one here as well. All parties in the Oireachtas should talk to get an outcome that would make sense to the families. They should be able to bear witness to the suffering of their loved ones and we might be able to find the truth of what happened in a transparent, accountable place like our Parliament.

I would also like to talk about County Louth, which has the highest rate of Covid-19 in the country. The national average per 100,000 is 1,160 cases. In Laytown and Bettystown, in my constituency, the figure is almost double that, at 1,876. In Drogheda rural, the figure 1,963. In Drogheda town, the figure is 2,415 per 100,000. That is an appalling and a frightening statistic. I accept that we are doing our best, but we are not doing enough. This evening, you can get no Covid-19 test in County Louth, or indeed in County Meath. The Minister can say what he likes about that, but this is the biggest town in the country. It has the highest rate of Covid-19 nationally but it has no test centre. It had a test centre during the summer for a significant period of time. We need it back. I have requested it and I understand the director of public health has requested it. To date nothing is happening. We do not accept this. It is unfair on families, particularly those with young children, who have to phone around and truck around to adjoining counties. That is unacceptable.

In October, there was demand in County Louth for 12,454 tests, and from 1 to 21 November there were 11,964 tests. It is a very significant issue and it needs to be addressed.

Vaccination is very important. There is great news in an ECDC report today, showing that 93% of the Irish population is vaccinated and our number of deaths per million is 15. It is not the lowest in Europe but it is the highest vaccination rate and one of the lowest death rates. Bulgaria, in comparison, is bottom of the list, with a 29% vaccination rate and a death rate of 325 per million. Clearly, vaccination works. There are too many people in our country who are not vaccinated and who are getting seriously ill. From 1 April to 20 November 2021, 623 persons over 15 years were admitted to ICU with confirmed Covid. Of those, 393 did not have a Covid vaccine. That is 63% of all the people admitted to ICU since 1 April. There is a huge risk to these people's health and lives. Like my colleague, I am very concerned about this. I accept that there are people who have medical reasons for not getting vaccinated but we must accept that more must be done. We should extend mandatory Covid certification to a significant number of other activities, excluding essential services. This is the only way to proceed. We cannot allow unvaccinated people to take up services that are urgently required and not available to the population who are vaccinated and need those services.

We all hoped we would be in a different situation going into December and the Christmas period. We must all reflect on the current trajectory of the disease, the current daily case numbers, the number of people who are hospitalised, the numbers in ICU and the very difficult situation we have in our hospitals. At the same time, for anyone who gets sick with Covid, it is difficult for them and their families. As I said, we all hoped we would be in a different space but we are not. This disease is very stubborn. It has not gone away and it is going to be with us for some time. We all have to collectively try to figure out how to manage, live with and deal with this virus for some time to come.

The last time we had a discussion on Covid was during the emergency powers motion we discussed a number of weeks ago. I reiterate a point I made in my opening remarks and repeated again to the Minister. I listened very intently to his response. It is reasonable for him to criticise me and my party, as it is for me to hold him to account as the Minister for Health. I support all the public health measures, as does my party. What I will not do is support emergency powers when we do not get any heads-up and there is no involvement of the Opposition. There is certainly no scrutiny, debate or accountability as regards any of the actions that flow from the emergency powers this Oireachtas has given the Minister, which we supported in the past.

There have been too many examples of regulations that were clumsily put together, where stakeholders or people who have to live with the measures arising from the regulations have been quite critical of the approach of the Minister, the Department and the Government. There is a better way to do it. We have to get back to more decisions being made by the Oireachtas and votes on the regulations if necessary. We certainly need debate and scrutiny. We cannot continue with a situation where we do not have that level of scrutiny. I do not believe having emergency powers to the extent that we almost fully devolve responsibility to the Minister for Health is where we need to be, at a time when the Dáil is sitting in full and we can respond, as the Minister would put it, in an agile way. I want to make that clear because there was a misrepresentation, if not a spin, put on what our position is. It is up to the Minister and the Government to present that in whatever way they want.

I want to deal with the issues of Covid and how we need to respond and can better respond. Sinn Féin and all of the other Opposition parties have for some time been critical of a lack of planning, and in some areas no planning, when it comes to some of the responses and tools we have at our disposal, which we need to deploy as best we can to get a grip on this virus again. A lack of planning, engagement and leadership presents challenges when people see it. There is a public health message that we all have to give, which is that people should abide by the public health measures. If they have symptoms, they should get tested using a PCR test. Antigen testing is not for people who have symptoms. They need to make sure they restrict their movements and self-isolate. We have to reinforce the public health message that has been given by public health officials. Everyone should look at his or her social interactions and limit them where possible. I fully support all of that. I have said this on countless local and national radio stations and I will repeat it again today. We all have a responsibility to repeat the public health message but the Government also has a responsibility to get its part of this right.

I want to deal with a number of issues. The first is PCR testing. Paul Cunningham from RTÉ tweeted ten minutes ago that he contacted all the PCR testing centres in the country and 21 of them currently have no capacity for today or tomorrow. People cannot book a test. That number was ten yesterday and 15 the day before but is 21 at this point in time. Of course the system is under real pressure but the Government needs to provide additional capacity and we need to be looking at where there are gaps.

Like me, the Minister of State, Deputy Butler, is from the south-east region. Yesterday, you could not get a test for 48 hours in Waterford, Kilkenny, Wexford or Tipperary. That is an entire region. It is unacceptable. We need to put in the capacity and resources. When we are telling people they need to get tested and restrict their movements the very least we can do is make sure there are quick turnaround times for them when they need it. I know the system is under pressure and I hear what the Minister is saying about the number of tests being done but what is happening at the moment is causing tension and difficulties for us in delivering a public health message to the community because people do not see the Government getting it right.

I do not even know where to start on antigen testing and how long we have been waiting for the Government to put a coherent plan in place. We are not at the races compared with where other European countries are. What we need first and foremost is a plan and clarity of message. I have a good understanding of how and when people should use antigen tests. Yesterday, the Chief Medical Officer, in a briefing to Opposition and Government representatives - although not Ministers - talked about circumstance and interpretation. He spoke about the circumstances in which someone should use antigen testing and how that person as an individual interprets the results of the test. The point that has been made to all of us is that, of course, if people are symptomatic, they should get a PCR test but if they are asymptomatic in a high-risk environment, they should be using antigen testing on a regular basis. That is the public health advice I have been given and that is what we should very clearly communicate so there are no mixed messages. People need to be really clear about when they should use antigen tests and how to use them and then we need to make a decision on how we are going to fund this. I do not see why we should not make the tests freely available. I do not see circumstances where people will be looking to hoard dozens of antigen tests. Let us just make a decision. We are already making them freely available in some circumstances. Let us just for once make a quick and decisive decision that we are going to do this and get it done. That is what people want to see.

We stopped contact tracing entirely in schools. I was one of the people who said yes to that when asymptomatic children or children who did not have Covid were having to self-isolate for ten days and missing school was a problem. However, we have gone from one extreme to the other. I do not see any balance. We need to better equip and better support our teachers, parents and children in schools and put more measures in place. As the Minister knows, substitute teachers are an issue. Ventilation, which I will come to in a second, is also an issue in schools. We need to have a level of contact tracing and risk assessment in schools which is not there at the moment.

Public health officials will say that schools are a safe environment. I, too, have used that expression because it is one we have been given by public health officials but of course, there is risk. No environment is fully safe because of Covid and in every environment there is an element of risk. It is the job of the State to minimise risk, particularly for young people in schools. We seem to have gone from one extreme to the other, with no contract tracing at all, which is not acceptable.

There needs to be more urgency in relation to the booster jabs. At the aforementioned briefing yesterday, I asked the CMO whether we will have to go to a general population roll-out of the booster jab and whether we accept now that at some point in the future, everyone will require a booster jab. His answer was not quite "Yes". He said he could foresee an extension of booster jabs but logic would tell me that everyone, at some point, is going to need one. If that is the case, let us accept that reality and start planning for it. We need timescales to give people a sense that it is going to happen and when it will happen. The Government must engage with NIAC and that committee must be front and centre in all of this but people are looking for certainty and clarity.

Ventilation is a bit like antigen testing; all we hear is talk and more talk but we do not see the solutions, whether in schools or workplaces. There is no responsibility on employers or the State, or at least people do not see the State taking responsibility in relation to ventilation. Again, it is one of the tools that we can and should be using, alongside all of the other measures.

The derogation for healthcare workers from the restricted movement for five days rule has been raised with me time and again. It has been raised by the INMO and I want to put on record that organisation's concern in this regard. We must protect people on the front line. I know we have a real problem in the hospitals. I have mentioned moral injury to the Minister previously in the context of those on the front line being unable to take breaks and afraid to take annual leave. Now they are not to be subject to the same rules as everyone else and they have a real concern about that. At the very least, the Government must listen to what the healthcare trade unions are saying and engage with them so that we can properly support people on the front line.

I have spoken several times with the Minister about ICU capacity. We are far behind where we need to be in relation to the 2019 and the 2009 capacity reviews. While additional capacity has been provided, we are still far short of what is required. I do not have the time to go into all of the problems we have in our health system at the moment. We have discussed them several times. We had a discussion with Paul Reid and others in the HSE today but it is a real crisis and challenge and the rising cases of Covid are adding to that challenge. I agree with the Minister that all the measures I have just talked about, as well as reinforcing the public health message and people abiding by that message, are required to reduce the levels of infection and hospitalisation of Covid-positive patients, which are causing a real difficulty.

I want to address comments that were made about people wearing masks. The Deputy who made the contribution was passionate and he may have had a negative experience on a train but I have to say that my experience is that, for the most part, most people are abiding by the restrictions most of the time. I do not see any evidence of people not doing that. There may be some examples but generally, people are doing their best. There is fatigue and tiredness with this virus that we all accept. We are all fatigued and tired and we all wish the virus would go away but it has not done so and is still here. We have to continue to appeal to people to do their best but I think they are doing their best. I genuinely believe that. What they want to see is the Government getting it right at its end but in lots of different areas, they do not see that. We need to sharpen the State's response in many areas.

I raise the issue of Covid measures in education settings. First, while I welcome the Minister for Education's announcement regarding substitute teachers, we are 16 school days away from Christmas when schools will be breaking up anyway. We need to know the timelines in terms of substitute teachers. Can teachers expect substitute teachers to be available from Monday of next week? We need the specifics because there are too many vague announcements that do not get to where the people are, on the front line, like teachers and staff. Parents, students and staff will appreciate the long-awaited recognition of the crisis that they have been battling for weeks but more clarity is needed. More clarity is also needed for secondary schools on how this will work in practice for them. The ASTI has been calling for that clarity as well but people should not have to call for clarity continuously. They should be given clear and timely messages. It takes mental gymnastics to accept that there is a crisis with substitute teachers caused by teachers being out sick while not accepting that Covid transmission is a reality in the school setting. Things do not add up for people. That is the problem and it is why the Government is losing so many people.

It is absolutely vital that we do not lose social solidarity across the nation. People are always willing to play their part but they need to see the Government communicating clearly with them and playing its part as well. That has not been the case heretofore. In fact, it seems that when decisions are finally made, the Government stops to slap itself on the back, as if to say that everything is grand and it did a great job. What we need are timely decisions. The procrastination is killing people. People are waiting for decisions to be made. I spoke today to some business people in retail and the pub trade who just want to know what will happen. They do not want to be taking on staff or bringing in orders; they want clarity around what is happening. If the Minister has information, he needs to communicate it and help people to make sense of things. They will do anything that makes sense to them but a lot of things do not, unfortunately.

The best way to keep our schools open is to be straightforward with people, particularly parents and staff, given how much responsibility they are being asked to take on. A number of steps are needed. First, the Government must consider providing HEPA filters for every classroom or room where children are congregating. It is better to be safe than sorry. Hopefully, we will come out the other side of Covid at some stage but we know that adequate ventilation and air filtration is not an optional extra in a pandemic but is vital to maintaining health and well-being. How can teachers be expected to teach and children to learn if they are fearful of the environment they are in? These filters would be a worthwhile investment providing clean air within schools, regardless of a pandemic.

Second, the HSE should be given a clearly defined role in contact tracing in the primary school setting. That must be done. The changes that were made in September were wrong. Certainly issues needed to be addressed but we cannot continue on without the HSE having a clearly defined role. We also need to know how the antigen test plans will work. How will the tests be distributed? Are people going to be waiting for days for antigen tests? All of these issues could be cleared up in a few hours.

Third, the Minister for Education needs to reverse the decision to remove banked special education hours. Special education hours will continue to be lost if the banking system is not brought back in. Children with special educational needs were among the biggest losers of the lockdown. Indeed, the Minister launched the Covid learning and support scheme, CLASS, in recognition of the impact the lockdown had on their learning development but at the same time, she is not allowing schools to safeguard special education teaching hours. That really needs to be addressed. I would strongly urge the Government to consider the three points I have just outlined. We have always tried to work constructively on these vitally important issues and will continue to do so.

I am also concerned about third level students who have had a very rough ride throughout Covid. They have not been prioritised for a return to in-person teaching in the same way as primary and post-primary students. Those who are fearful about sitting in halls to do exams must be listened to as well. We must put measures in place, we must do so quickly and decisively and we must communicate clearly.

The lack of engagement and the disregard for the harm being inflicted on workers and businesses has left large sections of the culture and entertainment industries unable to maintain confidence in the Minister or this Government. They feel like guinea pigs being slapped in the face. This is a sector of Irish society which, despite all of the talk about engagement with stakeholders, was blindsided by the reintroduction of restrictions last week.

In addition, the public health messaging telling people not to socialise, combined with general fear and scaremongering, has led to major problems in this industry. There has been no proper response or compensation from the Government to the closure of this sector. We must remember that it is the Government that is closing this sector. We only need to look at what has happened in the past. That has not been good, and it does not augur well for the future for many musicians and performers. The Minister has refused point-blank thus far to take any responsibility for her part in the Government slashing the PUP at a crucial time for those in the entertainment industry, for performers and others whom we praised and to whom we looked up as being part of our culture. They are pivotal to the tourism industry in the future, yet all the Minister has had to say thus far is she will not be found wanting if it becomes apparent that additional supports are necessary. It is apparent. She only needs to ask any of the musicians, performers or those who had jobs lined up a fortnight ago to last over Christmas and get them through that period after sustaining a torrid time in terms of their income and ability to ply their trade. The key part is for the Minister to ask them directly. They will tell her that a week or two weeks ago they were looking forward to being able to play and to entertain people and that opportunity disappeared in a flash following a Cabinet decision and with no compensation.

Up to two weeks ago, almost 80% of musicians, deejays, entertainers and stage crew have experienced a return of less than half of their pre-pandemic work. Some 75% of those who responded to the Music & Entertainment Association of Ireland, MEAI, survey, which was carried out last week, said they are seeing their events cancelled for Christmas and that is not the end of it. This tallies also with the Amárach public opinion survey released by the Department of Health today, showing that 45% of respondents had cancelled social events between now and Christmas and many more are planning to cancel events. In the past two years, 40% of those in the sector have had to take up work outside the industry to survive. In the past two weeks a lot more will have had to take that option. A shocking 47% are considering leaving the sector for good. The Minister should think of that and of our culture in the future. This is a society that is supposed to value culture.

The Minister, Deputy Catherine Martin, all but admitted in the committee today that no work had been done to provide alternative supports for this sector and nothing will be done until it gets much worse. She even tried to present as a win the €25 million cut to funding to the live performance sector in the budget. Covid-19 inflicted terrible damage on our night life, musicians and cultural life but the Minister's laissez faire approach to that suffering could be the nail in the coffin for the hopes and dreams of many of a recovery for at least a number of years to come. She has not given serious thought to the proposal the MEAI made for a Covid support for arts workers to replace the PUP. She has given the impression that the proposals are not forthcoming. So much for making sure the plight of the workers in the sector is not going to be ignored. The workers have been ignored and it looks like that will continue to be the case.

I wish to share time with Deputies Howlin and Nash. I will take five minutes and they will have two and a half minutes each, or perhaps it will be six minutes for me and two minutes each for them. I will see how I get on.

Is that agreed? Agreed.

I thank the Minister of State, Deputy Butler, for her statement that people with mental difficulties such as schizophrenia, bipolar disorder and severe depression will be now offered a booster dose. She did it previously in the first round of the vaccination programme as well. I know she gets how serious this is for people who are living with those conditions. In recent weeks I heard of an individual whose story will not be captured in the overall figure of 5,609 as someone who died with Covid, but they passed as a result of Covid because they suffered from one of these illnesses and there was a direct correlation. I think of that person now when I am making this contribution and I will be thinking of that person for a good while to come. It is vitally important that these people are reached as soon possible and are offered a booster and every effort is made to get them to a vaccination centre.

Following on from Leaders' Questions yesterday and my discussion with the Taoiseach, our greatest concern in the Labour Party is that we are operating as if this wave is going to be our last. That is something we have been doing since the pandemic began. I accept it is done for positive reasons based on hope. With each wave that comes, we believe it will be our last. Unfortunately, this virus continues to outwit not only this country, but the region and the world, so we must plan for the virus being with us, as the WHO says, until at least 2023. It means putting in place the resources to cope with surges in the need for testing, vaccinations, boosters and critical care beds. That is where we need to look. We are in the eye of the storm with this fourth wave, and we can get caught up on a daily basis with the individual crisis within a crisis of the day, but we must talk about how we are going to make the health service robust enough to ensure we can mitigate against these waves should they come. I hope this is our last wave, but we cannot plan for that to be the case.

I wish to ask about ICU capacity. The Minister mentioned that we would have a baseline of 297 ICU beds. The Department's 2018 capacity review set the target at 330. Paul Reid said we would have 50 surge beds for December and into the early part of the new year. In summing up, will the Minister indicate how many whole-time equivalent hours that will take from non-Covid care and how it will impact on such care? Surge capacity has an impact on non-Covid care. I would welcome if the Minister could provide details in that regard. We know that providing ICU beds is not a case of rolling a bed into an ICU ward, and that skilled, trained staff need to go with the bed. As health spokespersons, we are fully aware of that. Surge capacity has an impact on non-Covid healthcare, which is also in a crisis.

We know there are issues with PCR testing. I have been raising the matter for more than a week and a half. It can take two days to get a test and another two days to get a result. That is four days from when a person could be symptomatic to when he or she gets a result. People like us in this House have the ability to control our diaries and we have staff that work for us to keep the wheels going, but people working in retail, as taxi drivers, in transport or in other low-paid work do not have that luxury and they are under pressure to work. The PUP has been cut. That must change given where we are going with this virus. Low-paid workers are under immense stress coming into the Christmas period to pay fuel bills and rent. We must reduce the four-day delay. We are doing 209,000 tests a week, which is substantial. I wish we did not need extra capacity, but we do.

A hames has been made of antigen testing. The opposition has been criticised by the Government for being partisan, but in the course of the pandemic, the Opposition has provided practical solutions such as antigen testing, testing and tracing, not cutting the PUP, sick pay and remote work. The Opposition, including the Labour Party, has been playing a very constructive role. What role does the Minister see antigen testing playing in households into 2022? Where antigen testing has worked at the latter end of last year and this year is where large companies, for example, big building companies, have made sure their workers have been serial tested on Mondays and Thursdays on big sites.

They have been catching cases, people have been self-isolating and work has been able to continue.

The Taoiseach said yesterday, in response to my question on promised legislation, that he sees a role for regular testing in households into 2022. Does the Minister think that is the case? If it is, how do we get clear messaging and how do we get accessible, affordable and, ideally, free antigen testing into enough households to ensure that we are catching this virus as early as possible and making sure it is spreading as slowly as possible? Given Dr. Catherine Motherway believes everyone in this country is probably going to get this virus, we have to slow the spread and we have to take the pressure away from our acute hospital system. I look forward to the Minister's summing up.

I thank the Minister and the Minister of State for their presentations, which contain very useful information. In the time I have, I want to make a brief contribution on the issue of vaccination, in particular on the booster jab. We have to underscore again and again that all vaccines are amazingly effective, particularly at preventing serious disease and death.

I want to advocate for a vulnerable group who I believe, through nobody's fault, have been short-changed in the programme, and that is the 60 to 69-year-old cohort. By definition, they were from the start vulnerable. They were given the AstraZeneca vaccine, which is very effective, and I have all the statistics here, but demonstrably less effective than the mRNA vaccines, that is, Pfizer-BioNTech and Moderna. To add to the disadvantage, there was a three-month gap between the first and second doses - in fact, a 15-week gap initially - whereas people getting the other vaccines got them within a month and were able to be fully vaccinated before others.

I can give the Minister the data from The Lancet but I do not have the time. However, all vaccines are now waning in effectiveness. My appeal to the Minister is very straightforward and clear. Do not delay a second in ensuring that this group, who are already contacting my office and all of our offices because they feel aggrieved, are vaccinated. Open the mass vaccination centres and get this group vaccinated before Christmas. Do not rely on the six months and start as soon as the five-month threshold is passed. Will the Minister give us the guarantee that all resources will be put into effect and that he will open the mass vaccination centres and get this group fully vaccinated this side of Christmas? If we can do that, we can make amends to a group who I think feel they got the short end of the stick last year.

I again want to raise with the Minister the need for a Covid-19 testing centre and vaccination centre in Drogheda. The Minister knows the incidence rates in Drogheda are again the highest in the State. One in 40 have tested positive and it is one in 20 if we take a 28-day perspective, yet there is still no testing centre in Drogheda - no permanent centre and no pop-up facility. This is unbelievable. It is Ireland's largest town. It neighbours east Meath, which has the fifth highest rate in the State. The HSE in the region is doing its very best but at national level, the HSE should be agile enough to deploy the available resources where they are needed and when they are needed, and it evidently is not.

I am not making a narrow parochial argument. The facts and the evidence are there to support the case for a full testing centre and vaccination centre to serve Drogheda, south Louth and east Meath. I have raised it with the Minister before and I will raise it again. Figures from the CSO tell us that vaccine take-up in the area is significantly lower than the national average, which is another reason we should make it as easy as possible for people to be vaccinated by providing vaccination centres where people live.

Today at 10 a.m., there were no slots available for testing in Louth, Meath or Dublin, and there were 115 in Monaghan. If the Minister is serious about dealing with this, he can use his functions and he can instruct the HSE to establish a testing centre in Drogheda. We had pop-up centres when the number of cases was lower yet nobody in the HSE can tell me what threshold is applied to establish a permanent centre or a pop-up centre. What is the problem and where is the transparency?

Accessibility is key. In Drogheda, families tell me of the difficulty they have in getting to Ardee to be tested. There are 3,000 households in the town of Drogheda that do not have cars, according to the last census. Too many people who need to be tested are not being tested, frankly, because they cannot access the centre, and the pressure then falls on the National Ambulance Service, which, as the Minister knows, is stretched. The Minister and the HSE nationally need to act. I appeal to the Minister to act in the interests of the people of Drogheda, south Louth and east Meath.

Ba mhaith liom mo chuid ama a roinnt leis an Teachta Colm Burke.

Is that agreed? Agreed.

I would like to also raise the issue of PCR testing. Undoubtedly, there is a massive surge in demand at the moment and there are difficulties in catering for that demand. I would specifically like to ask the Minister about the possibility of opening an additional PCR test centre in Cork Airport. The local media was reporting recently that RocDoc is operating there at the moment and there were reports the HSE was going to avail of that facility in the interim. If the Minister could clarify that in his closing statement or afterwards, I would appreciate it. There is undoubtedly the demand.

In my home town of Glanmire, we have a PCR test centre in St. Stephen's Hospital. At the moment, many people who avail of the PCR test there are under the impression that it is a drive-through centre but it is not. If there is a possibility that the HSE could advertise that better or, in an ideal world, that the PCR test centre could be converted into a drive-through centre, that needs to be considered because there is ample space on-site to ensure it can be done.

I want to comment on a point made by Deputy Cathal Crowe earlier in regard to mask wearing because he hit the nail on the head. I have noticed it. While I know other Deputies tried to contradict him, I have definitely noticed in various settings that mask wearing is slipping. We need a proper and concerted effort to double down on that and to make sure people continue to do the basics right, and we can all do the basics. Certain people have made sacrifices and continue to do so but, as Deputy Crowe alluded to earlier, the very least anybody can do is wash their hands and wear a mask.

I have made the case to the Minister previously in regard to patients who, for one reason or another, cannot avail of a vaccine or who have received the first dose and, because of a reaction they had, are receiving medical advice to not chance taking a second dose. I would particularly make the case for patients who suffer from myocarditis. I ask that an exception is made for them in terms of Covid certification because many of those patients would have been under the impression initially that the Covid certification was going to end back in October or November. Obviously, that did not happen and, going forward, I am not sure if they can indefinitely be excluded from certain aspects of a normal functioning society. Again, I ask the Minister to talk to the CMO and the HSE in that regard.

I want to raise the issue of the Covid tracker app, which is a fantastic tool if utilised correctly. I know that, in the early stages, when I downloaded that app, I could see how many people had registered and logged in from day to day to say they had no symptoms or whatever the case may be. Thinking back over the months, there were 300,000 to 400,000 people logging in daily to use it. I checked before I came into the House today and it is at 78,000 so, clearly, the use of that app is not being maximised. It is something that should be constantly reviewed. Many people on the Opposition benches will go on about mixed messaging and lack of communication. The Covid tracker app is a perfect way for all people in society to access basic information, whether it is to advise people of PCR testing availability in their locality, to remind people of how to avail of and access antigen testing correctly or to advise people of a spike in their local area. I believe it is underutilised and that is reflected in the number who log in or do not log in every day. As I said, in the beginning, there were hundreds of thousands logging in and only 78,000 today, so it is clearly underutilised.

I have a final point on antigen testing, which is something I have spoken about for the best part of a year and a half. I am disappointed to see its slow roll-out and there is no point in me denying that. However, it is a tool. It is not there to supplement PCR and we all know that. We are not stupid. At the same time, we need to advise people how to use it correctly. If people are symptomatic, whether it requires an information campaign, information going on an app or adverts on the television or radio, we need to advise people it is there and should be utilised.

Antigen tests should be free of charge in order to get them to people and to get people using them. It was referenced earlier that companies in meat factories and on the construction site of the national children's hospital have been using antigen testing with their employees three, four or five times per week. If antigen testing can work in those settings then I do not see why the population at large cannot use it as well. If we inform them how to best utilise it then the more we test the more effective and accurate it will be. That will be better for all of us in the ongoing fight with Covid.

I thank the Minister for dealing with this issue. We are coming from a situation where the Health Protection Surveillance Centre was yesterday notified of 3,666 confirmed cases of Covid-19. That gives a seven-day average of over 4,400 cases per day. We have had over 630 patients in hospital with over 130 of those in ICU. This is the challenge we face. Since Covid was first identified in Ireland we have had over 5,600 deaths so it is a huge challenge for all of us and we all have a part to play.

I want to thank all those who have been involved in the healthcare sector. In the last week alone over 210,000 lab tests were completed and we have completed over 600,000 booster vaccinations. We have made good progress with the over-80s and I understand that the vast majority of those should have received their booster by the end of this week. There is some confusion about the over-60s and over-70s. Full clarification needs to be provided on the roll-out of the booster vaccine for them because there seems to be a situation where people are not sure whether they will be notified, when they will be notified and the timeline for their boosters. It is important that we get the vast majority of those people vaccinated as early as possible.

I am also concerned about the delay that occurred in the vaccination of front-line hospital staff. If that needs to be expedited then every effort should be made to ensure that every person who is working in the healthcare sector, whether it is in a nursing home, a care centre or a hospital, is provided with the booster vaccine. There is also a group that we can easily lose sight of, namely, people who are in facilities for people with disabilities and in day care centres. I am particularly thinking of the Cope Foundation facility in Cork, which caters for over 1,500 people, both residential and day care. It is important that we give priority to those centres and complete the vaccinations there as soon as possible. I know we are increasing capacity in the vaccination centres and that needs to be prioritised. My understanding is that the target is to have the capacity to administer over 160,000 vaccines per week and that is something we need to fast-track.

I want to ask about the use of antiviral medicines. I understand that in clinical trials it has been found that the use of antiviral medicine can reduce hospitalisation by 50%. Medication can be prescribed to those with positive Covid tests and it is taken at home over five days. I understand the European Medicines Agency, EMA, has fast-tracked its approvals process for this medicine. Last week, the EMA announced that it would work with national bodies, including the Health Products Regulatory Authority, HPRA, in Ireland, to ensure early access to the drug is provided. There are two ways of ensuring supply of this medicine. There could be a joint procurement arrangement with the European Commission, similar to how we procured vaccines and then there is the national supply purchase arrangement. Already, more than a dozen countries, including the UK, the US, France, Australia and New Zealand, have signed their own national agreements. I am raising this at this stage because it is about supply. If we delay in entering into an arrangement on the provision of this medication we may then have a challenge in getting supply. This is something we need to work on at the earliest possible date.

I want to raise the issue of working with the key stakeholders in the medical area, namely, GPs. I have raised this with Paul Reid at the Committee on Health in relation to the Cork area. For instance, in Cork city I understand that recently, there was only one GP on call with SouthDoc one night. I am concerned that this has occurred because we have to examine what happens in such a scenario. One might say that people should wait until the morning but if one has a sick child and cannot get access to a GP, the immediate reaction is to go to an accident and emergency department, which puts more pressure on our hospital services. I ask that there would be further engagement with the key stakeholders and with GPs especially in order that we can make sure that we have people available and that people do not feel the need to go into an accident and emergency department when they can be treated at home. We need to do a lot more work in that area.

A lot of good work has been done in recent months but we have a major challenge before us. It is important that we do everything possible to get the message out there that we all have a part to play and that people can make their contribution, whether that is in hygiene and handwashing, using masks or trying to avoid large numbers congregating because this virus spreads so easily. We need to get that message out more. We do not want to have a lockdown again but we need to ensure we get everyone on board in getting that message across over the next week or two.

The recent surge in Covid cases has proven that the Government does not have a coherent plan to get us through the surge we are experiencing. There is a range of measures we should be using, including free antigen tests, adequate PCR tests and booster jabs. The feeling in the general public is that the Government is dithering and indecisive and that the result is thousands of daily cases and unsustainable numbers of patients in our hospitals and ICUs. Earlier today, 13 counties had no testing appointments available for today or tomorrow. Apparently five other counties only had one appointment available for those times. This is causing huge stress and is leading to people taking extended leave from work, as well as causing childcare issues and other problems for people. The surge was predicted and now it is here but the infrastructure to deal with it is not there.

In my county of Louth cases are the highest in the country and Drogheda has been particularly badly hit with one in 40 people testing positive in the past fortnight, which is a staggering statistic. I had been calling for a test centre in Drogheda and I asked if even a mobile clinic that would be quick and easy could be provided. We have heard nothing and had no indication from Government that this will happen. I contacted the HSE locally at the start of the week to request a pop-up centre. That would be another simple measure to implement, given the high rate of cases in Drogheda, and the HSE has yet to respond. Where is the sense of urgency when case numbers are through the roof?

As others have said, testing is a shambles at present and no test is available in Louth until Friday at the earliest, despite the fact that case numbers are so frighteningly high. That is unacceptable.

I ask the Minister, Deputy Stephen Donnelly, to give me a commitment that he will pick up the phone to the HSE in Louth and request that it provides a pop-up test centre in Drogheda. It is not too much to ask. It has the highest rate in the country. Will the Minister give me that commitment?

I will address it in my wrap-up.

I thank the Minister.

Also, the booster jab regime has been far too slow. As others have said, we need to speed it up. There is confusion among some groups. When will those who got the Janssen vaccine get the booster? They should have been given one three months after their vaccine. Many of them were vaccinated over six months ago and there is no sign of a booster yet. There is concern amongst this group of waning immunity and a lack of protection from the virus. Everyone will need a booster jab eventually. Where is the plan?

Also, some pharmacists are saying that they are very confused. They do not know what is going on yet. They have heard nothing. Maybe the Minister can clarify that too. The same goes for antigen testing. It is November 2021 and there is still no decision on subsidising antigen tests. Of course, they should be free but the Government cannot seem to even organise a subsidy.

On top of that, the hospitality sector is taking the brunt of this, with new restrictions being imposed in recent weeks. The sector has really suffered in the past year and a half. Christmas parties, concerts and other social events for the month of December have been cancelled due to the surge. Venues are closing or operating at reduced capacity. Staff are the ones who pay the price yet the Government is ploughing ahead with cuts to the employment wage subsidy scheme and the pandemic unemployment payment, PUP. People in this sector will not survive without these payments.

Most sectors are back at work - many of them from home - but tourism and hospitality, entertainment, music and performers cannot work from home and are still affected by restrictions and the surge in cases. There are fewer sectors affected this time around and the ones that are must be supported. I note that the Minister, Deputy Catherine Martin, did not oppose the cuts. She went along with the reduction of the payments despite it affecting thousands of workers in sectors under her remit. The Government has to prioritise these cohorts and recognise that now is not the time for cuts for those working in tourism, hospitality, entertainment, such as musicians, and all the other badly-affected sectors.

The Minister cannot have it both ways. If he is telling people to cut their social contacts and not to go out as much, he has to subsidise the workers and businesses that are being directly affected by that policy. The real result of all of this poor planning is the outrageous pressure on the health service and I do not need to go into the cause of that in the policies over the years.

There are various aspects of the Covid issue that I want to reference here this evening and comment on but I want to start with one that has received very little attention. I refer to the question of the migrant community and the impact of Covid on them and the question of vaccines.

Figures came out in recent days which are enlightening in relation to what is actually going on. It drills down into the figures and tells us a lot of interesting and concerning things. Much important analysis was done of these figures by Mr. Mark Coughlan of the "Prime Time" team. Mr. Coughlan has published that on the RTÉ website and it is very insightful. We cannot afford to ignore those figures. I will put them on the record here this evening with the intention of bringing them to the Minister's attention and, hopefully, that we will get action on them. Real action can be taken to impact these figures, which are so worrying.

Seven per cent of the population is unvaccinated and 54% of all ICU admissions are unvaccinated people. That was found through study of the figures in September and October. What is very interesting is the fact that 50% of all unvaccinated people in ICU were born abroad. That gives us insight into an important cohort of people who are not availing of the vaccination programme.

A total of 44% of people employed in Ireland but originally from the EU's eastern European member states are vaccinated and the remainder, obviously, are not. The latter is a substantial number.

Five per cent of the population in Ireland is originally from the so-called 13 EU accession states. Most of these countries have very low vaccine uptake rates. It is worth looking at some of those. For example, in Poland, the vaccination rate is 54% and in Lithuania, Latvia, Slovakia, Romania and Bulgaria, the rates are 61%, 62%, 45%, 36%; and 25%, respectively.

It is worth repeating that 50% of all unvaccinated people in ICUs were born abroad. That should tell us that there needs to be a targeted programme to reach those traditionally hard-to-reach groups and that we must work hard and redouble the efforts to reach that group. I am not saying that nothing has been done about that. The HSE has done quite a bit of work on this. They ensured that public health messaging was translated by native people. Those messages are being put out on various websites in 27 different languages. I accept that translation work has been done. There have been radio advertisements on community radio. There have been print advertisements in some of the Polish, Lithuanian and Russian language newspapers. There are also multilingual advertisements on digital and social media. The HSE has made reasonable efforts but I do not believe that they are enough because those figures show that they are not sufficient. The message is not getting across. There are many reasons for that. I am not blaming anybody but I am saying that those figures are so stark that they demand a response. The kind of response demanded is a detailed strategy based on the evidence and on advice from community leaders in those communities and from migrant advocacy groups because there is a tendency at official level in this country to do things through the eyes of the officials, who are often Irish born and bred, middle-aged and middle-class people. Such officials design communication programmes and they are not always the successful ones. You have to speak to representatives of the communities which you are targeting. In my view, that is what needs to happen now.

What we need, first and foremost, is a clear strategy. We need a strategy that measures the impact of the messaging that is going on, for example, as to whether it is making any difference. When we have those kind of figures, you would have to say the current approach is not working particularly well. As I say, you need to be able to measure what the response is.

It is critical that there be engagement with migrant groups in order that we know what are the best ways of communication and what are the best channels to use. Because something might work for Irish people and work in this country does not necessarily mean that it will work with migrant groups.

We also know that quite a number of migrants are working in low-paid industries, for instance, seasonal workers, meat packers and fruit pickers, and there could well be significant literacy problems. Not only is there the language issue but there could be a literacy problem as well. That has to be addressed. One of the ways of addressing that would be through using influencers in those communities. We should be engaging with those communities to find out what is the most effective way of communicating.

Obviously, the other issues that arise are in relation to children. We talk a lot about the issues in schools at present in relation to Covid and what is the best thing to do about children, what is the best advice to give them, and what about sending them to school or not. For migrant workers who have children, there is the added issue about advice needing to get through to them, not only in relation to the importance of availing of the vaccine programmes, knowing where vaccines are available and knowing how to go about getting a vaccination, but also in relation to how to handle situations with children.

That relates to getting teenagers vaccinated but also what to do about younger children, keeping them off school when they have symptoms and so on. We must redouble the efforts here because we are not reaching those hard-to-reach communities, in spite of reasonable efforts. Those efforts must now be redoubled. However, the Government needs to find out from a cultural and ethnic perspective, what are the best ways of doing that and seeing what are the best platforms and ways of communicating. I strongly urge the Minister to do that.

There were 3,500 PCR tests available in the Dublin area last night at midnight. That is a huge number. At 7.30 a.m. there was not a single one left. In spite of the huge efforts that were made, we are not meeting the demand that is there. That means people do not have the opportunity to get tested and get advice, and nor do their immediate contacts. It also means that while we are seeing very high numbers every day, inevitably they are understating the situation because there is under-reporting due to the lack of availability of testing. That has to be addressed urgently.

At one point there were no tests available in the Minister's constituency and someone contacted their GP and got a test very quickly. That is great for that person but what exactly is the route to getting tests? If it is the case that you can get one if you go through a GP, that puts further pressure on GP practices. There needs to be clarity on the best way for people to go about accessing tests. Up to the last couple of days, it took at least a week for people to discover that the tests were only being loaded at midnight. Many people went without having tests because that was not known. Overall, there is a shortage.

Antigen testing is a huge issue. I raised it with the Taoiseach earlier today. I was concerned that he seemed to be very definitely rowing back from the commitment that had been given. The Minister said he thought the tests should be available free or heavily subsidised. Today, the Taoiseach did not exactly say that. There was considerable disappointment. We expected the announcement of a scheme after yesterday's Cabinet meeting. That did not happen. We are now told it might happen later this week or next week. However, the Taoiseach did not confirm that there would be a subsidised scheme and that concerns me. Will the Minister clarify that this evening?

Ventilation has been consistently ignored in spite of it being one of the single most important tools that people can use. There is need for very clear advice. The NHS has put out a campaign telling people to treat it as though it is smoke in a room. You open the windows to create ventilation and airflow. It is an airborne virus. People pick it up by breathing it in. The priority must be that as far as possible in indoor spaces, the air is kept clean. There is very little advice on that here - in fact it is rarely mentioned in public health messaging. That is a huge omission. I ask the Minister to address that.

Reflecting on what is effectively two years of tough decisions and lockdowns, it is hard to believe we have societal integrity in the State, particularly when we look at countries very near us beginning to have difficulties with spikes in Covid and then the protests against subsequent decisions. It is testament to the Irish people in their entirety in how they approached this. This Government and the previous Government have approached this from an entirely scientific basis.

(Interruptions).

Shall I continue? The lights are off but the mics are still on so I can keep going.

It is the data centres.

It is important to highlight that the Irish people have reacted to this appropriately. They have followed the science, as has the Government, and continue to do so. It is the only way.

A great deal has been learned in the last year in particular. As noted many times, there is no handbook for society's response either in Ireland or globally. Those tough decisions have been taken with public support and have saved lives. There is really no other issue to be discussed. We have one of the lowest per capita death rates in the world and compared with our European partners we have performed extremely well. When I say "we", I mean the Irish people. At all times, the Government has faced extremely difficult circumstances and has been guided by the medical and scientific community. While there have been a few differences along the way, in the main the vast majority of medics have agreed with the approach adopted.

The vaccination programme has been an extraordinary success both in its uptake and the trust that people placed in it, but also in the work done by the HSE and Department of Health in getting it rolled out. There were some initial supply issues, but in the end we have one of the highest vaccination rates in the world. That is an extraordinary testament to the Irish people. It is imperative that anyone who remains unvaccinated speaks to a GP. They should speak to a trusted family practitioner or, if they have access to an epidemiologist or virologist, they should speak to them. With the exception of those who might have medical conditions or who took a dose and had an adverse reaction, something I am sure has happened in every constituency, by now it is evident given the numbers of vaccinated and unvaccinated in ICU and hospitalisation that there is a clear pathway to ensuring that we continue to protect one another and avoid unnecessary death as a result of the virus.

The recent European Centre for Disease Prevention and Control, ECDC, chart proves that. It shows the level of vaccinations with Ireland at the top of the graph at 93%. Bulgaria is at the bottom with 29%. However the stark reality is that Ireland has 15 deaths versus Bulgaria's 325 per million. The populations are 5 million here and 7 million there, so it is not far off in being an appropriate comparator.

The ECDC also reported on the case numbers in hospitals in Ireland, Luxembourg and Slovakia. It showed that 2.5 persons per 100,000 in hospital were vaccinated with the balance being unvaccinated, which was 7.5 persons per 100,000. Those figures are extremely stark. Some of the consequential death rates around the world, then, are avoidable. To emphasise that, between April and November of 626 people admitted to ICU with Covid 19, some 63% had not received a Covid vaccination. The data cannot be clearer. We must also ensure that the third dose, or booster, campaign is rolled-out with the same efficiency that we saw with the initial vaccination programme, and in particular the use of our regional facilities, GPs, pharmacies and others, to get it out as quickly as is we possibly can. I welcomed, with some relief, the Minister's remark that 300,000 is now the weekly possibility for the third dose programme. That is up from 230,000. However, we must also be cognisant of the different rates of efficacy of the vaccines already administered. MRNA vaccines are more effective in the long term and non-MRNA vaccines, particularly that of Johnson & Johnson, is waning, as the Minister and others have noted.

While the age-based approach is of course the correct thing to do, we must have a conversation about when the cohort who received the Johnson & Johnson vaccine will be vaccinated again.

The Deputy is sharing time with Deputy O'Donnell.

In that case I will conclude by emphasising the importance of antigen testing and the importance of the HSE getting behind it, which was referenced by my colleague, Deputy Higgins, earlier. It is now policy. It is now in the public domain. It is now being used so we need our medical experts to bring the same level of expertise they brought to everything else in this pandemic and get behind antigen testing as well. As a final remark, others have described at length how it is very difficult to get an appointment for a PCR test in Dublin. We need to do considerable work to improve on that.

In the time I have, I want to deal with a couple of items relating to Limerick. They come under the headings of testing and University Hospital Limerick, UHL. On the testing side, we have a testing centre in Ballysimon on the Ballysimon Road and RocDoc in Shannon is also being used. This morning you could not an appointment in Ballysimon. Later today you could not get an appointment either in Ballysimon or in RocDoc. We have an issue. We need a further test centre in Limerick. I ask that request be looked at seriously and that it be put in place. If we are encouraging people to get tests there must be available capacity. I understand the pressures. The Minister will appreciate I follow metrics. This morning you could not an appointment in Ballysimon Road and this afternoon you cannot get one there or in RocDoc in Shannon. That needs to be looked at. We need another test centre in Limerick.

Moving to UHL, the number on trolleys was down to 43 which is a welcome change. A little over a week ago we were at 95. I wish to point to a number of issues. My first request is one I have made already. The Taoiseach has given an assurance, and I put it to put it to Paul Reid of the HSE today as well. I ask that UHL be entitled to apply under the winter preparedness plan for whatever resources are required. For me, the metrics are we have 43 people on trolleys as of today but we have 14 people in ICU. The last time we had 43 people on trolleys was back on 14 November, a little over nine days ago, and the number of patients in the ICU was nine. Thus, we have 43 people on trolleys but we have 47 patients with Covid, so in UHL we now have more patients with Covid than are on trolleys. It is a welcome change with the trolleys but it shows the significance of Covid. Of the 47 Covid patients, 14 of them are now in the ICU. The last time we had 43 people on trolleys, we had only nine people in the ICU. We therefore have a serious problem in UHL with bed capacity. Yes, the 98 beds were very welcome but we got 60 beds that were brought in to alleviate pressures. That is something for which I campaigned for a long time. However, that 60-bed ward is now being used as a Covid isolation ward, and correctly so. Nonetheless, it is not being used for the purpose of alleviating pressure on the hospital itself.

It is not just about bed capacity. It is about available medical personnel, including doctors, especially junior doctors, nurses and medics right across the board. This is something I am looking at. On 16 November, which was last week, we had 95 people on trolleys. Within two days, that was down to 58. I must ask the hard questions. It is a combination of major capacity issues that are historic, the 60 beds being used as a Covid isolation ward and the staff being under immense pressure. They are fatigued, tired and worn out. They have people coming to them who are seriously ill. My ask is straightforward, namely, that UHL be provided with whatever it needs to get through this winter period. It will probably be multifaceted. It will be step-down beds out of the hospital and it will be extra staff. Whatever is required must be provided. We have a 96-bed acute block going out for tender and we will be pushing very hard for that to be funded so we can get it up and running quickly. However, in the interim, we must get through Covid and through the winter period.

My first ask is that UHL can avail of the winter preparedness plan and that it be flexible. It would not just be about looking at going into the community. It would be extra junior doctors, as I have mentioned, coming through so they can deal with the volume of patients presenting. Covid is endemic in our hospitals at the moment. If you have 43 people on trolleys and 47 people with Covid in the hospital, it gives you a dynamic. Of the latter, 14 are in the ICU. Second, we need a second testing centre in Limerick. People are availing of it. The Ballysimon centre and RocDoc in Shannon are now booked up. I ask that the provision of a second centre in the city be looked at seriously.

I am sharing my time with Deputy Cronin. We are lucky in this State to have widespread public support for the broad suite of measures we are implementing. We do not have the same difficulties as other countries have. However, the public want solutions and quicker and decisive action to address the Covid-19 surge. We need to see a much quicker roll-out of the booster vaccine programme. This has been referred to by Government Deputies as well. It needs to be ramped up with additional centres in additional locations, as well as greater involvement from GPs and pharmacies. We need to get up to the pace we were at in June and July. I think the Minister mentioned 200,000 earlier. We should push that up to 300,000 and beyond if possible. We need to gear that up because it is going to be trickier to control this in winter.

We also need to deal with the issue of antigen testing. Workers and families need access to affordable antigen testing on a regular basis. We were asking for antigen testing to be looked at as far back as 18 months ago. Right now outlets are charging up to €15 for a single such test. If you want to slow down the spread of Covid, we need people who are asymptomatic to be regularly testing themselves and to avoid unknowingly spreading the virus. We need greater access to PCR tests for those who have symptoms. We must try to deal with this issue. It is really important people have access to a very accurate PCR test. People are having difficulty accessing the PCR centres. We need more walk-in centres opened so the public can have access to them in order to slow down the spread of the virus.

On healthcare facilities and hospitals, I am aware we came into this crisis with under capacity, with less than half the ICU beds we need. That is accepted now. However, we have had more than 18 months to respond to this. I know the capacity cannot be magicked up as specially-trained staff are needed and it is not as simple as just putting a bed into a room but we must try to improve ICU capacity. We have hundreds of people on trolleys. We have that every winter. We knew this was coming and the capacity issues are nothing new. I highlight to the Minister that in Midland Regional Hospital Portlaoise there are only two permanent ICU beds. There are four in Midland Regional Hospital Tullamore. If you do the maths, with the population ratio of the region, it is way under what is required.

I ask the Minister of State to look at increasing the capacity in Portlaoise and Tullamore hospitals as we move ahead. We put forward a proposal in our budget - we were serious about it and did not do it for fun - for the allocation of funding for 600 extra acute beds, 34 ICU beds and 194 specialist beds at a cost of €124 million. The Government proposed 19 ICU beds and while every bed is welcome, we believe we need to go further than that. Our proposal includes provision for 2,500 extra staff. We need to see that level of ambition coming from the Government.

There has been a lack urgency and some foot-dragging by the Government on this. We are living with a virus for almost two years now, yet we are still trying to play catch-up. We need to be more proactive, we need to get ahead of it and we need to up our game.

When it comes to the new Covid measures, parents in north Kildare and I are still very worried about primary schools. The Minister for Education, Deputy Norma Foley, knows that I have been asking about air quality in classrooms for a long time now. Her most recent reply came back yesterday. I had asked when high-efficiency particulate absorbing, HEPA, filters would be installed in each classroom, given the growing international medical and environmental evidence that is building and the consensus that Covid-19 is airborne. HEPA filtration is an important and effective mitigation measure. The reply came back but, as is customary within the walls of this Chamber, the question remained unanswered. Instead, there was the usual "whatever you're having yourself" about ventilation being part of a suite of measures. What is that suite of measures? Given that there is no contact tracing, isolation, masks or vaccines for that age group, what suite of measures is the Minister for Education talking about?

Covid is airborne. That is a fact, whether this Government wants to accept it or not. Carbon dioxide monitors, pods in the classroom and monitoring do not clean the air. The €57 million that was spent on hand sanitisation does not clean the air and neither does repeating ad nauseam that schools are safe. No more than the Taoiseach saying there was no bank bailout, I am glad the deputy chief medical officer has come out this afternoon and decided to stop repeating that schools are safe. That does not mean we have forgotten about the Minister for Health and the Minister for Education repeating that schools are safe. We know that nowhere is safe in a global pandemic, certainly nowhere indoors.

We have had 14 cases in Leinster House over the past week. There is all this political nonsense while teachers are out sick, children are being exposed to a novel virus when we know very little about its long-term effects and parents are being left in the dark. It is not too late to do the right thing, which is to prioritise clean air in our classrooms. It is penny wise and pound foolish doing anything other than that. Our children need their schools to be open and they need access to education. Schools need to stay open, but they need to do so safely. HEPA filtration is a no-brainer and I ask the Minister of State to put it in place as quickly as possible.

I will share an encounter I had today in the canteen in Leinster House. I spoke to one of the service officers who I had not seen in a considerable time. He said I could mention his name, John. I said I had not seen him in a while and he said that he had been very sick with Covid. It was very touch-and-go as to whether he lived or died. He lived, but he wants to say a big thank you to all the staff in the Mater hospital who saved his life. It just shows that, through this pretty awful virus, people survived and can tell the story. I wanted to start with that good news story.

Many people are fatigued and weary of this virus, but a collective resilience is also going on that has brought us through the worst ravages of this pretty awful disease. Whatever we do next, things hang in the balance. This virus has shown itself to be very adaptable and we have to adapt to it. There is almost a counter-attack by this virus on the world and we need to attack the virus because it is like a war situation. I will be constructive rather than destructive on this issue. I try to be constructive as much as I can because it is collective effort that will get us through the dark days of this dire virus.

A number of issues need to be looked at, including contact tracing in schools and walk-in PCR testing, both of which the Government has let its guard down on, and ventilation, which, as many of us have said, has not really been taken as seriously as it should. Even in the Chamber, many of the windows are open. They are open for one reason; this is a viral condition and the more fresh air that comes into a building, the better the chance that people will not contract the disease.

There are also mixed messages about antigen testing. There is quite a lot of ambiguity on that, and on whether people will or will not use antigen tests and the situations they will use them in. They are a good tool to have in the arsenal against this disease. I will make the comparison to hand-to-hand combat. Sometimes those antigen test kits are needed and they should be freely available. The Minister talked about the cost of them on the radio a few days ago, but that is open to question. Pop-up centres were very successful at the height of the pandemic. Many people used them and they are very useful during this pandemic.

On ICU capacity, I will run this movie forward. I do not want to be pessimistic but if the worst ravages of this disease, as projected by the National Public Health Emergency Team, NPHET, were to result in 400 to 500 people in ICU we would have a serious problem in this country. Doctors and nurses would have to choose who gets ventilation and who does not. That is a pretty dire situation that will, hopefully, never happen but if it does, we do not have the capacity because of the historical legacy of cuts to public health services throughout the past 25 years.

When we come out of this, which we will, and we will come out a stronger people because that is who we are and it is what makes us good, one issue will be access to health services. I do not know the Minister's ideological position regarding public and private health services. My ideological position is that I am categorically for a one-tier health system, not a two-tier system or one of private insurance. I am for a system like the National Health Service, NHS, which is not perfect by any means, but it is the system that produces better results for everybody. Hopefully, at the end of all this, we can say our Irish system gives to everybody regardless of whether someone is on social welfare or is a millionaire.

I will focus my comments on the situation in schools. We have 600 teachers who tested positive for Covid in the first two weeks of November and 10,000 primary students absent from school for Covid-related reasons. In fact, one school in Cork has 100 students who have contracted Covid since mid-term out of a school population of just 765. Why? It is clear that the Government moved to reopen society too quickly and bowed again to business interests on that front.

I do not have time to drill down into that. I will focus on mistakes I believe have been, and are being, made in the schools and need to be corrected. We have a school population of approximately 1 million people. There are 3,000 primary schools and 1,000 secondary schools, with a population that is indoors for the vast bulk of the day at a time when we are combating a disease that is mainly airborne.

The question of ventilation is clearly key. I have been following the comments of Professor Orla Hegarty from the UCD department of architecture who seems to be very sharp on these issues. She has calculated that we would be able to provide best possible defences for the school population, with ventilation measures, for approximately €12 million or approximately €10 per child. That would not just mean keeping the windows open or sharing CO2 monitors but having monitors for every classroom and, crucially, not having just a few HEPA filters but a HEPA filter in every single classroom in the State, which is the position in Germany and a million miles from the position in this State. The situation here needs to change.

In Scotland, Greece and France, for some time now, there has been antigen testing on a twice-weekly basis of the entire school populations. The test kits are sent out to families and they are asked to conduct tests on a Monday and Wednesday. It is not a perfect system - screening systems are never perfect - but it is a good one and way ahead of the position in this State on antigen testing in schools. It seems this is an example that could and should be followed.

I have spoken before about contact tracing and I will not spend much time on it now. It was a serious mistake to scrap the test and trace system in schools. We only have to look at the current case numbers among primary school children to show that was a mistake and one that needs to be fully and completely rectified.

As I have only a short time to speak, I will comment on two issues we will need to deal with going forward, namely, the wearing of masks at primary level and vaccination at primary level. Mask wearing operates in primary schools in France. It seems to work quite well, but seems to be off the agenda for the Government here. That issue needs to be revisited as there would be real advantages in doing that.

Vaccines have been approved for under-12s in the United States. In Europe, we are awaiting a decision from the European Medicines Agency, EMA. If it makes a positive decision, the Government must not look around this way and that way asking what we should do now. The bones of a plan need to be in place in order that we are able to move very quickly on that issue and not pushing it back unnecessarily deep into the new year when a start could be made at an earlier point.

I am sharing time with Deputy Murnane O'Connor.

I remember 20 months ago, in March 2020, we were here debating the amendment to the Health Act 1947 in response to the pandemic that had just arrived on our shores. I know many other Members in the Chamber this evening were here when we were all congregated discussing the amendment of the Act and the emergency measures to be introduced to provide financial support in light of the closure of businesses that was taking place. If we had been told that 20 months later, we would still be talking about the pandemic in this Chamber, our hearts would have dropped. I do not think we expected it to go on for this length of time or that it would be so challenging. At the beginning of the pandemic, we had limited information. If we looked at it objectively, we would be able to look at history and the experience of the Spanish flu from 1918 to 1920. We would note that the Spanish flue went on for two years and there were four waves.

Although the pandemic has gone on longer than any of us would have hoped, we are in a stronger position than we were in March 2020. We now have a huge amount of information about the pandemic. There will not be a pandemic that has as much data prepared and recorded about it as this coronavirus pandemic of 2020 to 2022. We need to learn from those data and see what they have taught us. The first thing we learn from them is that this is a highly infectious and contagious disease. However, we know that Covid cases can be cut down through the imposition of restrictions. The more severe the restrictions, the more likely it is that we will be able to reduce Covid cases. However, experience has also taught us that while restrictions can be imposed quickly, it can take a long while to remove them. It is difficult to remove restrictions once they are imposed.

We have also learned that once restrictions are lifted, Covid cases will rise. If we look at any country around the world where there have been restrictions that have then been lifted, we will see that, inevitably, Covid cases will rise. Such has been the case. It applies especially to colder countries. When one looks at the statistics in respect of Europe, the countries in northern Europe, in particular, are going through this latest surge of the virus.

We also need to recognise that vaccination has transformed the position we were in last year to where we are today. We are now in a situation in which 93% of those eligible to be vaccinated in this country have been vaccinated. We can see the effects of that in the growth of Covid cases since we have lifted restrictions. There has been significant growth in Covid cases, but not the exponential growth we saw previously in the pandemic. We can also see, fortunately, that the number of deaths has reduced remarkably, which must be due to vaccination. We can also see the number of Covid cases going into hospital and ICU is not as great as it was prior to this wave. We are learning more and more information about the virus as we go on. We need to use that information carefully when we come to making decisions in respect of it.

We are now seeing people in Ireland reduce their social interactions and that is having a consequence on Covid cases. I am hopeful we are now going through a plateau period in Covid cases and we will subsequently see a reduction. However, it is important to emphasise there is nothing surprising in the fact that Covid cases have risen in recent months, as a result of having lifted restrictions. What is not inevitable is that they have to keep growing and, fortunately, because of the behaviour of Irish people, that growth has been reduced.

In terms of areas on which we need to have greater emphasis and concentration, we need to ensure we get the booster vaccines out as quickly as we can. We saw they were effective in reducing the wave that took place in Israel a number of months ago. We also need to be aware that when it comes to the booster programme, those who are immunocompromised have to be prioritised and I welcome the fact the Government has done so. The very elderly have now received their booster vaccines and the immunocompromised are in the process of receiving them.

The Minister for Health, Deputy Stephen Donnelly, and the Minister of State, Deputy Butler, are supporters of antigen testing. I raised the matter in the Dáil in April. We have probably been too slow in coming to use antigen testing. That may have been because of the opposition of NPHET and the HSE, but it is now apparent we need to use it as a tool of assistance to us in our response to the pandemic.

A number of Deputies made statements about schools. Obviously, there is an issue of concern about schools. However, we also need to recognise that we cannot overstate the importance of children attending school to their educational and social development and, indeed, their general public health.

It is important to public health in this country for schools to be open and for children to continue to go to school. It is essential for their educational and social development. We saw what happened when schools were closed. Children suffered badly, particularly those with special educational needs.

Something that we probably do not mention sufficiently is that the ongoing anxiety and uncertainty related to the pandemic cause significant trauma for the people of this country. I do not think we recognise the public health implications that the anxiety caused by the pandemic is having for the general population, especially young people.

My concern is the pressure on the health system. I receive calls from people in Carlow asking what is going to happen. It is five weeks until Christmas. Are we looking at a local lockdown? Will schools close earlier? What will happen with businesses? Should people get their vouchers now? If we can, we need to give people more information about what is happening.

I raised issues with PCR testing in Carlow with the Taoiseach, the HSE and the national immunisation advisory committee. At 9 a.m. today, there was not one PCR test available for anyone in Carlow. I have listened to other Deputies and it seems to be an issue across the country. I have had calls from constituents who had symptoms, could not access a test and had to take time off work. They may not have Covid but they are still losing out on work because they do not know if they have it. I ask that we look at what we can do about people who do not know if they have Covid and whose families may have to stay at home.

Regarding the extension of Covid passes, are we not looking at antigen testing as an option, as is the case in many other countries? It is used in colleges and schools. Why not provide access to other services, such as cinemas or gyms? It could be helpful. Vaccinated people can spread the virus as easily as unvaccinated people, which is important. I recently raised with the Minister the matter of a Carlow business which can play an integral part in tackling the crisis. Other businesses have solutions too. People are worried about whether they are doing enough.

People have a genuine fear about the drug being trialled. They are too scared to get the vaccine. It is not that they are being selfish, but that there is genuine fear. I know we are trying to provide information that the vaccine is safe but young people are still nervous. Another group of people I have spoken to includes those who, through no fault of their own, cannot get the vaccine because of medical conditions. One woman told me the other day that she feels she is being discriminated against. She wants to get the vaccine but cannot do so because of her medical issue. I note the European Commission concluded that fully vaccinated people are less likely to die with Covid-19 than those who are not vaccinated. The higher the vaccination rate, the lower the death rate.

I know the matter of schools has come up. I raised it with the Minister for Education previously. Carbon dioxide monitors need to be supplied to schools. Some record inadequate levels of ventilation. I know the Minister is working on the issue. When I was driving to Dublin today a lady from Carlow rang and told me she had been trying to get a PCR test. She said her kids were at home and were coughing, so they had to be tested because they could not go to school. The school the boy goes to will accept three negative antigen tests to allow him back. The other school, which her daughters attend, requires a PCR test. While she can send her son back to school because his tests were negative, she cannot send her daughters to school because the school is looking for a PCR test, which she cannot get in Carlow. Maybe the Minister could look at this issue. I was delighted to hear the news from the Minister about substitute teachers yesterday.

When I get word about the booster vaccine, I will definitely go for it. I encourage people to get it. A man came into my office who had got his two vaccines. He is well into his 60s and has a medical condition but has not received any word on the booster. I ask the Minister to come back to me about this. My understanding is that people have to be referred for the booster vaccine by their doctors. It is not like before when we went for our vaccines and were all delighted to go. People got a message by text saying they had an appointment at a certain time on a certain date. I understand the position is slightly different for the booster. I am trying to figure this out. Will the Minister clarify the matter? Can I tell people they will get a referral from their doctor and that it is not like it was previously?

We should compliment everyone in the HSE. We have a good Covid-19 vaccination rate. People say the vaccination was really well done. I compliment everyone involved. It is important that we all get the booster. I will go straight away when I get word about it. People are worried about the current setback. We could give them more information. Many people ring me about Christmas asking what they can do. I ask that we keep that in mind. I thank the Minister.

Cuirim fáilte roimh an deis labhairt ar an ábhar seo. The Government is failing the Irish people in its response to Covid. While we in Sinn Féin agree with the approach of following the available medical advice, the Government is slow to share this advice. Yesterday's briefing to the Opposition by the Chief Medical Officer was a welcome development but communication must improve. There is a lack of planning and leadership by this Government. There is no strategy that I can see except for the kite-flying that we have seen, the latest example of which is the subsidising of antigen tests. There is no sense of urgency in the Government's approach. Keeping the health service functioning must be a priority. Why is it business as usual for private hospitals while public hospitals have widespread cancellations of surgeries and appointments? Waiting lists were bad enough before the pandemic. Urgent action must be taken before we reach a tipping point where a return to normal services becomes an impossible task.

The Government must do better with workplace planning in the health service. I have spoken with front-line workers. They do not feel appreciated. We have had suggestions of various one-off bank holidays, including suggestions for a thanksgiving holiday, with the latest being that we have a black Friday, a toy show day and whatever else. There was a crazy suggestion of a trip to Leinster House. Surely front-line workers have suffered enough. They want the health service to be fixed. They want a normal place to work where they do not feel they are under constant pressure. They do not want gimmicks. They just need what they deserve.

The testing system is broken. A friend of mine went to the HSE website yesterday to book a Covid test. Thankfully, my friend did not have symptoms but needed a negative test to be able to undergo surgery later in the week. They tried to book a test on Sunday, Monday and Tuesday in Kildare. There were no available appointments on three successive days. Yesterday, my friend tried Offaly but no appointments were available there either. Then they managed to secure the last available test in Laois. This is not good enough. We now know that 21 centres cannot offer tests.

Why is the Government dragging its feet about ventilation for schools? I know other Deputies have spoken about ventilation. A HEPA filter would make a significant difference to the health of our children, their teachers and special needs assistants. I was in a charity shop a few weeks ago which had a portable air filtration system. Even a charity shop, with its meagre resources, had prioritised the health of its volunteers and customers. This Government must do better.

I want to raise two specific issues this evening, the first of which is testing. In my constituency of Longford-Westmeath, there are no slots available today for PCR tests. People want to get tested. This delay and the inability to avail of a test during the current surge of Covid are unjustifiable. One of my staff members needed to get tested. She was fortunate to be able to get a slot, but that required a 128 km round trip from Athlone because there is no testing centre in the area. Anyone who goes to the website will be directed to the centre in County Laois referred to by Deputy Patricia Ryan.

This Government has no plans to increase the number of testing centres. I have spoken to the HSE locally and I was told it is a national decision and that the HSE has not been given the go-ahead or any hint of a go-ahead for additional testing centres in Athlone, Mullingar or Longford. I raise this issue because Westmeath has the highest percentage on a 14-day rolling average of cases across this country. Longford has the fourth highest percentage of cases. We need additional test centres. Earlier this week, I implored the Minister for Health to put those in place. I am still waiting for a response to that request. I would have appreciated getting it this evening but the Minister has left the Chamber.

There is another issue. From the beginning, we have been hearing from the HSE about the importance of hand hygiene. There are still 17,500 people in Longford on a boil water notice. Most of those who have underlying conditions are terrified not only of the pandemic but what is coming out of their taps.

I will move on to schools. While I welcome the introduction of antigen testing in schools, finally, this is not good enough. There needs to be change. We need to move to a place where schools feel supported. We all agree that children were out of school for too long, but the principals with whom I am engaging are telling me they feel abandoned. To add insult to injury, the Minister of State, Deputy Troy, was on national television trying to tell people that schools were funded for HEPA filtration when the funding was for CO2 monitors. One principal I spoke to got five monitors, two of which, straight out of the box, did not work and three gave different readings while hanging in the same room. We all want and need proper HEPA filtration systems in classrooms. They need to be put in place as soon as possible.

One of two things are happening here. This is either chronic bad management and a lack of leadership or it is the first step in the Government accepting what Dr. Ronan Glynn said earlier about Covid being out of control and moving to a stage of assuming and accepting that we will all get it.

The next slot is being shared by Deputies Verona Murphy and Fitzpatrick.

In the first days of Covid, in February 2020, we were a country gripped by fear of a pandemic for which we were ill-prepared. The scenes from Europe alerted Government in Ireland that we did not have a plan to deal with a pandemic. The Government decided that to prevent the spread and allow it to prepare, time and money was needed. We locked down, private hospitals were taken over to ensure bed capacity, preparations commenced to put in place a gold standard test, trace and isolate system, and capacity was increased to ensure we could contain the virus, reduce spread and increase ICU capacity. The motto was "No stone would be left unturned".

In May 2020, we had no sight of a plan that the Government intended to reopen. We had to push on the floor of this House for one to be produced. In late October 2020, I raised concerns and questioned the capacity of the test, trace and isolate system. I was told it was more than adequate. Yet, three weeks after opening up in November, it collapsed, and just as Christmas dawned, the country went into the longest lockdown in the EU. In contrast, elsewhere in the EU, antigen testing was being widely used as part of an armoury to allow society to reopen. In March this year, the French insisted that every Irish driver entering France had to provide a clear antigen test to show a clear Covid status or risk being turned back. The French authorities gave the Irish Government a list of over 40 approved antigen tests that could be used. At the same time, NPHET continued to deny that antigen tests were reliable.

There was talk of a vaccine. It would be the Holy Grail. Despite numerous calls from eminent medics and Opposition Deputies, including me, to invoke antigen testing on a widespread basis as the vaccine on its own would not be enough, such was NPHET's disbelief that one of its members described antigen testing as snake oil. Needless to say, those requests fell on deaf ears. Twenty months into the pandemic, we are still a country gripped by fear of a pandemic for which we are ill-prepared. Twenty months since the Government first said it would implement a gold standard test, trace and isolate system, it has not done so. Today, in 21 counties people are unable to get a PCR test.

The Government said it would increase ICU capacity and implement widespread antigen testing; it did not do so. Public confidence in the Government's ability to do anything but lock down is waning because the most elementary of measures required to contain the virus and allow society to live with Covid are in the same place 20 months later. It has been clear to everyone that the vaccine was a bonus, not a panacea. There is no panacea. Medics predict that this virus will be with us for years. The Government's inability to devise a long-term strategy to allow us to live with Covid is now compromising the health of the nation, with the cancellation of critical transplant operations and almost all other elective surgeries.

I agree with Government that this is a surge. The question is what is it doing about it. In addition, the messaging on antigen testing between the Government and NPHET is now more confused and contradictory than ever. People believe that the Government's default position is lockdown. The Government will say it has no choice and that other countries have failed. We should not rely on the failure of others to defend ourselves. There were choices, but the Government did not make them. If we are to endure another lockdown, can we at least have a commitment from the Government that NPHET and the HSE will devise a long-term strategy, one which must ensure a resourcing of all of the aforementioned and the use of whatever supports are available in the armoury to allow us to live with Covid in the long term once and for all?

I am asking for a commitment from the Minister of State, Deputy Butler, that walk-in test centres will be set up immediately, especially in the 21 counties where PCR tests cannot be obtained. Councillor Jackser Owens, an independent councillor in Enniscorthy, County Wexford, called for this on Tuesday. I have endorsed his call. I am asking for a clear commitment from the Government that this will happen in order that people will be allowed to enjoy Christmas.

I welcome the opportunity to speak. Ireland had its first official case of Covid in late February 2020. Almost 20 months later, we are still fighting this pandemic. Case numbers have rocketed in recent weeks. As we get closer to Christmas, many people and businesses are unsure of what is going to happen. Unfortunately, the message from the Government is not clear. To be honest, it is creating a situation where people are speculating on what is likely to happen next.

We hear members of NPHET making statements daily in the media that appear to be at odds with what Government Ministers are saying. This is adding to the worry of people and businesses in general. We have had a number of lockdowns, but we are back at a point where case numbers are increasing at an alarming rate and hospital cases are steadily rising. We have been led to believe that Ireland has one of the best records on vaccination in the world, yet our case numbers do not reflect that. Surely the Government must learn from previous actions taken and realise that something different needs to be done.

I do not have the answer to solving this crisis, and nor does any Member of this House. We must look to other countries that have managed to contain the virus to see what has been done differently. Simply locking down society is not the answer. We have tried that and each and every time we have returned to the position in which we now find ourselves.

It is important that this issue not be used as a political football by people trying to get publicity. We must all work together, along with the public health advisory team, to ensure Covid is beaten once and for all. My greatest fear in all of this is what is coming down the road for health services. How many people have had medical appointments cancelled as a result of the pandemic? How many people have had diagnoses of serious medical conditions such as cancer missed because of a cancelled appointment? Unfortunately, the answers will only become clear over the next number of years. I hope I am wrong in this but I fear what is coming next. This week, we heard of an organ transplant operation being cancelled because of issues in the health system arising out of the Covid crisis. How many more life-saving and critical medical procedures were cancelled for the same reason?

The public are very weary. People are weary of all the restrictions they have faced over the past 20-odd months. They are weary because they do not know what is happening from one day to another. I have generally supported the Government in its handling of the pandemic. This was a situation nobody could have predicted and there was no roadmap for it. However, having had 20 months to deal with the situation, it still seems like the Government does not to know what to do next. I call on the Government and the Taoiseach to lead this country by bringing forward a roadmap that clearly shows how we can beat the pandemic. The public needs to be given assurances that the measures that are proposed will work if implemented. I know from speaking to many of my constituents in Dundalk and the surrounding area that people want to know how we can get ourselves free from this pandemic. The roadmap needs to be clear and simple, with a clear timeline of implementation. We cannot continue with a situation where there are different messages coming from all parties on almost a daily basis.

To reiterate, we need a clear and precise roadmap. The Tánaiste said recently that the implementation of strict measures cannot be ruled out. The Minister for Transport said a final decision will be made down the line. The Minister for Health has said our situation is not unique and he is monitoring it closely. The Taoiseach stated that the current surge is a dramatic reminder of what this virus can do and that continuous progress in a journey to normal conditions is not inevitable. NPHET has indicated that further measures may be required but it has not specified what measures are needed. I listened to Dr. Ronan Glynn's statement yesterday in which he gave an update on where we are. He said the Delta variant has increased dramatically over the past four weeks, from 5% of cases in June to approximately 70% now. It is twice as transmissible as the variant we were dealing with this time last year. Over the past two weeks, our 14-day incidence rate has increased by 30%, with the five-day average of cases rising from just over 300 to 500 per day. The positive test rate has increased despite the higher numbers attending test centres.

As I said, the measures introduced must be clear and concise and we must have a roadmap. I urge the Government and NPHET to work on a clear plan that will get the country free from this virus. It is not a simple task but we can look to the countries that have been successful, see what they have done and implement the same measures. Simply putting the country into another lockdown is not right. It has not worked on the three previous occasions and we cannot expect it to work now. We deserve to know what is happening and to have an end to speculation. I do not want to walk down the street in Dundalk or Drogheda and have people asking me whether such-and-such is happening on 13 December or 20 December. We need to stop the speculation and get a roadmap in place. I am glad to see the Minister, Deputy Donnelly, is back in the Chamber. We need a roadmap that is precise and we all need to be speaking the same language.

Many Deputies referred to PCR tests not being available in 21 counties. That is the case in the two largest towns in my home county, Louth. The Minister gave a commitment earlier that a pop-up centre will be set up in the area. There are 21 counties in this situation and we know prevention is the best cure. It is very important that we acknowledge that.

This evening, we learned of 3,893 new Covid cases within our community. A total of 43 people with Covid-19 have, sadly, passed away in the past week. There are currently 611 people in hospital with Covid, 132 of whom are critically ill in ICUs. I ask the Minister to imagine for just one second that we could change this. Let us imagine if we were able to bring in a simple and cheap intervention that could decrease dramatically the number of people fighting for their life in ICU, and if we were brave enough to take a bold decision instead of waiting for additional information and evidence that may come to light to satisfy NPHET. The vaccine is most certainly the critical armour in our fight against Covid-19, but vitamin D can also play a role. Yet, I have never once heard the Minister talk about it and it has not even been considered by NPHET since last May.

Emerging global scientific studies show vitamin D supplements are proven to help people fight infection and recover from illness. We know there is too low a take-up of the vitamin in Ireland. Recent studies by the school of biological and health sciences at Technological University Dublin, Trinity College Dublin and the Royal College of Surgeons all suggest that low vitamin D status may be associated with poorer clinical outcomes and increased mortality among those hospitalised with Covid-19. These results complement the data coming from St. James's and Connolly hospitals, where studies were conducted independently and on different patient groups. These scientific studies show that increasing vitamin D intake among the population could be a game changer during the Covid pandemic.

Why is the Minister not recommending that people take vitamin D? Why are high-dosage vitamin D supplements not being given to people presenting at PCR test centres? This simple and cheap intervention could be a mitigation measure that protects our health service at the time it most needs it. It is nine months since I asked the Minister to do this and six months since the Joint Oireachtas Committee on Health recommended he take action on the use of vitamin D in the context of Covid. Let us look at the statistics. Almost half of those aged 18 to 39 in Ireland are deficient in the vitamin. More than two thirds of people over 80 years of age and two thirds of those in nursing homes are deficient. A total of 93% of members of black, Asian and minority ethnic communities are deficient. Considering what we know about the vitamin's role in infection prevention and recovery, through the scientific studies, our level of deficiency does not bode well in the context of the rising Covid numbers as we move into the darker winter months.

The vaccines and other public health measures offer us a very strong line of defence against Covid-19 but vitamin D supplements can offer yet another avenue of protection against severe illness or death. NPHET, through HIQA, examined ten studies out of 909 on this issue and did not even reference them. I am no scientist but I know that is shoddy research and the conclusions are unreliable. Against the backdrop of rising cases, with queues for PCR tests and high hospitalisation numbers, surely there has never been a better time to advise the public to increase its intake of vitamin D.

Public health awareness campaigns need to be stepped up a gear, not just in regard to vitamin D but also antigen testing. We are all too aware that accessing PCR tests is especially difficult right now. I commend the Minister and the HSE on increasing the number of tests available. A total of 207,000 people were tested last week for Covid-19. That is a great achievement but it clearly is not enough. More testers, laboratory technicians and testing centres are needed. There is clear information available about antigen tests, when and when not to take them, but I constantly hear about people with symptoms relying on them. The issue is that many people who have Covid and have symptoms are showing a negative antigen test. They are walking around and socialising unaware they have the virus. It is really important that we follow the public health advice that antigen tests are not a magic bullet solution and should not be used when people have symptoms. A PCR test remains the gold standard and it is the only way to be certain whether someone has Covid. However, it is very difficult to follow this advice when PCR test appointments are so difficult to come by. That needs to be addressed.

A criticism that is constantly being levelled at the Government is that people do not have the correct information relating to antigen tests.

Perhaps it would be helpful to reiterate the information on the floor of the House today. You should do antigen tests regularly if you do not have symptoms of Covid-19 and are regularly in high-risk environments. Such environments include bars, restaurants, cinemas, theatres, concerts, participating in contact sports, multi-household visits and car sharing with people from other households. You should do two tests each week, with three days between each test, because leaving a few days between each test allows time for the virus to show up in your system. If you are designated a close contact, you will be prompted to register to receive free antigen testing kits. I have heard from numerous people that they received their antigen testing kits extremely quickly once they were designated a close contact. We have to give the HSE and the Minister huge credit for that. That is so vital. All the information regarding antigen testing is available on the HSE website. I would highly recommend to anyone who is unsure to take a few minutes to familiarise themselves with it because it is important information. I ask the Government to roll out an information campaign, including videos through social media, particularly TikTok and Instagram, where young people who are more likely to be in these high-risk environments are getting their information. I made the same request of the Taoiseach in the House this morning.

Our vaccine roll-out has been a huge success. However, 7% of the adult population is unvaccinated and that cohort accounts for more than half of the people being admitted to ICU. It is undeniable that it would be so beneficial for our hospitals and our healthcare workers if we encouraged that 7% of people to get vaccinated. It is often believed that those who have chosen not to get vaccinated have made their mind up and are flat-out anti-vax. I do not necessarily think that is the case. We still need to encourage people to take up their vaccinations.

We have had huge uptake throughout all of the cohorts. Yet, there is room for improvement, especially given the number of young people we are seeing in hospitals and in ICUs with Covid-19. We simply must do more to reach out to our younger cohorts. In particular, 80% of 16- to 17-year-olds are vaccinated and 20% of that age group need to hear this message. The vaccine will protect them, and it will protect our health service.

Some 50% of ICU admissions with Covid-19 are people who were born outside of Ireland. That is startling. Those working in ICU tell us that many of their unvaccinated patients originally come from a small number of countries mainly in eastern Europe. Some may have poor English language skills. It is so important that we reach out to those people. Ireland is such a diverse and inclusive community. We need to include them in the public health messaging. I welcome the measures that are being adapted, such as making Covid-19 messaging available in other languages, but it is clear that we must do more to ensure that our new Irish are receiving reliable, straightforward information about the vaccine. They might not be listening to our news. They might not be picking up on our messages. We need to do more to inform them.

At the outset, it is of the utmost importance that we reassure the general public. We need to make it clear that the seven-day positive-test percentage is continuing to fall. In the past seven days, we have tested nearly 210,000 people. Yesterday saw hospitalisations down from 639 to 609. That is still a high number. We need the number to continue to decline to take the pressure off our hard-pressed hospital staff. There is no doubt it is a challenging environment. It is also important that we keep what is still a significant challenge in perspective. We have two to three difficult weeks ahead, but I hope we can avoid further restrictions. Indeed, I hope we can keep the recent restrictions imposed on the hospitality sector under review. Despite what many people think, the Government does not control the media. If the media wants to speculate to its heart’s content about lockdown, there is nothing we can do about that. However, this Government is determined to ensure there is no lockdown coming up to Christmas. I know that is very much on the Minister of State's mind.

The roll-out of the vaccine programme was unquestionably a great success. However, the public needs reassurance on the pace and effectiveness of the booster roll-out. The statutory instrument, as I understand, was issued on 29 October. Yet the indications from the HSE are that we will not be vaccinating people in the 50 to 59 age group until 13 December. That is six weeks later. As far as the public is concerned, it is too long and it is too late. People want the vaccine. They are turning up at vaccination centres pleading for the vaccine. On the basis of the five-month efficacy interval from the time of the second dose of the vaccine, a huge number of the 50 to 59 age cohort are now eligible for their booster, but we are not administering them. Members of this cohort are accompanying their parents to the centres and cannot understand why they cannot also get their booster. It is clear to see that we are not utilising the capacity that we have at our network of vaccine centres. Some of them, I understand, could be administering as few as 200 vaccines per day. I appreciate that the tempo of vaccination will increase from next week as we start to administer to the fourth and seventh cohorts. However, I remain concerned that as many as 900 healthcare workers in the Longford environs could still be awaiting their booster vaccines.

We have heard much discussion today about PCR testing. We need to ramp that up. I know there is a huge logistical and staff effort involved, but there has to be an opportunity, particularly over the coming days, to roll out more mobile and fast-moving PCR testing teams as quickly as we can.

A great surprise over the past 19 months has been the number of people who have acquired medical degrees online, because it seems everybody has the solution and everybody is able to tell the Minister what he is doing wrong. However, there is only one real solution to the problem. That is ramping up the roll-out of the booster. Our messaging over the past ten days has not been the strongest. The public needs and deserves clear and reassuring messaging over the coming days. I believe we will cautiously turn a corner over the coming three weeks. However, I urge a ramping up of the roll-out of the booster campaign over those three weeks.

We will go back to the Sinn Féin slot. Deputy Paul Donnelly has two and a half minutes.

This evening I would like to address the issue of confusion about Covid-19 in schools. It is compounded by the repeated assertions from the Minister for Education that the situation in schools is fine. We know from repeated messages from parents that everything is far from fine. Teachers, special needs assistants, cleaning staff and parents just want honesty. Yesterday alone, I received first-hand reports of schools with three classes where there are more than four positive cases of Covid-19. Two of these classes were in the same school and teachers were out on sick leave. The principal was forced to close two of those classrooms and send the children home due to an outbreak. Schools have been struggling for months to get substitute teachers. I welcome the Minister's comments yesterday and the action on this. However, a simple strategy for substitute teachers when the schools came back in September would have given people confidence and much-needed support.

Communication between schools and parents is also verging on the comical, with coded messaging being given to parents regarding outbreaks of Covid-19, because the word “Covid-19” is prohibited. I will give the Minister an example of how ridiculous this is. One of the local schools in my area of Dublin 15 has said:

We have been told by the Government, the Department of Education and the HSE not to inform parents of any Covid-19 positive cases in the school. In fact, the only way we now hear about positive cases is when the parents of a child are kind enough to inform the school. Even then we cannot pass on the information. However, I have been thinking about this for a while. In Ireland, we are always allowed to talk about the weather. So, here is the weather forecast for our school in St. Luke's at the moment. The weather can change quite suddenly and at any given time. Please take the necessary precautions if you think your child is experiencing any symptoms as a result of the weather. Book a test if necessary. It is raining in junior infants class and senior infants class. It is raining very heavily in sixth class and in second class. We are monitoring the weather in junior and senior infants.

If that is the way schools are being forced to communicate, we can see how bad the situation is at the moment. I have spoken to many teachers and principals. They are talking about contact tracing and isolation. It is taking far too long to roll out the antigen testing. We have been talking about HEPA filtration systems for months. We know they are needed in all classrooms. As the Minister can see, things are not fine. Teachers, principals, special needs assistants, secretaries, cleaners and catering staff who show up for work daily need clear and concise plans.

It has been said straightforwardly by many others that we need a straightforward, coherent plan. People are incredibly worried at this point in time. The people who work in the health sector have done amazing work. They are under incredible pressure at the minute.

Our health sector started with a lack of capacity in the primary care system, the hospital system and ICUs. We are dealing with that and are therefore starting from a bad place. When I refer to having a coherent plan, I am talking about vaccinations. Vaccinations have not been the game changer we wanted them to be but they are still huge from a health point of view. The follow-up to them is boosters. I do not like extolling the virtues of Israel, but many people will have seen the triangle graph which showed Israel on an upward trajectory of Covid infections. It then followed through with its booster campaign and suddenly we saw the bottom end of the triangle as the cases started to go down significantly. That is what we need to get to, which means boosters across the board. We need the Minister to engage with NPHET and NIAC, and we need to make sure we have all the capacity we are going to need. We must also utilise the capacity we have, that is, the mass vaccination centres, pharmacies and GPs. It is about using all that we can. I accept that we also need to deal with the wider issue of vaccinations across the world, whether that is through the TRIPS waiver or just ensuring that the capacity is there by whatever means. None of us is safe until all of us are safe.

We have all bored each other about antigen testing. We will all go back through the material on kildarestreet.com to see who said it first but the fact is that for a significant period we have known that we need a greater element of antigen testing. We need to facilitate it as much as possible. That means using it beyond schools and close contacts for everyone who is going through their life at this point. It is another tool that can catch mistakes. We are having difficulties with PCR testing. In County Louth, Dundalk, Drogheda and Ardee have significant issues as regards infection. We need pop-up clinics, and we need to do whatever we can to bring ourselves to a better place.

After one of the longest lockdowns anywhere in the world, compulsory mask-wearing for almost 22 months and the highest vaccination rates anywhere, why are Covid numbers so high right now? So far, neither the Government nor the NPHET experts have answered this question in a truthful and sincere manner. The Government was given time and space, through lockdowns and restrictions on people's freedoms, to ramp up capacity in our healthcare system but it failed to do so. That is shameful and bordering on criminal, especially in light of the billions of euro of extra resources provided to the Government over the past 18 months or so. That money is not falling out of the sky. It is our taxpayers' money. The Minister for Health and the CEO of the HSE have failed completely in their duties. The Taoiseach has failed and the Government has failed. The Irish healthcare system is completely broken, despite spending the highest amount of money of any European or OECD country per head of population on healthcare. If such failings occurred in the private sector, the board and the CEO would be sacked with immediate effect. Here, under this Government, there is no accountability, no delivery based on outcomes for the patient and no transparency. Ireland has the least efficient healthcare sector in the world. This is due to the approach of the bureaucrats who currently govern the country. They are not interested in patient outcomes but, rather, in controlling administration budgets. They were given the power to do so under a system originally established by the current Taoiseach, Deputy Micheál Martin, when he was Minister for Health. The system has failed our people and our hardworking hospital staff, who I thank and compliment for what they are doing. It has failed to put the needs of patients front and centre.

Under the HSE system, the bureaucrats and the middle managers do not care if money can be spent better. They choose instead to manage the devils we know rather than those we do not. We are throwing money at the health service but we are not getting proper management and, to be honest, it is the Minister's fault. He is responsible. He has been given massive powers and a massive budget and he has failed to deliver proper healthcare. He has failed completely in his role. Time and again, we in the Rural Independent Group, along with the leader of our group, Deputy Mattie McGrath, have made very sensible proposals and suggestions, which at all times the Minister chose to completely ignore. I do not know why he did this. It is a case of the Minister's way or no way and his way so far has failed. In life, all a person can do is their best but, unfortunately, with regard to this issue, the Minister's best is not good enough.

Our healthcare system is at breaking point almost two years into this pandemic. On 21 November 2020, we had 344 cases of Covid. Fast forward to 21 November 2021 and there were 4,181 cases. On 21 November 2020 we had 273 Covid patients in hospital, while on 21 November 2021, we had 668. On 21 November 2020 there were 32 Covid patients in ICU and on 21 November 2021 there were 125. The Taoiseach recently stated on Newstalk that if we all collectively behave, this too will pass. That was utterly condescending of him. The reality is that the general public have behaved. In fact, the public held firm and followed all the rules. It is the Government that has failed to play its part by not delivering on ICU beds. What the hell has it spent the €28 billion extra Covid money on? Ireland needs 200 additional ICU beds to bring us up to even the EU average.

The true cost of the pandemic will probably never be fully quantified. The knock-on effects of prolonged shutdowns are immeasurable. The Government has handed itself extraordinary powers and the members of NPHET bask in the bizarre celebrity status the media conferred on them from the start. The mixed messaging and lack of transparency coming from the Government is ridiculous. People are terrified, businesses are going to the wall and people do not know whether we are going into another lockdown. Some of the key measures we need are a return to testing and tracing and increasing our ICU capacity. You would like to think that this would have been done by now, nearly two years later. We also need free antigen tests and clean air systems in schools. Professor John Crown has argued, "We do not have the worst quality of healthcare in the developed world, we have instead the worst managed healthcare system in the developed world, run by technically deficient, medically illiterate bureaucrats." That is what he stated recently and it is hard to blame him.

I have to bring up the confusion faced by businesses that do not know from day to day if they are going to be closed next week. There is a major issue here and it is not being addressed. There are rumours coming out from the Government that there might be closures from 13 December. We have to dispel those rumours because these businesses are hanging on by a thread in the context of their very survival. That is the simplest thing the Minister can do. Everybody has to be careful, take care and follow the guidelines as best we can but some confirmation as to the future of people's businesses needs to be announced by the Government going forward.

Seven or eight months ago, when we were in the convention centre, I was the first Deputy to hand over a booklet to the Government and to the head of the Oireachtas about purifier air systems for schools. I asked for some of them to be put into Leinster House so we could return to this Chamber. I was the first person to do this and I have not yet received any feedback from the Government or the Oireachtas on those machines. Now in some schools, temperatures have gone down to 7°C or 8°C in classrooms because of ventilation. Eight months ago, I brought this to the Government's attention and nobody listened. Now every Deputy in the House is talking about ventilation systems for schools. Eight months ago, the man from Limerick told the Government about this and gave it the booklet for it and now everyone in the House is on about purifying air systems for schools. More than one concerned teacher contacted me last week. There are schools that do not have the adequate area for students to social distance so the teenagers in secondary school are being asked to leave the school and stand in different pods around the school during their breaks.

Some of them are out on wet grass and are then asked to come back into school and sit down with wet feet. They are already cold but the windows are open to ventilate the building such that the school is at only eight or nine degrees. I have also been told of schools that have closed their canteens because there is not enough room to allow for proper distancing when students are going in and out for their breaks. Vulnerable children are doing without food because of circumstances at home but schools have closed their canteens because of Covid guidelines.

I ask the Minister for Health and the Minister for Education to talk about the mental health of leaving certificate students who are afraid because they have missed so much time in school and their exams are coming up shortly. Students who were in third year when Covid struck are now in leaving certificate year but have never sat a State exam because of predicted grades. There are massive mental health implications, not only for the students but also for the teachers. Teachers are telling students they are so far behind because they have missed school time over Covid and over being close contacts. Parents are at the end of their tether worrying about their children. Children are leaving school and going to after-school study six and seven days a week to try to catch up because they have been told they are so far behind.

The Government must make a decision on predicted grades now. It must make a decision now because this year's students are trying to compete with those who got predicted grades. This is a mental health issue. It concerns the mental health of our teachers and students and will be with us for years to come. The knock-on effect is that third years have not sat State exams. This will be a mental health problem for years to come. I ask the Minister for Health to discuss predicted grades with the Minister for Education for the sake of mental health.

I thank the Minister and Ministers of State for being present. Having listened to members of the Opposition, I am very tempted to look back at the past year and where we were this time last year or a little before that, when the world felt a vaccine would not be available until now. To the Deputies who say the Minister has failed and the Government has failed to look after its people, I would point to the 93% to 95% vaccination rate, which includes those who are doubly vaccinated. The chief executive of the HSE was in the House this morning and told us that in excess of 600,000 booster vaccinations have gone out, with huge progress being made in relation to those who are immunosuppressed and those who have underlying health conditions. By Christmas or late December, we are all hopeful everybody who has had a second dose five months ago or more will be in a position to receive booster shots as well.

I look at all of the supports that the State correctly put in place for those in business. I have just come from a parliamentary party meeting where the Minister for Public Expenditure and Reform, Deputy McGrath informed us that to date, €8 billion has been expended on the employment wage subsidy scheme, EWSS, and rightly so, and hundreds of millions of euro have been expended on the pandemic unemployment payment, PUP. This is not a case of the Government saying, "Look at what we have done for you." This is only right and proper. It is the fulfilment of the unwritten contract that exists between the State and its citizens that holds that, in times of trouble or crisis, the State defends and supports its citizens, particularly the most vulnerable.

Earlier today while the Minister was in the Chamber, a number of parliamentarians from my own party met representatives of the Licensed Vintners Association, the Vintners' Federation of Ireland, the Irish Hotels Federation and the Restaurants Association of Ireland. The Acting Chairman, Deputy Crowe, was there and he, along with others, is cognisant of the fact that public behaviour, involving people pulling back from attending indoor settings, is having a detrimental effect on the hospitality sector again. Once again, the Government that does nothing according to the Opposition, in the form of both the Taoiseach and the Minister for Public Expenditure, following a motion tabled by me and some Senator colleagues, met representatives of the hospitality sector. There was no question but that they would meet them.

There has always been an agility and flexibility on the Government's part in dealing with the Covid crisis. Today, another member of the Government that has done absolutely nothing according to the Opposition, the Minister for Education, Deputy Foley, has moved to deal with the crisis of teacher supply and substitution in our school system. She met the higher education institutes, colleges and universities that provide teacher training faculties and pushed an open door on the part of the colleges and their administrators and the student teachers in their third and fourth years who have made themselves available to plug the gap that is causing so much anxiety to principals, parents and teaching staff throughout the country. The Minister has now ensured hundreds of supply teachers will be in place to provide supervision and teaching, over and above the placements students already provide as part of their teacher training.

All of this has been done against the background of a cyberattack. This country's response has been remarkably calm and that has been in part because of the calm, non-knee-jerk reaction of its leadership. Calm, level heads have ensured the country, by and large, has been kept safe. Remember that last year we were beginning the learning curve of our mistakes. We opened up and then realised we should not have done so. The figures came back to haunt us and January was an especially dark month. One significant difference, among other differences, between this time last year and now is that 95% of the country is vaccinated. We have known from the start, through NIAC and NPHET, that vaccines do not prevent contraction of the virus but they do prevent serious illness, hospitalisation and death. Imagine the situation we would be in now, with cases at their current levels, if the vaccination programme had not been rolled out to the extent it has been.

I remember saying at the Oireachtas health committee, when the extension of emergency powers came up previously, that this is not Putin's Russia. I have not heard any hue and cry that has overwhelmed me as a constituency politician or that has caused me to believe that vast swathes of people in the land are concerned and anxious about the manner in which the Government is behaving in relation to this legislation. In some cases, the public would possibly favour legislation that goes further. I certainly think they would favour legislation to ensure rigorous enforcement of the vaccination certificate rules. Imagine the civil liberties furore to which that could potentially give rise.

While we cannot rest on our laurels, we can take some comfort from the fact that as constituency politicians, we tend to have a reasonable idea of what the public are thinking at a given time, particularly in terms of their contacts with us, and the overwhelming majority of emails coming into my inbox are related to everyday issues. I am dealing with passport issues, as are my colleagues, which is a good sign and shows that people still want to travel. I am dealing with business-related issues, especially from the hospitality industry which is suffering significantly.

This issue was raised at the Fianna Fáil Parliamentary Party meeting tonight and both the relevant Ministers and the Taoiseach have responded very positively to it. I could not score the Minister and his colleagues more highly for their own stewardship. They are continually available to their colleagues and they have responded way above and beyond what is required, especially in terms of the hours the Minister has put in. When we questioned the CEO of the HSE this morning, he talked about an exhausted healthcare system and an exhausted human resource in the sector. I think of the politicians, the administrators and all the officials in the Department of Health in particular, because this is the Department we are talking about tonight, whose staff have worked tirelessly. We had some bellyaching about pre-legislative scrutiny in recent days at the Oireachtas Joint Committee on Health, with no regard whatsoever for the man and woman hours the officials have been putting in and the demands being placed on them on a daily and weekly basis to produce legislation that will pass muster, stand up to the scrutiny of the courts of the land and stand the test of time.

I wish to return to an earlier point and finish on it. We live in a vibrant, open democracy which, by and large, has served us well and where if a Minister or an official was trying to pull a fast one, it would get exposed pretty quickly. There are bodies such as the Irish Council for Civil Liberties, for example, and, as I suggested this morning, I have no issue with inviting them in before the Oireachtas committee to enable them to voice their concerns. I have no doubt if the system could have produced legislation more quickly, it would have done so. We are living through a pandemic and a national emergency yet life for a great number of people, while ridden with anxiety on a day-to-day basis, is as close to normal as could be expected in the circumstances. Businesses are running. Hospitals, which had to shut to elective and routine procedures and non-Covid procedures last year are dealing with them, by and large, this year in spite of the surge. Doctors, nurses and ancillary staff are at work. Schools remain open. Today's decision, supported by the higher education institutes, will ensure please God, barring a catastrophe, that those schools will continue to stay open and that children from five to 18 years will continue to receive their education, go through the State examination process and sit their examinations in sunnier times in June.

The Minister, Deputy Donnelly, and the Minister of State, Deputy Butler, who is also present, continue to do exemplary work. They have the support and confidence of this side of the House. We live in extraordinary times and have extraordinary stories to tell. They should never mind the begrudgers. There is a very positive story. When the history of this time is written, historians will see that the people of the country were dealt with and cared for by people to the best of their ability. We did not get everything right, but it was not for the want of effort. They kept the country safe and continue to keep it safe. Who knows what kind of slings and arrows remain ahead of us, but we have been well protected and cared for on the official side by our scientists, medics, physicians, nurses, teachers and politicians, who get so little credit for being responsible for steering the country through these very difficult and challenging times?

I wish to share my time with Deputy Joan Collins. We will have five minutes each, but if our colleague comes in it will go down to three. I will proceed as if it is five minutes for the moment.

That is perfect. Is that agreed? Agreed.

I will take up where Deputy Lahart left off, but first I wish to say that I make my comments, as always, fully in the knowledge that we have a pandemic and that the number of cases to date, as of 20 November, is 538,255 - obviously it is a little bit higher now - there have been 5,609 deaths, 609 confirmed cases in hospital and 130 in ICU. That said, I wish to look at the comment made by Deputy Lahart on "begrudgers". Twenty months have passed since the introduction of the first Covid legislation. Around the same time, the idea that people would be discriminated against on the basis of their Covid-19 immunity status was described as "a scary possibility" in April 2020 by the WHO special envoy on Covid-19, David Nabarro. He said: "It will be a frightening schism. Those with antibodies will be able to travel and work, and the rest will be discriminated against". We have proceeded with that discrimination. It is at the point where it is accepted, and I have a great problem with that.

Let me deal with other matters first in my few minutes. As the Minister well knows, I come from a city and I have repeatedly asked the Minister about respite services and day centres there, which remain closed despite the vaccination rates we have of 92% and the praise we have received for that. I would have thought that any civilised society that learned from its mistakes would put the vulnerable first. I would class them as the most vulnerable, but they are certainly not being treated in that way.

I come from a city where the news today was that public health nurses are not available to visit mothers who have just gone home from hospital having had a baby because we do not have enough public health nurses.

I come from a city where people are waiting for an MRI. There is one MRI machine in a hospital that serves almost 1 million people. In 2013 my sister died. I will not go into that now, but she was waiting for an MRI. I rang for her at that point to find out that there were 36 others waiting for an MRI in June 2013. Here we are in 2021. I do not think begrudgery is part of my make-up, but things must be put in context. The pandemic came on top of a creaking hospital system that was falling apart and that remains the case.

Twenty months on, the legislation continues without any review. The Irish Council for Civil Liberties has made its concerns about this emergency legislation repeatedly known and the fact that there has been no human rights impact assessment on the vaccination certificate. There has been no assessment of the efficacy of the vaccination certificate in curbing the spread of the virus, so there is no relation to what is targeted.

The Oireachtas Special Committee on Covid-19 Response completed its work more than a year ago, but there is still no action. It highlighted that in the urgency of the pandemic vulnerable people were forgotten. It recommended strongly on a cross-party basis – I do not think any party objected – that we analyse and examine why the vulnerable were not protected in nursing homes. That did not happen, and it still has not happened.

I have repeatedly asked for a proactive debate in the Dáil to look at all aspects of the matter, vaccination being just one element in a whole approach to dealing with the pandemic and the pandemics that are to come, because of the way we behave in society, looking on it as if we can endlessly extract, which we cannot. We know that from climate change. We have never had a proactive debate in this Chamber looking at all of the measures. We proceed from crisis to crisis. This crisis has come once again because the Government has utterly failed to plan, prepare or anticipate or to come back to us regarding public health and tell us what has been done since, regionally and locally and in cities so that we have a public health system that we can believe in when we hear them talking to us in Galway and in the region. The Crowe Horwath report was completely undermined as well.

In my remaining 20 seconds I wish to point out another inconsistency. I have received no reply from the Minister to this. On 11 November the Chief Medical Officer wrote a letter to the Minister including many important points. Based on the advice provided by HIQA, it endorsed the recommendation that the period of presumptive protective immunity following infection would be nine months. Members of my family had Covid and they got a certificate for six months. Could the Minister explain the discrepancy? I am sorry, as I am over my time so I will leave it at that, but I would really like an answer.

It is becoming very clear that the Covid-19 vaccines are not the silver bullet we thought they were going to be or could be. Despite our 93% vaccination rate, we are now in a fourth wave of what may be more of an endemic than a pandemic. I believe Covid-19 is here for the foreseeable future, with all that entails, such as future mutations and new variants.

Currently, Europe is at the epicentre of an outbreak. Despite our generally high vaccination rate in comparison to only 8% of the population of Africa, a new wave of Covid on that continent could be devastating and with consequences for the rest of the world. It seems there is a variety of reasons for the current situation in Europe - relaxation of restrictions, opening up, pandemic fatigue and slippage regarding masks, social distancing and socialising, and also the waning of vaccine efficacy. There is a relatively high number of unvaccinated people throughout Europe and high rates of Covid among children aged five to 11. It struck me when I saw the report from Dr. Tony Holohan that this is the highest group in terms of contracting the virus.

Again, as I said, there is no silver bullet but we know that certain things work in keeping infection rates relatively low, preventing serious illness and death, and maintaining a reasonable level of normal life and economic activity. Vaccines are a key weapon but there are many comments coming from certain sections that vaccination is not the answer we were told it was and that people are right not to get vaccinated. However, the number of people in hospital compared to the level of infection in the community, and the number of people in ICU, unfortunately, proves that the vaccines are having a big effect. If we were in this position this time last year, we would be devastated as a country and our people would be greatly compromised by the virus. We have evidence from Israel, which had 8,000 cases a day and 500 in hospital with serious problems in August and September. The booster roll-out has reduced this to 500 cases a day and 29 in hospital, with just 75 of the positive cases among the unvaccinated.

We have been very slow to act on boosters and the Minister has to take that as a positive criticism. We do not really know why. For example, in Inchicore, the cohort in their early 70s are getting vaccinated this Saturday but it has been a couple of weeks since it was announced they were going to get vaccinated. We moved much more efficiently during the general vaccine roll-out. Among people in their 60s, I have heard of people aged 63 who got the booster but others have not. It seems very erratic. I know the over-70s are getting the booster through their GPs and those aged 60 and over are getting vaccinated in the centres. Is there a problem in that people got vaccinated through their GPs previously, but GPs are handing over the information to the HSE to get people in quickly?

I was delighted to hear the Minister say that those with underlying illnesses are being added to the cohorts. However, cystic fibrosis sufferers have not yet been vaccinated. Given they are one of the most compromised sectors, it is amazing they have not had their booster yet.

We need to make boosters part of the vaccine pass as people get them. It is common knowledge that some premises are not making vaccine passes a requirement. We know from community feedback that pubs and cafés are not asking people for their passes, which is serious. I asked the Minister a parliamentary question on this issue. I have not heard of one establishment getting closed down because it did not comply with the restrictions, whereas we know certain establishments are breaking the rules. Something is wrong somewhere from that point of view.

I call Deputy MacSharry. Dhá nóiméad.

I encourage anybody listening who is not vaccinated to get the vaccine and to get their booster as soon as it is available to them. That said, and everybody knows me here so it is not personal, there are a couple of things to say. Either Israel is reckless or NIAC is too slow. We are going the scenic route to things. I was vaccinated in May as I had an underlying condition. We knew when I was getting the vaccine that it waned after five or six months. On the basis that we vaccinated the first healthcare professionals in June, we should have been hitting the ground running in July or August and, instead, we started in October. Israel had its fourth wave in June and it peaked in August, and then it hit the ground running with the booster and saw an 80% reduction in its cases by mid-September. Whatever it is, whether members of NIAC need to sleep on it, whether they want to see other countries do it first, or whatever peace of mind they are looking for, it is too slow.

For example, it is quite likely, just applying basic common sense, that we could have to go again every six months. Therefore, what arrangements are being put in place for next March, given the first of the boosters will have lapsed in five or six months? Can NIAC start considering that now, so we are not all running around like headless chickens next June or July wondering why cases have gone through the roof again? That is the first point.

The second point is on restrictions. Nothing undermines public resilience more than mixed messaging, and I have been saying that since April 2020. When I was in the Fianna Fáil parliamentary party, the Taoiseach, in particular, used to take issue and he went out publicly and said I wanted to disappear NPHET. No, I do not want to disappear NPHET, but I think the people could do with hearing one voice.

How much time did you give me?

Two whole minutes.

Yes. I apologise but that is the way it is set out. There will be other chances.

Okay. Thank you for the two minutes.

I call the Minister to conclude.

I thank colleagues for the debate this evening, which has been very useful. I have taken a lot of notes and I have been checking in with the HSE and with the Department as we have gone through the various issues raised. I thank colleagues for the debate.

I would also like to thank our healthcare workers, who continue to do an extraordinary job. This year, there is a level of tiredness in the system that obviously surpasses this time last year because it never let up in healthcare, be it in community care, in our hospitals or right across the system. Our home carers, nursing homes and so forth have done, and continue to do, an extraordinary job. They really have represented the very best of us in this very difficult time.

We must also acknowledge the wider public, who, I believe, are responding yet again to the latest public health advice. In response to this surge, I, the Chief Medical Officer and many others have asked the public to reduce their social contacts, to work from home wherever possible and to take various other measures, and we can see it. Anecdotally, we can see evidence of people doing the right thing yet again, protecting themselves, their families and those around them. It is wonderful to see and would make anyone very proud to be a citizen of this nation to see our country working together again and again in the face of this awful virus. I just wanted to note my thanks and real admiration for the people of this country and everything they continue to do.

I had a closing speech, but what I will do instead with the time is to try to address the various issues that were raised. I will move through them at pace to try to get to as many as possible.

I hear colleagues loud and clear on PCR testing. I met with the HSE on it earlier today. The HSE deserves enormous credit for this system.

It is one of the most comprehensive systems of PCR testing around. Some 210,000 PCR tests have been carried out in the past seven days, which means that about one in every 25 men, women and children in this country has had a PCR test in the past seven days, which is incredible. We are all conscious that some people are not getting them as soon as they go to book them and this causes anxiety. People are symptomatic, they want tests and they are right to want tests. We are asking them to take tests and then they see messages telling them there are no tests available, and this understandably causes some anxiety. We are working to do everything we can to that end. Some four in every five people are getting a test within 24 hours, which is good. The one in five people who are not getting a test within 24 hours are those who are coming to Deputies and who we are representing. We want to see more done for them.

Prioritised referrals are for either close contacts or that come from GPs. Some 97% of the prioritised referrals are getting a PCR test within 24 hours, so that is still a high rate. The median end-to-end times for testing and tracing are still good. The end-to-end timeframe for a not detected test is 1.1 days and for a detected test the end-to-end from contact, through testing, getting the results and doing the close contact work is 2.1 days. The system is still moving very quickly and the people in that system are doing incredible work. Lines of people are coming in hour after hour and day after day to get their PCR tests and the people working in those centres are doing incredible work.

A lot of work has been done on antigen testing. It has a strong role to play, which is why I set up the various groups on it. Those groups have done an awful lot of work to make sure we could get to where we are now. We have clinical guidance on it, extensive training materials are in place and communications on it are ongoing. Antigen testing is being used widely. It is being used in hospitals, nursing homes and many other non-healthcare workplaces. It is being used in schools and colleges and for close contacts. The HSE has sent out more than 70,000 packs to people who are deemed to be close contacts. As well as that, the information we have suggests one in five people in the country are using an antigen test every week. Many of us wanted to achieve the widespread use of antigen testing. That has been achieved as they are being used widely in multiple sectors, commonly by individuals.

I want to go further and subsidise the price. The prices range from about €4 to €8 per test and I want them to be cheaper. That is a price that is affordable for some people but not for others. We also have public advice that says if you are regularly engaging in high-risk activities, which could be close contact sports, going to the pub, going to a concert or any other activity listed on the HSE website, you should use antigen tests twice per week. We have to make sure that they are affordable and that is one thing I want to see happen.

The other thing I want to see is even more communication. The information we have from Amárach Research is stark. For example, it says that of those with symptoms, nearly 70% of them took an antigen test when those people are meant to take a PCR test and only one in three of those people went on to take a PCR test. A serious concern is expressed to me by public health officials that if antigen tests are not used correctly, they reduce the number of people doing PCR tests who we want to do PCR tests. We need more communication in that regard and we are working on that.

On ICU capacity, we started the pandemic with 255 ICU beds, which was not remotely enough. It should have been an awful lot higher. We have done a lot and we are planning to do a lot more. Between this year and next year we will have invested about €52 million in increasing our ICU capacity. We have essentially asked the HSE how many ICU beds it can add, so there is no issue around funding. The HSE is working really hard on this to build the facilities, and the biggest constraint is recruiting and training the ICU staff, particularly the ICU nurses. We went from 255 ICU beds at the start of the pandemic to 297 today. We will add more beds in the coming weeks and months and the plan is to be at 340 ICU beds by the end of next year or early into the following year. That would be a 33% increase in our ICU capacity in a short time and that is as fast as the system believes it can go, but I want us to go further than that. The Department's 2018 capacity report stated that we should have 430 ICU beds by 2031. I stand to be corrected on that figure but that is what I recall. We want to go beyond that and I have secured Government agreement to go further than 430 and to go up to 446 ICU beds. A lot of work is being done and we would all love to have more capacity. I assure the House I am working closely with the HSE on this and it is scouring the healthcare and hospital system to find opportunities to put in more ICU beds.

Boosters are a huge weapon in our fight against Covid and I thank the vast majority of colleagues in the House for their ongoing support in getting the message out to encourage people to take the vaccine and the booster. Good progress has been made and about 630 doses have been administered between boosters and the third dose for the immunocompromised. The majority of those in the highest priority groups, which are those in long-term residential care, the over-80s and the immunocompromised, have either received their booster or been offered an appointment. That does not mean all of them have received their boosters but most have or have been offered an appointment. The next group is healthcare workers and those in their 70s. As of today about half of them have received their boosters and progress is quick on both counts. The next group is those in their 60s and those with underlying conditions. As I said at the start of the debate, it was important to me that those with underlying conditions would start to receive their boosters soon and they will start to receive them next week, which is positive news. About 33,000 of those in their 60s have received boosters to date and that will start increasing rapidly because the five-month period kicks in now. As that comes due, we are building capacity to have well in excess of 200,000 booster doses administered per week through all the various channels.

I want to reiterate the public health advice, which is so important. For any of us who are symptomatic the advice is to stay at home and get a PCR test. If you are deemed a household close contact, you should stay at home for five days and get three antigen tests, which will be sent out by the HSE. People should work from home wherever possible. We have all said we should get the booster and get the vaccine if we are still thinking about getting it for the first time. We should use the various layers of protection when going out, including hand hygiene,coughing and sneezing etiquette, ventilation, the booster, the masks and so forth. Between all of that, the work the Government must do, the work industry must do to play its part and the work we can all do as individuals, we will push this virus back again and protect public health and our healthcare system.