Joint Committee on Health debate - Wednesday, 2 Feb 2022

Update on Covid-19 and Easing of Restrictions: Discussion

Chairman

I welcome the witnesses from the National Public Health Emergency Team, NPHET: Dr. Tony Holohan, Chief Medical Officer; Dr. Ronan Glynn, deputy chief medical officer and Professor Philip Nolan, chair of the Irish epidemiological modelling advisory group.

Before we hear the opening statements, I need to point out to witnesses that there is uncertainty as to whether parliamentary privilege will apply to their evidence if given from a location outside the parliamentary precincts of Leinster House. If, therefore, I direct them to cease giving evidence relating to a particular matter, they must respect that direction.

I call Dr. Holohan to make his opening remarks.

Dr. Tony Holohan

We have circulated a statement. I thank the Chair and members of the committee for the invitation to provide an update on our national response to Covid-19. I am joined by the deputy chief medical officer, Dr. Ronan Glynn, and Professor Philip Nolan, chair of the Irish epidemiological modelling advisory group.

While we are clear that the pandemic is not over, the epidemiological profile of Covid-19 nationally provides a broadly positive outlook. A range of data indicate that incidence is high but has reduced from its peak, and demand for testing and PCR test positivity in the main have also reduced. The number of confirmed cases in hospital has also decreased, with the average number of newly confirmed cases in hospital also reducing. The total number of confirmed cases in ICU, daily admissions and cases requiring mechanical ventilation have decreased. The number of Covid-19 patients in receipt of advanced respiratory support in hospital settings outside of ICU has also reduced. The evidence in relation to Omicron, as well as our experience of it, indicates that the burden of severe health outcomes appears reduced compared to previous waves of infection. In addition, overall Covid-19-related mortality remains relatively stable at this point.

We are in this much improved situation as a result of the population’s engagement with the vaccination programme, and the booster programme in particular, and high levels of adherence to public health measures, as well as the reduced virulence of Omicron. Given this, on 20 January, NPHET recommended a fundamental change in the approach to the management of Covid-19 in its advice to Government. In broad terms, a transition from a focus on regulation and population-wide restrictions to a focus on public health advice, personal judgment and personal protective behaviours was recommended and the Government was advised on the removal of the majority of the remaining public health measures.

In advising that social and economic restrictions could be removed, NPHET stressed that the pandemic is not over and that, with a significant level of infection nationally, Covid-19 still poses a risk to public health. In this regard, there will be an ongoing need to retain some of the public health measures that are still in place for the month of February and those will be reviewed towards the end of this month. Protective measures should remain in place in primary and secondary schools, masks should continue to be worn in all settings where currently regulated for, and we must continue to encourage everyone to complete their primary and booster programmes of vaccination. In this regard, I would urge anyone who has not yet received their booster dose or completed their primary course of vaccination to do so as soon as possible. The main purpose of vaccination has always been to prevent serious illness and death. Covid-19 vaccines continue to prove remarkably effective in this regard, especially for those who have received their booster.

Masks will also continue to play a key role in reducing transmission of Covid-19. It is important that people wear the mask that is most appropriate to them and the circumstances they may be in, ensuring it is well fitted and worn correctly. It remains critical that if people have symptoms of Covid-19 or any respiratory or viral infection, they must self-isolate immediately. Those who are identified as a close contact of a confirmed case need to follow the appropriate public health measures for them.

It is recognised that the removal of restrictions, while very welcome, will cause anxiety for some people. In particular, this may be the case for people who are immunocompromised or more vulnerable to the severe effects of Covid-19. I wish to reassure those who may be anxious that the risks associated with Covid-19 are greatly reduced through vaccination and that, with appropriate caution, they can go about their daily lives. At a societal level, the Covid-19 pandemic has impacted upon the physical and mental health of many. It is important that people are assured that, while the pandemic is not over, it is safe to return to the activities we all enjoy in terms of socialising, exercise and travel.

While, as I said, the outlook in Ireland is positive, the global epidemiology of SARS-CoV-2 is characterised by the emergence and rapid spread of the Omicron variant, continued decline in the prevalence of the Delta variant and a very low level of circulation of the Alpha, Beta and Gamma variants, which are the early ones we had in this country. The evolution of SARS-CoV-2 can be expected to continue, Omicron is very unlikely to be the last variant of concern, VOC, that we will have to face and the global public health risk remains very high. Therefore, we must remain vigilant and ensure that our response is agile and flexible, with an ability to respond rapidly and appropriately to any emerging threat that might arise.

I am grateful for the opportunity to make an opening statement. We are happy to take any questions committee members might have.

Chairman

Thank you. The members know the format. It is ten minutes for each slot and that is for questions and, hopefully, answers within that slot. I call Deputy Durkan.

Deputy Bernard J. Durkan

I welcome our guests and thank them for attending. First, I want to congratulate them on their management skills in handling and dealing with the challenges raised. All credit is due to their team. It is not an easy task, either for the system in general or for each of the team individually. We need to record our appreciation for the job they have done and hope they can continue it.

The uptake of boosters in a general sense has certainly slowed since Christmas and the new year. In the weeks running up to that period, we saw a very significant uptake. That has slowed but, that said, there is a variety of reasons. Taking the proportion of people who have been boosted and the proportion who cannot be boosted because they have recently been infected and who are waiting for a booster in a month or two, we estimate that 80% of all those eligible to be boosted have been boosted. That compares very favourably internationally but, again, there is a proportion of people who have not taken the opportunity. We have to take every opportunity we can to reiterate the importance of being boosted It is very clear from data from the US that the risk of infection among unvaccinated adults, by comparison with those who have been boosted, is five times higher. Their risk of death is 50 times higher. We are aware that the risk of infection from Omicron among those who are boosted is approximately 50% lower, and they are 90% to 95% protected against severe disease, hospitalisation and death. Therefore, boosting really does have a significant impact in protecting people from severe illness. While our uptake of boosters is excellent overall, there are pockets of people who, for whatever reason, have not yet come forward, but of course it is not too late. We encourage everyone to come forward in the weeks ahead to get themselves protected.

Importantly, given where we are with the easing of measures at present, we will all be coming into contact with people around us who are potentially older or vulnerable, so there is an onus on us from that perspective to protect ourselves from infection so we will not pass an infection on to others. While vaccines do not provide absolute protection against transmission and perhaps do not protect against transmission at the level we anticipated this time last year, they are still effective. Compared to all the other measures we have, they are probably the most effective we have against transmission and the most effective in reducing the possibility of infection for an individual.

Deputy Bernard J. Durkan

Does Professor Nolan want to add anything?

Professor Philip Nolan

The messaging in several weeks will be important because people will become eligible to be boosted in the three months beyond their Omicron infection. Hopefully, the disease will be reducing in prominence, but, since people will have it much less on their minds, it will be important for us to remind them to take the opportunity to be boosted when they become eligible in the post-infection period.

Deputy Bernard J. Durkan

I will end on a comment rather than a question. We were very lucky to have the teams we have had in dealing with this virus. They have done very well. The fight is not over yet, however. The next battle will go into another area, that of enabling the health services to combat the waiting times and problems that have backed up during Covid and that were backing up before that. We do not have the luxury of being able to wait for four or five years. The health services in general, therefore, have a serious issue on their hands, that is, to devise a plan to deal with the backlogs quickly, particularly in respect of acute conditions such as scoliosis. It is really embarrassing that they remain on our radar screens and continue to emerge. I have every confidence in our health services despite the fact that they get a lot of criticism. I have every confidence that they are capable of dealing with the issue but the plan must be drawn up very quickly. If drawn up quickly, the response will be dramatic.

Deputy David Cullinane

Good morning to Dr. Holohan and his team. I join in the comments commending them on their work over the past two years. We all know it was a very difficult period for everybody, but NPHET, in navigating through it, had to impose or recommend restrictions that had a huge impact on people’s lives. It was all about keeping people safe. The vast majority of people recognise that and would commend the witnesses on their work.

My first question is one that I hope the witnesses will not take personally and that they might have anticipated: when are we likely to see a winding down of NPHET? Is it likely, and what is the timescale?

Dr. Tony Holohan

That will ultimately be a matter for consideration by the Minister. What I can say is that we still have work to do. We have a further meeting of NPHET to consider the ongoing need for the restrictions still in place, including in regard to schools and mask wearing, under the regulations.

We indicated we would give consideration to that and give further advice through the Minister.

There is an emerging sense and much work being done not just in this country but at a European level. We expect the ECDC will be giving guidance on that. The emphasis in that guidance is likely to be on transitioning from a response very much focused on transmission as well as reducing the severe impacts of the disease to one focused on managing and limiting the severe impacts of the disease based on all the experience but especially the experience of Omicron. Much of the emphasis on that is going to be on, as the Deputy said, what is the right kind of surveillance, what role do things like contact tracing play, who should be tested as part of the surveillance system and then obviously the maintenance of testing for the purpose of clinical decision-making. We still need to test people for clinical purposes to inform clinical decision-making. We are doing some specific work on that as part of the work of NPHET at the moment. We expect to be in a position to give further advice on those matters to Government in the coming weeks through the usual mechanisms and informed by some of the work happening at an international level. Just as his question is suggesting, I think the Deputy will see a move in that general direction. We do not anticipate we are going to continue to be advising the need to test every individual irrespective of severity of symptoms and irrespective of, let us say, how vulnerable he or she might be individually to the disease itself.

On the question of vaccination, the Deputy is anticipating that may arise because these considerations are happening in every country. I wrote to NIAC more than two weeks ago to ask the committee to start to consider what the future of vaccination will be, given we have got to where we have got to in terms of both primary vaccinations and boosters with this programme. What is the continuing need for vaccination? What will be, based on the primary objective of protecting people from severe infections, the need for vaccination on an ongoing basis? Certainly one of the possibilities - and I am not anticipating what advice NIAC will give yet - is we could end up in a less frequent vaccination situation whereby the topping-up, as it were, of one's vaccination is for the purpose of preventing severe infection. It may well be that recommendation is not focused on the whole population but people with particular vulnerabilities.

Deputy David Cullinane

Okay, that is understood. I thank Dr. Holohan. From his perspective, given he was in the thick of responding to Covid, what lessons would he take from how the State was prepared to deal with the pandemic, with respect to both the health service itself and the public health infrastructure? From my perspective, many people stepped up to the plate. I am referring to people in the health services, public health departments, testing and tracing and the vaccination roll-out. We had ripples along the way but, by and large, we had a very efficient system and people working in the system stepped up to the plate. However, surely there are lessons to be learned. I ask the CMO to spend a minute outlining what lessons he feels should be learned and what action needs to be taken to ensure those lessons taken on board.

Dr. Tony Holohan

We will be doing some work on this, as the Deputy knows, but in the interests of time I will focus on the public health aspects. I would be positive about this - and am not suggesting the Deputy's question is otherwise - in the sense that much went well in the stepping up to the plate he referred to. I will pick a couple of examples. We did not have the capacity to do the kind of modelling work we have had and we did not have a plan to create that, even though we had good systems of pandemic preparedness in place. We had to respond on the hoof to try to create that capacity almost overnight. The work Professor Nolan led to develop a capacity with all the best mathematical and analytical brains in the country to put us in a situation to be able to better understand what might happen with the disease is just one of the examples of the stepping up to the plate. A huge amount of that work was done on a voluntary basis, in addition. It was done off the sides of desks by many of these people, whose names are not known at all. They were in mathematics departments and various different places around the country. I offer that one example. For me, it shows when the need arises and the ask is made, people respond. That is one of the really strong characteristics. That esprit de corps was in evidence right the way through the pandemic. When people got tired, including ourselves as two years has been a long time for everybody, that has very much been the hallmark in this country in the way it has not in others. Of course, there are things that can be improved upon and that will be the trick, that is, as we continue to go forward we improve-----

Deputy David Cullinane

I apologise to Dr. Holohan but we are short on time. Will there be a report from NPHET looking at what we did right - and a huge amount was done right - but also at the lessons to be learned?

As we are tight on time I have one final question for Professor Nolan. The most recent meeting we had, and the CMO was on that call, was before Christmas with Opposition Oireachtas Members. It seems on the face of it the hospitalisations we saw in January were on the more optimistic side. Can that be confirmed just so people have a sense of that? Maybe Dr. Holohan will respond very quickly to whether we are going to see a report from NPHET looking back at all of that and the lessons to be learned, as well as what was done right?

Dr. Tony Holohan

The Deputy may have seen the Minister and Government have decided to put a process in place led by Professor Hugh Brady. That is going to very much focus on the kinds of measures we need to take to try to strengthen-----

(Interruptions).

Dr. Tony Holohan

-----and give us the best assurance possible. We will make whatever contribution we can to try to support the work of that group, which is largely independent. Most of the people who make up that group are either from outside the country or have not worked on the pandemic response here. We look forward to that work being completed expeditiously.

Deputy David Cullinane

I ask Professor Nolan to reply very quickly.

Professor Philip Nolan

On case numbers we were at the more pessimistic end. The vaccines did not offer a whole lot of protection against getting infected with Omicron but exceeded expectations in their protection against people getting severely ill and requiring critical care. Thus, the cases tracked our more pessimistic scenarios. Hospitalisations were actually around the central scenario. We peaked at in excess of 1,000 people in hospital but the most important thing was that with critical care admissions and deaths, we were well ahead of the optimistic position. We could not have known that in advance. It would have been foolishly risky to imagine that might happen but we were not only fortunate as it was a critical step when Omicron was coming that the decision was made to accelerate the booster programme.

That protected a significant number of citizens and then those boosters turned out to be more effective than we expected in preventing people requiring critical care or dying. That is a summary of where we are against those models.

Deputy David Cullinane

I thank Professor Nolan for that, and for his work as well.

Chairman

I will move on. Deputy Lahart is next.

Deputy John Lahart

It is good to see the officials again. Before the Chief Medical Officer, CMO, arrived, I was saying that our last session had brought to mind Mark Twain's quote, that "The reports of my death are greatly exaggerated." We were kind of saying, "Goodbye and thank you", but they are all welcome back.

Deputy John Lahart

The Taoiseach has favoured the term "evaluation", looking over the past period as opposed to a critical inquiry in the negative sense. I favour that too.

There were some popular voices who assisted in the transmission of information and who helped to build up a body of public confidence. The obvious one, I suppose, that comes to mind is Professor Luke O'Neill. It has always intrigued me as to who made it on to National Public Health Emergency Team, NPHET, what the process was, whether someone such as Professor O'Neill was ever considered and whether there was interaction between NPHET and people such as him, Professor Jack Lambert and Professor Sam McConkey.

Dr. Tony Holohan

The NPHET first met in relation to this pandemic - we passed the two-year mark last week - on 25 or 26 January 2020, when most people had not heard of this particular virus or maybe some people might have seen some bits in the newspapers of reports from China. We were worried at that point about the potential. We had a certain amount of engagement over the course of a number of weeks to try to determine what was happening, largely among the public health and virology community such as Dr. Cillian De Gascun, Dr. Glynn and I, and a number of senior colleagues in the HSE, and then, when we got to assess that this was something that was not going to go away and we were concerned about it, the formal decision to establish the NPHET was made.

The membership of NPHET has been added to somewhat over time. In broad terms, there are four people from the infectious disease community - one of the individuals the Deputy mentioned comes from that specialty - already. These are consultants in that individual specialty. We have people from microbiology, virology and elsewhere. When the need has arisen in the past, or has been identified, either by us or the Minister, or, indeed, by Government, to add an expertise to that we believe we need, then we have done that. That is the process that has pertained in the course of the two years. It has grown, but proportionately, in response to what has been an unprecedented public health emergency.

Deputy John Lahart

The evaluation might probe that a little further. I have always been interested in that.

Dr. Holohan will not have time to answer this. I do not want him to answer it but I would like a written response. It will form part of the evaluation. I will not call it a change of mind over antigen tests. By the way, I had an experience over Christmas, and many people did, with a particular brand. All I could think of was the "snake oil" reference and I thought there was some truth in that. The information on antigen testing has now been uploaded onto the HSE portal. However, there are legitimate questions to be asked about the delay in seeing antigen testing as having a role to play. I do not want Dr. Holohan to answer it now because I am limited in time but that is something the public would like to have answered.

On masks and children, I have had quite a number of queries with links to reputable medical websites and information that is kind of contradictory. Briefly, could Dr. Holohan say something about masks and children and the efficacy of same and what is underlying NPHET's decisions around that?

Dr. Tony Holohan

I might ask Dr. Glynn to come in on the question of masks.

If the Deputy will permit me a brief comment on the antigen test, and I am happy to come back on any written response, our advice on antigen tests and how they should be used has not changed and never changed over the course of the pandemic. The difference is their use at a point in time depends on the breakdown incidence of the disease. Antigen tests are useful when the disease prevalence is high, particularly when there is a constraint on PCR capacity. They are useful in situations such as outbreaks. We have always advised that. That is why they are in use now but were not being advised, let us say, when the disease incidence was much lower, such as last summer. We were concerned that people were using them and then using the negative test as a licence to do something that they would not have otherwise done and it was not safe, and about green light use. We stand over our advice and it has not changed.

Deputy John Lahart

That is okay. I am only saying that it is something I think will form part of the evaluation but I am happy to hear that.

I must limit Dr. Glynn to a brief answer on the children's masks because I have one or two other questions. We will talk about it again.

Dr. Ronan Glynn

In light of the changing prevalence and incidence before Christmas, we made a recommendation to introduce masks for children over nine. We committed at that stage that we would look at it again in advance of the return to school after the mid-term break and we are doing that at present. That will form part of considerations over the next couple of weeks.

Deputy John Lahart

I refer to the Taoiseach's comments last Friday week when he specifically said that we need to smile again and "we need to sing again". I have had a specific request from a teacher in Firhouse Community College. When will children be allowed to sing again in school?

Dr. Tony Holohan

There are a range of measures in schools and we recommended that those measures would continue and allow us the period of February to give further monitoring to those. We have a meeting due on the 17th and we expect to give further advice. We wanted to allow a period of time to have every child in the school system offered the opportunity to be vaccinated and to monitor what the trends in the disease were over that time period.

The decision making and how NPHET came to the conclusion on antigens is one of the big issues people are asking about. We have asked for a written reply. I am just giving him a chance, if he wants, to expand on it more. If he is happy enough, that is fine.

Dr. Tony Holohan

I will ask Professor Nolan and Dr. Glynn if they wish to come in. I previously tried to answer the question briefly in general terms. I apologise for using up so much of Deputy Lahart's time in answering the question, but it is important that we get the opportunity to articulate our position. We have given that advice on antigen tests. They have a particular sensitivity and specificity. An antigen test is not as good as a PCR test, which is regarded as the gold standard. However, it has the advantage of being rapid, easily accessible and so on. In the hands of healthcare professionals, their use is better than in the hands of the public. Certain tests have been evaluated for their use as self-care tests, so it is based on that.

In general terms, the advice we give is that antigen tests are useful in certain circumstances. They are useful, in particular, in the circumstance of high incidence. Where what we call the “pre-test probability” of the disease being present is high, meaning the chances of the person in the first instance having the disease, the results of the test can be trusted much more in those kinds of situations than in a situation where the disease incidence is low.

The behaviour that we have always been concerned about and that has given us reason to express concern - and we have some data to back this up - is the situation where somebody does the test, particularly a person who is symptomatic, gets a negative result, concludes that means they do not have Covid and then goes on about their business without restricting their movements and so on, thereby putting other people at risk and contributing to disease transmission. That is the use - members may be familiar with this categorisation - as a “green light”. In other words, somebody does the test to give themselves permission to do something as if the test result is negative. We have always advised against their use as green light tests, and I think most international authorities advise against this as well.

The real value of an antigen test is in a high-incidence situation when a person does the test, gets a positive result that they would not have known about otherwise and decides not to go out to the pub, to work, to a wedding or whatever it might be. That is the real value. We have evidence through the Amárach tracker, which is a survey we do every week and have been doing over the course of the pandemic. The committee might be aware that we do this . We ask different questions, depending on what is topical at a point in time. When we go back to about three or four months ago, we see that where a significant portion of people who had symptoms were using an antigen test and had a negative result, that was not being followed up in a number of people by a restriction of movements and a confirmation through PCR, which was our advice at the time.

The public health messaging was focused on trying to improve that performance, and we did see an improvement in that performance. However, the most recent set of data that we have from earlier this week - and I can share these figures with the committee - shows us that about 30% of the adult population report using antigen tests in the previous week. That was as high as 55% or so in the first week after Christmas. Of the 30% using the antigen tests, many of them are in the situation where they have symptoms, and then when they have a negative result they are reporting that they are not self-isolating. I am generalising because I do not have the figures in front of me right now, but this happens in a significant majority of circumstances. We know this situation was also happening in schools, where people using the antigen test when children were symptomatic and a negative result was used as a basis to send children back into school. That is exactly the concern.

It is not about the antigen test per se, but the way in which people interpret and use the result. When it is used in the right circumstances and the interpretation of the result and people's resulting behaviour is appropriate, then we do not have a concern. Our concern is that it must be used in the right circumstances, where disease incidence is high, and then the interpretation of both the positive and negative result needs to be right and inform people's behaviour. As I said, for a period time we can see that a substantial portion of the population with symptoms were using the test inappropriately and then using the negative result to not self-isolate. That is the reason we have expressed concern about their use.

Chairman

Does Dr. Glynn wish to come in?

Dr. Ronan Glynn

To build on that very briefly, I would simply point people back to a previously released report. We have had discussions among the membership of NPHET this morning, but of course there is a very wide membership on the Health Information and Quality Authority, HIQA, expert advisory group, which also feeds in with a range of expertise. I would point people back to its report in September. Many of the key findings of that report still hold true.

Ultimately, we have said all along that antigen testing was most appropriate in high-prevalence settings, outbreak situations or where PCR testing capacity was constrained. All of those scenarios played out over recent weeks, which led to the recommendations that were made on antigen testing. However, the underpinning advice on the use of that modality has not changed over time.

Chairman

That is great. I just thought it would appropriate to elaborate on it. A number of people have told me that, particularly around the Christmas period, they were concerned about meeting elderly people and whatever else. They were starting to use antigen tests and it was an element they felt was part of the safety process. However, I can understand what Dr. Glynn and Dr. Holohan are saying in that it is not the be all and end all. Yet, they were helpful for many families and those who used them appropriately.

Deputy Gino Kenny

I wish the witnesses a good morning and thank them for their attendance. I apologise, as I am competing against this bell. There is nothing I can do about it.

Two years ago, we were in the throes of a general election and the vast majority of people in the State had probably never heard of Covid. Obviously, we got to know Covid very well over the past two years. It has left a huge mark on this country and issues that will probably take a long time to heal. It has been a very traumatic two years for many people. Hopefully, things are looking brighter than they have been in the past two years. Looking at the figures of the people who died of Covid, they are staggering. Some 10,000 people on the island of Ireland, nearly 1 million people in the US alone, and 6 million people worldwide - and counting - have died of Covid.

It is incredible how many people this awful disease has killed. It is not over by any means, but certainly in recent weeks there has been a sea change in people's thinking regarding us being over the worst of the pandemic for now. We must, however, be cautious and adhere to the guidelines.

Turning to another issue, already touched on by Deputy Cullinane, I wish to ask Dr. Holohan about something that struck me when he was making his statement. Perhaps he cannot comment on this aspect, but I ask him to take his doctor's hat off, and, looking back over the past two years, tell us what NPHET could have done differently during the pandemic.

Dr. Tony Holohan

As I said, we have some systems in place concerned with trying to make improvements. I say that because we are still in the middle of something that is still ongoing. While we are not predicting that we are going to see the kinds of impacts we saw previously, we must still be prepared for something else to happen and to happen quickly. As the Deputy knows, the first reports of the Omicron variant began to emerge in the last days of November, and we were then in a very different situation as a country by Christmas. That is an example of how quickly things can happen. We must be ready and we must ensure that we will be able to respond as quickly as that if something were to happen in future.

Compared with other countries, one of the things that has worked well here is that trusted public health advice, and I am not just talking about advice from me but from right across the board, and including colleagues in the HSE, has been to the fore in the response. The public health voice, particularly in the context of the health service and the leadership of the health service, and how the public health message is articulated is the key measure on which we have some further progress to make. There are plans to strengthen that aspect as much as we can.

Every public health system in the western world has been challenged by the scale of this pandemic and, as the Deputy rightly said, its mortality impact. It has been on a scale that we have not seen in many decades. We must now go through a process where we try to figure out how we can do better in anticipating, preventing and responding in this type of context. We will be doing that work assiduously in the coming weeks. We cannot wait until this pandemic is over to do it. We cannot wait until we get to a point when concerns about the potential emergence of new variants have abated. We must try to apply these kinds of measures and try to continually improve our response in this regard.

We have seen a large-scale operational response from the HSE to do some impressive things. We are all aware of the instigation and ramping up of the vaccination and booster programme, the testing and tracing capacity, etc. As we move forward, we must now also ensure that we build all those aspects into a regionalised public health response capacity which is intelligence-led and that will ensure we will have good quality public health data available to public health teams on the ground to enable them to respond as quickly as they possibly can. In general terms, it is a correct principle to say that the earlier it is possible to intervene in the case of the emergence of a new outbreak, the better will be the chance to mitigate the impact of any such infection. I refer to the capacity to spot something unusual happening at a local level and to put in place good measures to try to mitigate the phenomenon developing and to prevent it becoming established as a wider-spread infection.

In addition, given what we know now about Covid-19, I refer especially to the measures to be put in place to protect people who are vulnerable and most impacted by this disease. Unfortunately, we have seen that impact in the case of older people and those with significant underlying morbidities. We must put measures in place as fast as we can to try to protect them in future. Considering the speed at which this variant has shown it is possible for the disease to move, if there were to be new variants of concern, then there is every reason to believe they could move as quickly as this variant. We must be able to respond rapidly and appropriately to any such an occurrence. As a result, we would not claim in any way that we have no room for improvement. Every country in the western world can clearly see there is significant room for improvement in how we can all respond in this regard. That is what we will be trying to do from here on in.

Deputy Gino Kenny

Moving on to the long-term effects of Covid-19, also called long Covid or post-Covid syndrome, symptoms can include fatigue, shortness of breath, cognitive dysfunction, etc. How prevalent is long Covid among those who have contracted the virus? Many people in the State, especially in the past six to seven weeks, have got Covid-19. Some people who get it are fine afterwards. How prevalent, though, is the experience of long Covid and, from a clinical point of view, how concerned is Dr. Holohan with its legacy in the context of public health?

Dr. Tony Holohan

If the Deputy does not mind, I ask Dr. Glynn to respond to that question.

Dr. Ronan Glynn

Broadly, a range of studies has estimated the prevalence of long Covid. To be honest, we do not have a firm view on it yet. It is clear that most people who contract Covid-19 will recover quickly. They will have a form of the illness that will not require them to end up in hospital or intensive care, and they will recover relatively quickly in the weeks following the acute infection. A proportion of people, however, will go on to suffer longer-term symptoms for weeks or months following infection. Much work is being done on better understanding the prevalence of these symptoms in Ireland and internationally. The HSE is instituting an approach to ensuring that people who need access to care for these symptoms will have it. In broad terms, then, it appears that approximately 10% of people may experience symptoms for a prolonged duration beyond the acute period. The rate among children and adolescents, though, seems to be much lower. Unfortunately, we do not have a fixed figure. This topic is the subject of significant ongoing research and evidence synthesis.

Deputy Gino Kenny

If the prevalence of long Covid is nearly 10% among adults who have had the virus, then we are talking about more than 100,000 people suffering the prolonged effects of Covid-19. That is a lot of people. I am not sure that is absolutely scientific as an estimate, but if the prevalence is near that rate of 10%, and, bearing in mind that it is probably difficult to quantify the time it takes to make a full recovery, then it is concerning. I refer to a perfectly healthy adult possibly having symptoms of long Covid three to six months after contracting the virus. What would Dr. Glynn consider the classical symptoms of long Covid to be?

Dr. Ronan Glynn

We cannot say there is a classical picture for the symptoms of long Covid yet. I also express caution regarding the estimate of a 10% rate, because it could be as low as 2.5%. A major study in the UK suggested that 2.5% of adults aged between 35 and 70 experienced symptoms of long Covid after contracting the virus. Equally, the estimated rate in children decreased to 0.3% 0.4%.

The common symptoms mentioned are fatigue, shortness of breath and some problems with cognition. Again, however, the duration of those symptoms and how those affected recover over time remains an area of significant research. I take this opportunity to again drive home the key message that long Covid is a risk for anyone who gets infected with the virus. That is a reality. It is for this reason that we have been doing all we have been doing during the past two years and it is why we continue to emphasise the need for people who have not been vaccinated or those who have not availed of the booster vaccine to come forward and get the jab. At a population level, it is true that most people who get infected with Omicron will not end up in hospital or severely unwell. It is also true, however, that a proportion of people who do get infected will end up in those situations and another percentage, albeit we cannot accurately quantify it yet, will end up with long Covid-type symptoms. Again, therefore, I urge anyone who has not been vaccinated already to get vaccinated now. It is never too late. There will be no judgment if people come forward at this stage and say that while they were not sure previously, they have now decided they want to get vaccinated.

We say that from the perspective of dealing with the Omicron variant now. We do not know, however, what may manifest down the line. We do not know if a new variant that impacts more people more severely will emerge in the months to come. Therefore, although we are moving out of this stage of the pandemic at the population level and the picture is relatively optimistic, we do not know what is ahead.

It therefore remains very important that people protect themselves insofar as they can.

Deputy Gino Kenny

If somebody has got three vaccine doses and is still suffering from long Covid, is there a medical reason he or she would still have those legacy symptoms? We have always said that vaccination is not a silver bullet, but is there any medical reason such a person would still be suffering from symptoms of Covid after six months?

Dr. Ronan Glynn

Obviously, I cannot speak to individual cases but, in general terms, the duration of symptoms people experience seems to be associated with their level of health before they got Covid and the extent to which they had mild, moderate or severe Covid. Beyond that, however, I cannot really give more detail on individual cases, unfortunately.

Senator Martin Conway

I thank the Chief Medical Officer and his team for the fantastic job they have done over the past two years and for their accessibility to us as a committee and as politicians. Their daily press conferences, when they carried them out, were extremely informative, and when they moved to a weekly basis they were still informative. It has been very difficult, and it is important that the work they have done is recognised.

One side of this pandemic - Deputy Kenny spoke about it earlier - is long Covid. Has NPHET a plan regarding long Covid or specific advice as to what the Government now needs to do to help people with long Covid, that is, people who have the symptoms of Covid for a long period? I do not know if there is proper research or information available in numerical terms. Dr. Glynn spoke about specifics. I know of cases in which people have been severely affected by long Covid. What is the witnesses' view on what is being done in that area? Is enough being done? Does more work need to be done, perhaps? The witnesses might comment on that.

I have always been very interested in the weekly research that is carried out and the information NPHET gleans from it. I think Dr. Glynn spoke about it earlier. It is very interesting. I agree, from the bit of knowledge that I pick up when out and about, that when people got negative antigen tests they assume they are free to go, essentially, particularly children in school. I know that the research NPHET did showed that as a particular problem. I would be interested to know what research it is doing at this moment in time. What are the questions it is asking? What are the areas it is concerned about and on which it is doing research in terms of public attitudes and what the public are doing?

Would Dr. Holohan mind answering those two questions?

Dr. Tony Holohan

I will respond to the latter question first and then Dr. Glynn might come back on the question about long Covid in a moment.

There is a weekly survey ongoing. We are looking, as we speak, at the question of the periodicity of that and whether we need to keep that going weekly at this point in time. It is just another feature of all the measures we have in place that we might need to look at. We look at many features of the response, the public attitude to the disease, the level of worries, the views on restrictions and whether people feel that further or fewer restrictions are needed. Those are general questions we have asked all the way through the pandemic. Then, from time to time, we ask more specific and focused questions that might be relevant to a particular set of measures at a point in time. That is where we have been looking more closely at antigen tests and these behaviours. I will give the Senator the precise data because I did not have them in front of me when I spoke to this subject earlier. For the most recent week for which we have data, which was the survey done on Monday of this week, 31 January, 30% of adults said they had taken an antigen test in the past week. Some 14% of the population told us they had symptoms consistent with Covid in the previous week. Of those 14% who took an antigen test and received a negative result, 8% went on to arrange a PCR test and only 22% reported that they self-isolated, which is very low. Therefore, of those people who had symptoms, who then got an antigen test and received a negative result, only one in five of them, in effect, self-isolated. That number has dropped. The number reporting that they had self-isolated was a good deal higher a number of weeks ago. We have tracked that as one important measure. That is what I was referring to briefly earlier. I am happy to give Senator Conway a copy of the full set of questions. We can arrange to make that available to the committee and Senator Conway if that would be of interest.

Senator Martin Conway

That would be great. We have seen what I consider a very worrying situation with the antigen tests. Is there any way around that? Is there any messaging that can be done to get self-isolation back up to an acceptable level?

Also, I think mask wearing is becoming a problem. I travel by train all the time coming up to and down from Dublin because I do not drive, and I have noticed in the past two or three weeks in particular the number of people who are just not wearing their masks, which is very worrying. A train is a very confined space and I would consider it very high-risk. I am not blaming Irish Rail or anything for that because it is impossible to police everything, but it is reflective of a change in attitude among the public. As we move out of the pandemic, there is a challenge in terms of the final public health measures that are in place. How do we communicate and sell the message in an effective way such that people actually listen?

Dr. Tony Holohan

That is a very fair question about antigen tests. Dr. Glynn might reflect on the masks when he responds to the question about long Covid. Regarding antigen tests, we have to continue to do what we can to try to raise public awareness and understanding of the way in which they are used. A lot of the discourse, I know, has been about whether NPHET is in favour or not in favour of antigen tests. We are in favour of them being used in the right circumstances and used properly. We know that there is room for improvement in public understanding of that. To the extent that any of us can influence that, we all have a role to play. The other thing I will say about this is that, as I think the Chairman said earlier, antigen tests are not a silver bullet. There is no one single measure that is a solution to this disease. That is true of antigen tests as well as everything else. We need to try as much as we can over the course of the weeks and months, as we begin to transition in our response, to shift the emphasis away from the test that people get to what people do as the correct measure when they have symptoms. If an individual has symptoms and responds appropriately and self-isolates, that will have a benefit not just in respect of the transmission of Covid but also in respect of the transmission of many other respiratory viral infections and other viral infections. There has been too much emphasis on tests, as though the test itself is the thing that prevents you from getting Covid. The test is only a means of informing your behaviour. Your behaviour and the measures you take as an individual are what is important in protecting you. That will have to be the emphasis as we move on from the very significant volume of both PCR testing and antigen testing we currently have in place, not just in this country but across the world. Does Dr. Glynn wish to come in?

Dr. Ronan Glynn

The HSE is developing a model of care around long Covid at the moment. We can provide a written update on that if that would be of use.

Regarding masks, the advice is still clear that anyone 13 years or older who has a case of Covid or is a close contact of a Covid case should wear a medical-grade or FFP2 mask and that children aged nine to 12 should wear a well-fitted mask. As Dr. Holohan rightly said, it is inevitable over these few weeks that we will see a reduction in compliance with some of the core measures as people sense that we are moving on. Equally, however, I reiterate that those measures were left in place over these weeks because we feel they have a very significant role to play as we try to transition out of where we are at the moment and to get to a more stable level of incidence across the population.

On the Senator's question on weekly testing, another point that is perhaps not that well known is that throughout the pandemic, in addition to the weekly service that we did at population level, we also did very regular focus group work with all the various groups impacted in different ways by the pandemic. All of that qualitative information, whether from parents, older people, younger people, people with disabilities or people in particular vulnerable groups, was fed in, as well as the results of the surveys that we did on a weekly basis.

Senator Martin Conway

I do not have any further questions. I have to run off to the Seanad. I thank the witnesses and their teams for the phenomenal access that they have given this committee. It is much appreciated.

Chairman

I call Deputy Crowe.

Deputy Cathal Crowe

I confirm that I am in Leinster House 2000. At the outset, I wish to join others in thanking Dr. Holohan, his colleagues and everyone in NPHET for their stellar work over the past two years. They have all become household names for good reasons. They have been on our televisions every night shepherding the nation through what has been a national crisis. Some people refer to the pandemic as our Second World War. It certainly was a national crisis. We have had two years of bedding into it. Thankfully, heads are now starting to poke up out of the ground again and we are getting back to some degree of normality. I wish to thank the witnesses for all their efforts in that regard.

My next question is for Dr. Holohan. I have praised NPHET which has done a lot of good work. However, there are some areas in which NPHET and, indeed, the other cogs of public health could be accused of tardiness over the past 12 months. There are two that I wish to reference, in particular, and I hope Dr. Holohan can comment on them. The first is the report compiled by the Joint Oireachtas Committee on Health on addressing vitamin D deficiency in Ireland. We undertook a significant body of work. Expert witnesses appeared before the committee and strong recommendations were made in the report. The report went to NPHET and I think it is with the Food Safety Authority at the moment. The second was the report of the Covid-19 Rapid Testing Group on antigen testing.

Again, it was a Government report - Professor Ferguson's report - and NPHET dismissed elements of it. They were two critical pieces in our national armoury against Covid that I believe there was tardiness in introducing. Will Dr. Holohan offer some commentary months later on the reason for the tardiness and if NPHET has any regrets about the lack of progression on those two areas?

Dr. Tony Holohan

I will make an initial response to the question on vitamin D and Dr. Glynn might be in a position to respond further. In general terms, NPHET has no difficulty and never did with the measures recommended by the committee. They are incorporated into the general advice and guidance on the use of vitamin D and the promotion of that as an issue, in particular among some of the people who were at risk in that regard. We have no issue about that.

On the Ferguson report, the Minister decided to establish a separate process and asked Professor Ferguson to oversee the group he appointed to advise in relation to that, of which Dr. Glynn was a member. We were always fully informed of what was happening in relation to that. In the interests of time, I will not go back over some of the things I previously said about antigen tests. The question for us was never one of whether an antigen test was a good one or not. We knew, within reason, the different performance levels of different tests that were approved and available. It was always about the circumstances in which they were applied, and then also how the result of the test was interpreted by the person who did the test. We were concerned in particular about the circumstances and the level of incidence of the disease. I refer to doing tests that work well in a situation where you have got high incidences of the disease like in outbreak situations or in the kind of high prevalent situation we have had in the course of recent weeks. They are not tests that work well and that we should rely upon when the disease incidence is very low. It is not so much about the tests but about how the test is used and in particular then how people understand that test. I shared some evidence that we have from our weekly survey earlier to show that a very significant portion of people throughout the pandemic who have symptoms use an antigen test and get a negative result and then do not go on to follow the basic public health advice around self-isolation. Self-isolation when you have symptoms is the public health measure that will prevent transmission. Our concern is that some people interpret it in a way that a negative result means that you do not have Covid, and you can go about your business. That is the reason that we have a concern about that, rather than having any difficulty per se with what Professor Ferguson had to say. Dr. Glynn was a member of that group.

Deputy Cathal Crowe

I thank Dr. Holohan and his colleagues as well.

Dr. Ronan Glynn

Just quickly on vitamin D, to be very clear, there are significant levels of vitamin D deficiency across the population, so we would wholeheartedly support any measure to improve supplementation where appropriate and to ensure that people are getting it in the first instance through their diet.

However, we did look at this issue. Our expert advisory group, through HIQA, did an evidence review and it found no evidence to support the view that vitamin D could either prevent Covid in the first instance or was associated with a reduction in severe outcomes for those who were infected.

I am fully on board with supporting vitamin D more broadly, but we have to be careful about how we then extrapolate from that to suggest that it might have a preventative effect for Covid-19 when the evidence does not support that to date.

Deputy Cathal Crowe

Dr. Glynn's point is well made. I appreciate that. I thank Dr. Glynn, Dr. Holohan and Professor Nolan.

Deputy Colm Burke

I thank the witnesses for their presentations this morning. I wish to deal with long Covid, which is an issue other speakers have already raised. I was looking at the progress being made in the UK on this, and my understanding is that there are now more than 80 NHS clinics specifically dealing with long Covid. What is the proposal for setting up specialist clinics in this area? I am not sure if the witnesses touched on that earlier. Perhaps they did and I missed it. There is evidence from several European countries. In one survey, for instance, 40% of patients had persistent fatigue 60 days after first being diagnosed with Covid. Sixty days later, another 30% were suffering from breathlessness. Do we need to set up specialist clinics to deal with this issue because there are many people who have long Covid?

Dr. Tony Holohan

Dr Glynn might respond.

Dr. Ronan Glynn

Deputy Burke may have missed it, but we have offered to update the committee with a report on this later. The HSE is developing a model of care around providing services for people with long Covid. The incidence of long Covid is being debated across the scientific community at the moment. In the UK there is another survey, for example, that suggests that approximately 2.5% of adults aged 35 to 70 years have suffered from long Covid, and it appears that it is much less than that in children and adolescents. The key message to get across is that the best way to prevent long Covid in the first place is to prevent yourself getting infected, and the best way to do that at this point is to come forward and get vaccinated if you have not already. That must remain our key message.

I agree entirely. They have been providing reassurance, explanations and guidance to their patients who are among the vulnerable people we expressed concern about. It is often to the GP these patients had recourse to get the assurance they did over the course of the pandemic. They have been exceptional as far as I am concerned.

Deputy Róisín Shortall

I apologise to the witnesses. I had business in the Dáil where the Social Democrats had tabled a motion so I had to drop out of the meeting for a while.

We might keep the focus on people who are immunocompromised.

Dr. Tony Holohan

That is a smaller group of individuals. As I said, clinical assessments, as well as public health assessments, will be important for those individuals with regard to the measures to be taken, such as vaccinations, medicines, how they respond to symptoms when they have them, and measures that other members of their households might have to take, because there is a requirement for their household members to limit the possibility of them picking up this infection and transmitting it to those individuals. A number of those measures will be required. Many immunocompromised people doubtless have a high degree of understanding of the nature of their immunity and the things they need to do to protect themselves from a range of infections that were already there. Many common respiratory viral infections have similar potential for severe illness from their point of view. They would be practised and familiar with the kinds of things that they need to do to manage and mitigate their own individual risk. It is a matter of adding Covid to those kinds of considerations in order that as they get out and about, they will be conscious of the necessary basic protective measures.

I will jot that down as a question to ask when we meet again in a couple of months. Those are all my questions. I did not get a chance at the start to thank our guests for all they have done. It certainly has not been an easy job. I thank them for all the work they have done in the past two years.

Senator Seán Kyne

I welcome our guests and thank them for the work they have done on our behalf in recent years. In the context of the work that is going on, obviously the elderly are particularly vulnerable to Covid. I refer to the importance of the vaccination programme and booster campaign for the elderly. In the context of flu, which is of particular concern every winter, what lessons can we learn and extrapolate from Covid? I am thinking of HEPA filters in schools, for example. Should such filters be used in areas where elderly people congregate, such as small community rooms used for get-togethers on Friday mornings or funeral homes, which are generally small rooms. Funeral homes are often attended by a significant number of elderly people when a relative passes away. They may be there for two hours or two and a half hours. Are there lessons from Covid in terms of the continued use of hand sanitisation and possibly the use of masks by the elderly or immunocompromised in such settings?

Dr. Tony Holohan

In principle, the answer is "Yes". Many of the measures that are and have been important in limiting the transmission of Covid will continue to be important measures either for us to recommend or for individuals to decide to take on for themselves. The benefit of some of the measures - the Senator identified some of them - is not going to be just in terms of transmission of Covid; it may also have benefits in terms of transmission of a range of respiratory viral infections and possibly other viral infections. I refer to the basic point on hand washing. It is one of the things that has been emphasised in the context of Covid, but it has benefits in terms of transmission of other respiratory viral infections. It also has benefits in the context of transmission of gastroenteritis of one kind or another, as well as food-borne illnesses and so on. To the extent that we can all up our game, so to speak, as individuals and keep our hands washed in all circumstances, that is a general benefit in terms of transmission.

Mask wearing is something people will choose to do. I expect and hope there will be a good level of understanding in the population that even if we move away from recommending the continued use of masks as a regulatory measure in defined circumstances, it will still be a sensible choice for individuals if they are out and about, such as in the circumstances referred to by the Senator, where there may be a predominance of elderly people in close contact. It might make sense for those individuals to wear a mask, particularly at times when there is a very prevalent level of infection from a respiratory viral infection such as flu or Covid. At those times, we may recommend that it is a good time for people in a vulnerable situation to choose to wear a mask when in close contact. If you know you will not be able to maintain social distance, particularly in an indoor environment, and you are vulnerable, wearing a mask in those situations will continue to be sensible because it will protect you from many things other than just flu, particularly, perhaps, in winter. These kinds of sensible behaviours will be dialled in to the culture and what we expect to see.

In the context of masks, it is important to point out that at the moment anybody who is a case between days 7 and 10 can resume their activities if they are symptom-free so long as they wear a higher grade mask. One can expect to see people out and about wearing masks who have been cases. People who are boosted close contacts will no longer have to restrict their movements. There will continue to be advice on mask wearing in particular situations but we expect many people to appropriately choose to wear a mask as a way of protecting themselves into the future. Those are basic lessons - I think the public has learned them as well as we have - on measures that can help in terms of population transmission of many common viral infections.

Deputy Seán Kyne

I thank Dr. Holohan. The COVAX facility has received surplus from this country and other countries for distribution in developing countries. If another variant or threat arises, is it likely to occur in a country with a low vaccination rate at present? Is that further evidence of the importance of the COVAX facility and assisting countries with low vaccination rates?

Dr. Tony Holohan

Again, in principle, the answer to that question is "Yes". Several factors contribute to the risk of the emergence of a variant. One factor is the total volume of infection, that is, the number of opportunities the virus has to transmit. That gives it an opportunity to mutate each time. The more transmission, the more such opportunities there are. One thing we do not yet fully understand is whether the virus is passing in and out of certain animal hosts, which might be giving opportunities for variants to emerge. In areas with low vaccination uptake, the opportunity for the virus to spread is much greater and that certainly might contribute to that risk at a global level. There are circumstances in which chronic infection in people who may have certain immune deficiencies can present the virus with opportunities to mutate. It is a general principle in the context of global control of this disease as well as our protection of our population in this country that the more people we can get vaccinated with vaccines that we know work, the more of a contribution we are making globally as well as locally to protecting ourselves from the effects of this disease. In principle, the answer to the Senator's question is "Yes".

Deputy Seán Kyne

Denmark today removed all restrictions. That decision was publicised, so I am sure there will be demands or views expressed by the general population that we should follow suit. What is the likelihood of other countries in Europe following suit in the coming week or weeks? When is it likely that NPHET will consider all remaining restrictions? This issue was touched on earlier. What is the timescale in this regard?

That is one question on which NIAC is advising and it probably would not be wise of me to guess, but there was a strong case for boosting the entire population in the way that we have. It looks to us as though the third dose that people got as a booster was important in restoring, in particular, some of the lost protection against severe infection. We think that is likely to hold up pretty well now and the same case may not exist for boosting the entire population. It may well be the case there will be a focus on people who are vulnerable, although I am not predicting that. NIAC will be independent in respect of the advice it gives us but, as the Chairman suggested, there is a likelihood we might move on from that recommendation that informed the first booster campaign and not necessarily assume there will be another round of booster doses at a defined interval. That is exactly the question on which NIAC is focused at the moment.

Dr. Ronan Glynn

I might add there have been some anecdotal reports in recent weeks that some people were anticipating that an Omicron-specific vaccine would become available in the coming months and that, perhaps, some people were holding off on getting their booster dose until that became available. I take this opportunity to encourage people not to wait for that but to come forward and get the booster that is currently available. Another example of how impactful our current vaccines are is that yesterday, fewer than 20 people who had been boosted were in our intensive care facilities. There have been hundreds of thousands of cases over recent weeks, yet yesterday fewer than 20 people who had been boosted were in critical care. Obviously, we want nobody to be in critical care but that statistic points to the effectiveness of our current vaccines in preventing serious illness.

Chairman

Two weeks ago, what jumped out was not only the figure related to the incidence of Covid that existed in society day to day but also the figure relating to the number of deaths. I think the figure was 48 or 49 last week. Was that over a long period? If it had been announced a couple of months ago, this would have been a headline figure but this was just buried within a newspaper article or statement. The figures did not seem to have the same impact. How important is that message in respect of reminding people that the virus is still a danger and that people are continuing to die from the disease?

Dr. Tony Holohan

The figure 49 is correct, for the week up to 26 January. We report deaths on a weekly basis and 49 is the total. The total number of deaths reported thus far is 6,136. The Chairman is correct that this has been a fatal disease for some people, even if we can see that the protection against mortality as a severe outcome of infection is significant for those who have been boosted, whereby a real protection can be seen arising from that. There will be people who are at risk, particularly those who have not been vaccinated or boosted or who have significant underlying medical conditions or vulnerabilities. We know, because we have been examining some of this, that the excess mortality rate in Ireland compares well with that in many other countries in what we have observed over the course of the pandemic. That is one factor that will be taken into account when we stand back and assess the nature of the response here.

Chairman

We have heard throughout the meeting mentions of people being afraid. Many of our population are now afraid of crowds and there has been a psychological impact in moving from being in lockdown to being able to freely enter pubs, restaurants and everything else. It is as though that is now all behind us but that psychological impact remains for many people. Young people say they are still nervous about hugging their granny, shaking hands and so on. When will we hear the message officially, whether from politicians, NPHET or whoever else, that it is now safe for children, in particular, and adults to hug their granny, father, mother or loved ones? Do our guests have a view on whether we are getting to the day when that positive message will be put out there?

Dr. Tony Holohan

I think we are. It has never been our advice not to hug your granny or whatever. The measures people have been asked to take have related to cutting down on social contact between people who are vulnerable and others who might infect them. People were asked to stay apart from one another over the past two years.

This has limited many of these opportunities. People can now conduct sensible risk assessment for themselves on their own individual risk. They should ask themselves whether they have symptoms, whether they are properly boosted, whether the people they are meeting are vulnerable, what are the circumstances in which they are meeting and whether it is indoors and well ventilated, whether they are using face masks appropriately when recommended, and whether they are using hand sanitiser and so on. When people are following the recommendations and interactions are taking place between people who are not symptomatic, we have not said they should not be hugging. Interactions between grandchildren and grandparents are important for all sorts of reasons. It is not that there will be a day when we say it is okay to hug grandchildren again. If people are following all of the basic public health advice and doing everything they can to limit the risk of transmission then it is appropriate in that context for people to consider those kinds of interactions as part of how they live their lives. It is important that we get back to these basic measures and interactions between people. Common sense will have to apply. If one of the grandchildren has a runny nose, they should stay away that day. It is these basic measures we are trying to promote for the whole population. If people can observe these basic measures I see no reason people should not resume this type of interaction. It is perfectly normal, natural and understandable between grandparents and grandchildren.

Chairman

I thank Dr. Holohan. It is important that we have this conversation and this message. It has been said during the meeting by many members but as Chair of the health committee I thank the witnesses for the work they did, for their accessibility to the committee, for their voices and time and for the commitment they made collectively to keep us all safe. As one of the members said, they have navigated us through a difficult period. This period is still not over but hopefully there is light at the end of the tunnel. I know that hard and difficult decisions have been made. Many of the witnesses have been personally targeted for having made decisions that, ultimately, were made by politicians and not by the witnesses. I thank them. The contributions at today's meeting have been very helpful. As someone suggested, I look forward to seeing a slimmed-down version of NPHET. I thank the witnesses for their attendance.

Dr. Tony Holohan

I thank the Chair and the committee for the opportunity to appear before it. People will form their own judgments. We have always done our best and tried to make the calls as honestly as we could and did so in good faith. I believe I am speaking for everybody involved in NPHET - and there are 32 of them to answer an earlier question - when I say it is a privilege to be involved in a position such as this and to be able to influence and provide some support and help. We take seriously the job and the opportunity to speak to the committee and have our voices out there, not as an end in itself but as a means for the public to be able to hear and inform themselves on the risks they take. We thank the committee for giving us opportunities and for the discussion we have had this morning.

The joint committee adjourned at 12.04 p.m. until 9.30 a.m. on Wednesday, 9 February 2022.