An Open Letter to Dr. Tony Holohan, Chief Medical Officer and Chairman of the National Public Health Emergency Team (NPHET)

Dear Dr. Holohan,

Thank you for your informative frequent press briefings reporting death-tolls and keeping the nation appraised of NPHET’s assessment of the pandemic situation. There are some questions I have however that do not seem to be asked by the media representatives admitted to those briefings. Perhaps you would be as informative in answering these.

Covid testing capacity was increased since the first lockdown, in the run up to this winter. Capacity has grown approximately twice as much in non-hospital (private) labs than in hospital labs. The stated estimated cost of the testing last year was €450 million euro.

What commercial labs have been engaged to do this? What was the process for selecting those labs? What was the tender process (and was it similar to that required for other public service contracts)? What measures were taken to prevent conflict of interest with any member of NPHET during this process?

I note in your recent briefing that the current test capacity level is to be maintained, but will be redirected to double-testing of all close contacts. Does that imply that some previously reported cases may not have been accurately diagnosed Covid cases? Does this relate to problems with using PCR testing for asymptomatic diagnosis? Under the new confirmatory testing protocol, how many previously reported cases would no longer now be considered positive Covid cases? Will the historic total case figure be adjusted to reflect this?

Have NPHET or the HSE mandated to test providers a requirement for the cycle threshold to be used in PCR tests? If so, what CT is used? Has it remained constant over the last year? If not, what CT was used/requested at the various stages during the pandemic?

Was any consideration given at any stage to apportioning instead some of the (borrowed) public money allocated for testing into the provision and staffing of critical care capacity in hospitals for this past winter season surge (that would perhaps remain available as on-going hospital care capacity for this and subsequent years)?

Of the deaths with Covid reported these last weeks, how many were contracted in a hospital environment? How many were contracted in a care home or institutional environment? Of the latter, how many of those had received their initial vaccination?

What practice will the HSE employ to monitor phase 4 trial follow-up on each vaccination, and how frequently will the public be briefed on those figures, and what informative metrics (other than the current total vaccinations) will be given about them?

I’m sure you or one of the 30 members of NPHET keep appraised of all recent Covid research, to keep best informed of any possible intervention or measures that can be made to achieve the oft-stated goal of limiting deaths and reducing pressure on the health services. NPHET are therefore aware, I’m also sure, of the growing research last year surrounding the link between Vitamin D3 deficiency and poor Covid outcomes. NPHET, of course, were aware of the results of the Cordoba clinical trial, and very successful outcomes from the widespread distribution of D3 to care home residents and the elderly last November in Andalucia province in Spain, reducing hospitalisations and deaths there by over a half. Given that the outcomes of that initiative dramatically met your stated goal of reducing deaths and hospital admissions of Covid cases, why was such an initiative not carried out in Ireland, especially when there were no vaccines yet available to the elderly and care home residents? Could the modelling expertise of NPHET be utilised to calculate how many unnecessary deaths occurred in Ireland as a result of not following the same initiative?

With it now becoming evident that mutations of the virus this year are likely to render existing vaccines less effective, will NPHET now be recommending a similar campaign of D3 supplementation for the elderly next winter, to prevent deaths? Will the HSE be adding to their media advertising campaigns this year information about the importance of vitamin D3 supplements against coronaviruses (a curious omission from last year’s winter health care booklet distributed to every household)? Or will the Department of Health be waiting to see instead if pharmaceutical companies provide updated vaccines, and would it therefore be recommending another round of expensive vaccines next year, to achieve a similar limited-timeframe population-wide immunity again?

How many deaths have been prevented by the “lockdown” levelled restrictions throughout 2020? Can you provide statistical evidence for such a figure? (What Infection Fatality Rate, broken down across age groups, are you now assuming?) How many premature deaths were caused by those restrictions in 2020, and will continue to be caused by restrictions going forward? How many other non-Covid “long” health and mental conditions were initiated by the protracted lockdown restrictions? Are NPHET gathering statistics for (or perhaps modelling) that also? When one of those sets of figures outweighs the other, I presume NPHET will be recommending an immediate switch in strategy, to best reflect and support the needs of public health?

When (and how) are blanket restrictions and the financially, socially, medically, educationally, and psychologically expensive measures to be phased out? What metrics will NPHET be using to determine when the temporary emergency coronavirus-related civil restrictions conceived last March will be removed (and the concomitant penal health legislation expired)? What level of asymptomatic positive test cases, hospital admissions with, or deaths from coronavirus will be sufficiently low for that to happen? Zero?

If economic contraction, revenue intake reduction, and increased national debt interest bills in future years necessitate a reduction in available budget for healthcare, what level of budgetary contraction could the HSE/Department of Health withstand and still be able to staff NPHET and continue the excellent public health advice that has kept us all so safe from calamity this last year?

Perhaps you would consider these questions and factor the answers into your regular press briefings. I and the nation would be very eager to know those urgent answers, to decide where we go from here.

Yours sincerely,

Brendan Cody