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The Belgian Approach

  • 24-09-2020 7:14am
    #1
    Moderators, Category Moderators, Arts Moderators, Entertainment Moderators, Social & Fun Moderators Posts: 16,509 CMod ✭✭✭✭ faceman


    This hasn't been covered in Irish news at all as far as I can but it is newsworthy. Belgium is overhauling their rules

    https://abcnews.go.com/Health/wireStory/masks-off-belgium-relaxes-virus-rules-rise-cases-73193834

    They're no longer using number of cases as their primary measure and are taking a more holistic view. Part of the change in policy is contributed to the widening of the advisor panel - it now includes an economist.

    Ireland is too archaic to take progressive measures like this however what's your view?


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Comments

  • Registered Users Posts: 1,226 ✭✭✭ Valhallapt


    faceman wrote: »
    This hasn't been covered in Irish news at all as far as I can but it is newsworthy. Belgium is overhauling their rules

    https://abcnews.go.com/Health/wireStory/masks-off-belgium-relaxes-virus-rules-rise-cases-73193834

    They're no longer using number of cases as their primary measure and are taking a more holistic view. Part of the change in policy is contributed to the widening of the advisor panel - it now includes an economist.

    Ireland is too archaic to take progressive measures like this however what's your view?

    Seems like a sensible approach. I’ve lost confidence in NEPHET, they are clearly smart people but their focus is too narrow, the outcome we should look for is a healthier Ireland overall. We’re now seeing spikes of terminal cancer diagnosis in what would have been preventable, spikes in coronary death, mental health issues which will be with us a long time, missed educational and work opportunities which will set back families for years, very large increase in suicide etc. If NEPHET had a broader scope it would perhaps be more surgical in it recommendations


  • Registered Users Posts: 2,677 ✭✭✭ Happydays2020


    My view is that NPHET have been energised by the living with Covid plan and see it as a new toy for greater restrictions.

    Michael Feeley’s piece today in the Times hits many nails on heads. Last time he spoke they forced him out, Will they burn him on a stake now?


  • Registered Users Posts: 4,082 ✭✭✭ Deep Thought


    My view is that NPHET have been energised by the living with Covid plan and see it as a new toy for greater restrictions.

    Michael Feeley’s piece today in the Times hits many nails on heads. Last time he spoke they forced him out, Will they burn him on a stake now?

    I agree, at some point until we have a vaccine, we have to manage this virus, people will get it, some will be fine and others will get very sick. We need to take care of the most vulnerable and treat the very sick.

    The government and NPHET have yet to tell us what is an acceptable level of the virus within our community. Are they happy with 6 cases per day? 50? 125?

    Data is key, numbers without specific details and data just scares people.


  • Moderators, Sports Moderators Posts: 11,205 Mod ✭✭✭✭ hmmm


    The government and NPHET have yet to tell us what is an acceptable level of the virus within our community. Are they happy with 6 cases per day? 50? 125?
    It's only the media and posters on Boards which keep going on about cases.

    NPHET and the government are clearly concerned about trends in hospitalisations & ICU capacity, not cases. The number of cases just provides an early warning of trends.


  • Registered Users Posts: 31,701 ✭✭✭✭ is_that_so


    My view is that NPHET have been energised by the living with Covid plan and see it as a new toy for greater restrictions.

    Michael Feeley’s piece today in the Times hits many nails on heads. Last time he spoke they forced him out, Will they burn him on a stake now?
    Just to clarify Martin Feeley worked for the HSE and he took a stance against his employer, for which he naturally enough had to leave. Can't say I share your views on what he has to say. For many who have contrary views to national strategies they tend to zoom in on one thing only and offer very simple solutions that apparently nobody else has thought of. That's not to say NPHET have made the right call every time but locking up the vulnerable is not an indication of a just and proper society.


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  • Registered Users Posts: 2,677 ✭✭✭ Happydays2020


    is_that_so wrote: »
    Just to clarify Martin Feeley worked for the HSE and he took a stance against his employer, for which he naturally enough had to leave. Can't say I share your views on what he has to say. For many who have contrary views to national strategies they tend to zoom in on one thing only and offer very simple solutions that apparently nobody else has thought of. That's not to say NPHET have made the right call every time but locking up the vulnerable is not an indication of a just and proper society.

    The fact that he had to leave was not ‘natural enough’ and rather a symptom of group think. We should be able to live with views which challenge the status quo.


  • Registered Users Posts: 14,289 ✭✭✭✭ banie01


    The primary driver for lockdown and restriction in Ireland seems to be hospital capacity and in particular ICU capacity.

    Belgium has a significant advantage over Ireland in this regard.
    Belgium has 15.9 beds per 100k of population.
    Ireland has at a high range estimate, 6 beds per 100k of population.

    From purely a capacity standpoint, Belgium and the vast majority of the EU have a far greater headroom to allow leeway without immediate adverse impact.
    EU average ICU bed capacity is 11.5 beds per 100k.

    Ireland is unfortunately in a position where even a relatively minor increase in the infection rate, will lead to a near immediate capacity issue in our ICU and high dependency beds.

    Beds that are necessary for far more than just Covid patients.
    If Ireland loosens restrictions, it is fairly apparent from our capacity issue that we would quickly encounter a choke point in capacity.
    That choke point will affect far more than just Covid patients.
    Every patient in need of High Dependency and ICU care will be subjected to a triage system similar to Lombardy at its worst, but at a far earlier stage in any outbreak.


  • Registered Users Posts: 5,089 ✭✭✭ storker


    The Belgian approach doesn't seem all that drastic to me. The social distancing rules still apply. Mandatory use of masks outdoors will be done away with, well Ireland doesn't have that in place anyway. There's a 10-person limit on gatherings except for professionally-organised events where presumably some level of social distancing will still apply, only close contact with a maximum of 5 people a month. It may be a relaxation of the rules but it's hardly revolutionary.


  • Moderators, Category Moderators, Arts Moderators, Entertainment Moderators, Social & Fun Moderators Posts: 16,509 CMod ✭✭✭✭ faceman


    banie01 wrote: »
    The primary driver for lockdown and restriction in Ireland seems to be hospital capacity and in particular ICU capacity.

    Belgium has a significant advantage over Ireland in this regard.
    Belgium has 15.9 beds per 100k of population.
    Ireland has at a high range estimate, 6 beds per 100k of population.

    From purely a capacity standpoint, Belgium and the vast majority of the EU have a far greater headroom to allow leeway without immediate adverse impact.
    EU average ICU bed capacity is 11.5 beds per 100k.

    Ireland is unfortunately in a position where even a relatively minor increase in the infection rate, will lead to a near immediate capacity issue in our ICU and high dependency beds.

    Beds that are necessary for far more than just Covid patients.
    If Ireland loosens restrictions, it is fairly apparent from our capacity issue that we would quickly encounter a choke point in capacity.
    That choke point will affect far more than just Covid patients.
    Every patient in need of High Dependency and ICU care will be subjected to a triage system similar to Lombardy at its worst, but at a far earlier stage in any outbreak.

    If Ireland cared, we would have more icu beds. Matt Cooper confirmed that no new ICU beds have entered the system since March.


  • Registered Users Posts: 14,289 ✭✭✭✭ banie01


    faceman wrote: »
    If Ireland cared, we would have more icu beds. Matt Cooper confirmed that no new ICU beds have entered the system since March.

    I agree that we should certainly have more beds.
    Even before the emergence of the pandemic.

    However extra ICU beds are not as simple as buying the kit, reallocating OR and theatre kit.
    It's also staffing, from consultant level down. That takes planning, allocation and long lead times.

    That's not available to us as an immediate option.
    Ideally we can move towards an EU/OECD ICU bed average.

    However, as of right now?
    We need to plan for surges with the capacity we have to hand, not with what we would like to have.
    From that standpoint alone it's quite clear that we aren't at a point where we can undertake a Belgian style loosening (and even Belgium's loosening is very, very limited)

    NPHET, the HSE and all our health experts have to deal with the hand they are dealt.
    That's why Stepdown hospital facilities are in place, it's far easier for our HSE to move non critical and non-covid patients to intermediate care facilities.
    This allows for the concentration of our very limited High Dependency and ICU beds into our main hospitals and allow best allocation of our high skill ICU/Critical care resources and staff.

    If we adopt any looser strategy immediately?
    How do you propose we deal with any surge that leads to our current capacity being swamped?

    It's imperative that with our current capacity, that we focus on managing the demand as we cannot manage a peak without risking far too many lives.


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  • Registered Users Posts: 1,226 ✭✭✭ Valhallapt


    faceman wrote: »
    If Ireland cared, we would have more icu beds. Matt Cooper confirmed that no new ICU beds have entered the system since March.

    Should this scandal not be the real headline, all we hear about are increases in infections, little to no analysis on how we've spent billions of euros extra, but not added a single ICU bed?


  • Registered Users Posts: 13,398 ✭✭✭✭ CIARAN_BOYLE


    I agree, at some point until we have a vaccine, we have to manage this virus, people will get it, some will be fine and others will get very sick. We need to take care of the most vulnerable and treat the very sick.

    The government and NPHET have yet to tell us what is an acceptable level of the virus within our community. Are they happy with 6 cases per day? 50? 125?

    Data is key, numbers without specific details and data just scares people.

    They care more about the rate of growth than an acceptable number.

    If there was 100 cases every day for the rest of the year I'd say they would be happy enough.

    If there was 25 this week and 50 next week they would be screaming for a shut down.

    If there was 2000 a day last week and 1000 a day this week they might be willing to relax things.


  • Registered Users Posts: 6,635 ✭✭✭ plodder


    I agree, at some point until we have a vaccine, we have to manage this virus, people will get it, some will be fine and others will get very sick. We need to take care of the most vulnerable and treat the very sick.

    The government and NPHET have yet to tell us what is an acceptable level of the virus within our community. Are they happy with 6 cases per day? 50? 125?

    Data is key, numbers without specific details and data just scares people.
    What seems to have spooked them was not the level of cases, but the rate of change. I imagine a case level significantly higher than what you quote would be acceptable if it weren't increasing at the rate it is.

    Many of us thought that the last few months would be used to reinforce the health system to increase ICU capacity (by now). But it seems that hasn't happened.

    I'll say it again. Rather than PR stunts like yesterdays Dail committee they should have a team of people in Sweden analysing what they are doing. Like how can they maintain a stable case level while pubs and restuarants are open with 1 metre distancing only?


  • Registered Users Posts: 695 ✭✭✭ DaSilva


    banie01 wrote: »
    However extra ICU beds are not as simple as buying the kit, reallocating OR and theatre kit.
    It's also staffing, from consultant level down. That takes planning, allocation and long lead times.

    I'm not advocating for lighter restrictions, but I am very tired of this Irish mediocrity. I hear this same argument constantly for why we can't do anything more sophisticated or novel. "long lead times.", Jesus... We can't even pull the finger out in a pandemic? What sort of timeline is achievable for us poor souls, maybe our extremely wealthy nation can reach parity the rest of Europe some time mid century, only if it's not too much trouble though, wouldn't want anyone feeling any sense of urgency or anything.


  • Registered Users Posts: 31,701 ✭✭✭✭ is_that_so


    The fact that he had to leave was not ‘natural enough’ and rather a symptom of group think. We should be able to live with views which challenge the status quo.
    The fact that the HSE was paying him was reason enough, he can can still share his views.


  • Registered Users Posts: 14,289 ✭✭✭✭ banie01


    DaSilva wrote: »
    I'm not advocating for lighter restrictions, but I am very tired of this Irish mediocrity. I hear this same argument constantly for why we can't do anything more sophisticated or novel. "long lead times.", Jesus... We can't even pull the finger out in a pandemic? What sort of timeline is achievable for us poor souls, maybe our extremely wealthy nation can reach parity the rest of Europe some time mid century, only if it's not too much trouble though, wouldn't want anyone feeling any sense of urgency or anything.

    The argument could be made that in "normal" times we don't have the need.
    It's not one I'd subscribe to, and we really should be aiming for OECD parity when it comes to our bed capacity.

    Dr Catherine Motherway who iirc is the head of the intensive care consultant group.
    Recently said that ideally in "normal" times we would be operating at 70-75% capacity with the remaining capacity as the surge space for disaster and other multi casualty emergency.

    The system as it stands, was not designed or conceived to operate at 100% capacity and it is certainly not capable of any safe surge past that.

    If over the course of the last 10/15yrs our "normal" ICU utilisation has been an average of 300 or so beds, then the planners can be forgiven for thinking that a 400 bed ICU system was sufficient for the needs as outlined by Dr Motherway.

    That additional capacity is very quickly eliminated by pandemic is unfortunate and if Public Health experts had been listened to, would have been far better accounted for in any capacity planning exercise.

    Our ICU system is built without regard for pandemic planning, that has to change.
    That cannot be changed immediately.


  • Registered Users Posts: 6,635 ✭✭✭ plodder


    banie01 wrote: »
    The argument could be made that in "normal" times we don't have the need.
    It's not one I'd subscribe to, and we really should be aiming for OECD parity when it comes to our bed capacity.

    Dr Catherine Motherway who iirc is the head of the intensive care consultant group.
    Recently said that ideally in "normal" times we would be operating at 70-75% capacity with the remaining capacity as the surge space for disaster and other multi casualty emergency.

    The system as it stands, was not designed or conceived to operate at 100% capacity and it is certainly not capable of any safe surge past that.

    If over the course of the last 10/15yrs our "normal" ICU utilisation has been an average of 300 or so beds, then the planners can be forgiven for thinking that a 400 bed ICU system was sufficient for the needs as outlined by Dr Motherway.

    That additional capacity is very quickly eliminated by pandemic is unfortunate and if Public Health experts had been listened to, would have been far better accounted for in any capacity planning exercise.

    Our ICU system is built without regard for pandemic planning, that has to change.
    That cannot be changed immediately.
    But, it hardly makes sense to provision in the normal way for ICU capacity for a once in a century pandemic. The initial reaction was so much more impressive. Even if it never had to be used (to the extent planned for) the deal with the private hospitals, and the capacity in places like City West, was a good reaction.

    It's like since the first wave finished, the health system wants to go back to normal with the usual glacial pace of change.


  • Registered Users Posts: 14,289 ✭✭✭✭ banie01


    plodder wrote: »
    But, it hardly makes sense to provision in the normal way for ICU capacity for a once in a century pandemic. The initial reaction was so much more impressive. Even if it never had to be used (to the extent planned for) the deal with the private hospitals, and the capacity in places like City West, was a good reaction.

    It's like since the first wave finished, the health system wants to go back to normal with the usual glacial pace of change.

    The intermediate care facilities are still in place and still in use(The limerick one is at least). They are an excellent way of freeing up HDU and ICU capacity in our main hospitals.

    You misunderstand my point regarding planning ICU capacity.
    Its more that in future, even if our actual "normal" requirement is 300 beds, with 400 as the surge.
    That we need to ensure a further stockpile of Ventilators, PPE and other long lead time equipment should be the main takeaway from this pandemic.
    Along with a serious reassessment of ensuring our healthcare spending delivers frontline services, staff and equipment rather than disappearing into a morass of admin spending.


  • Registered Users Posts: 372 ✭✭ JD1763




  • Registered Users Posts: 1,641 ✭✭✭ mohawk


    is_that_so wrote: »
    The fact that the HSE was paying him was reason enough, he can can still share his views.

    It is never ever a good thing for an organisation to all have the same views. Groupthink is not in any way beneficial. You need those people who are coming at a problem from a different perspective. When we having trouble solving a problem at work we often find ourselves with all different ideas/approach’s at the start and by listening to each other we come up with what we believe to be the best approach.

    Not everyone in HSE will all have same opinions on the approach to handling Covid and they will disagree. Big deal...if the process you use to make decisions is sound and based on good science then who cares if you have one or two going against the grain.


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  • Closed Accounts Posts: 2,950 polesheep


    is_that_so wrote: »
    Just to clarify Martin Feeley worked for the HSE and he took a stance against his employer, for which he naturally enough had to leave. Can't say I share your views on what he has to say. For many who have contrary views to national strategies they tend to zoom in on one thing only and offer very simple solutions that apparently nobody else has thought of. That's not to say NPHET have made the right call every time but locking up the vulnerable is not an indication of a just and proper society.

    I can't agree with this. Dissenting voices can be very important within an organisation. Especially one that is charged with running the nation's health service. The alternative is that everyone in the organisation stays schtum even when they know that mistakes are being made. The HSE is not a political party.


  • Closed Accounts Posts: 2,950 polesheep


    is_that_so wrote: »
    The fact that the HSE was paying him was reason enough, he can can still share his views.

    This means that every doctor,nurse, physio, etc working in the HSE should lose their job should they speak out when the believe that something is being done wrong within the HSE.


  • Registered Users Posts: 2,677 ✭✭✭ Happydays2020


    hmmm wrote: »
    It's only the media and posters on Boards which keep going on about cases.

    NPHET and the government are clearly concerned about trends in hospitalisations & ICU capacity, not cases. The number of cases just provides an early warning of trends.

    Yes. It is just the media and posters Boards on Boards which keep going on about cases.


  • Registered Users Posts: 31,701 ✭✭✭✭ is_that_so


    polesheep wrote: »
    This means that every doctor,nurse, physio, etc working in the HSE should lose their job should they speak out when the believe that something is being done wrong within the HSE.
    Nah, he spoke out against and wouldn't stand over the HSE public health measures. That's a P45 or resignation for someone in his position.


  • Registered Users Posts: 33,867 ✭✭✭✭ Boggles


    Valhallapt wrote: »
    Seems like a sensible approach. I’ve lost confidence in NEPHET, they are clearly smart people but their focus is too narrow, the outcome we should look for is a healthier Ireland overall. We’re now seeing spikes of terminal cancer diagnosis in what would have been preventable, spikes in coronary death, mental health issues which will be with us a long time, missed educational and work opportunities which will set back families for years, very large increase in suicide etc. If NEPHET had a broader scope it would perhaps be more surgical in it recommendations

    Are they?

    Have you citation to back up all these spikes?


  • Registered Users Posts: 1,226 ✭✭✭ Valhallapt


    Boggles wrote: »
    Are ye?

    Have you citation to back up all these spikes?

    It’s too early for anything other than empirical data yet. But wife is a palliative nurse, her hospital is seeing over double the number of terminal cancer diagnosis compared to this time last year in those aged under 40.

    But maybe you are right, stopping breast check and colon cancer screening for six months will have had no material impact.


  • Registered Users Posts: 33,867 ✭✭✭✭ Boggles


    Valhallapt wrote: »
    It’s too early for anything other than empirical data yet. But wife is a palliative nurse, her hospital is seeing over double the number of terminal cancer diagnosis compared to this time last year in those aged under 40.

    But maybe you are right, stopping breast check and colon cancer screening for six months will have had no material impact.

    Well if you have some handy?


  • Registered Users Posts: 33,867 ✭✭✭✭ Boggles


    Valhallapt wrote: »

    Neither news report backup any of your claims.

    But this did catch my eye.
    In a second case, a previously healthy young boy started exercising on his own to maintain his fitness during lockdown.

    “Unfortunately for him, it led to exercise addiction,” said Prof McNicholas. “To the point where he lost 20 per cent of his body weight and was medically compromised.”

    Da fuq?


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  • Registered Users Posts: 1,226 ✭✭✭ Valhallapt


    Boggles wrote: »
    Neither news report backup any of your claims.

    Oh, okay ;-)


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