It is now almost one year since Covid-19 barrelled its way into Northern Ireland. The first case of the virus was diagnosed on February 27 last year and the first coronavirus-related death was confirmed less than three weeks later, on March 19.
ven as the virus claimed its first victim and with Health Minister Robin Swann warning of a tragedy of “biblical proportions”, it was difficult to imagine what lay ahead.
How could anyone predict that schools would shut down for months at a time, that it would be illegal to visit family and friends, that patients dying in hospital would be denied the reassuring presence of a loved one in their final moments, or that we would become virtual prisoners in our own homes?
There are, of course, naysayers and conspiracy theorists who insist the virus is nothing more than a bad flu and who refuse to adhere to public health guidance.
But for most people, social distancing has become the norm, phrases such as self-isolation, clinically extremely vulnerable and herd immunity have become so entrenched in our psyche that it’s almost impossible to imagine a return to life as we knew it before the arrival of Covid-19.
It is true that the last year has been incredibly tough for the majority, and a steep learning curve for everyone – not just for those who have been in charge of the pandemic response. But what do we know now that we didn’t know last February?
The effect of the virus
According to Chinese government records, the first case of a person suffering from Covid-19 can be traced back to November 2019. Early reports from the country suggested their hospitals were dealing with cases of a pneumonia-style illness.
While the main symptom of Covid-19 is a cough and it is certainly very much a respiratory illness for many, we now know that the virus doesn’t just attack the lungs.
In fact, a recent study by the University of California has found that the virus can shut down energy production in cells of the heart, kidneys, spleens and other organs.
It has also emerged that Covid-19 causes abnormalities in blood-clotting and that patients with a severe Covid-19 infection appear to be at greater risk of developing blood clots in the veins and arteries.
This means they are at risk of complications such as a pulmonary embolism or stroke, both of which can be fatal.
In addition, it is now thought that one in 10 people who are infected with Covid-19 go on to develop Long Covid, which can include a range of debilitating symptoms such as chronic fatigue, breathlessness, chest pain, brain fog and even kidney failure.
This means there are now more than 10,000 in Northern Ireland living with long-term physical effects of the virus and that will ultimately put further strain on the health service in future.
From March 12 last year, health authorities advised that anyone who had a new and continuous cough, or a high temperature, should isolate for 14 days. Within days, the British Rhinological Society was arguing that a sudden loss of smell was a strong indicator that a person may have Covid-19.
As a result, the organisation wanted this added to the official list of Covid-19 symptoms.
In March, the British Association of Otorhinolaryngology (ENT UK) published a statement outlining that loss of taste and smell, known as anosmia, had been found among “a number of patients” in the “absence of other symptoms”.
On May 13, the World Health Organisation (WHO) added loss of smell and taste to the list of Covid-19 symptoms and, on May 18, they were added to the UK’s symptom list.
A continuous cough, anosmia and fever remain the three symptoms to which the public must remain alert. Of course, nothing about Covid-19 is straightforward and a long list of other symptoms has emerged over the past year, including nausea, headache and rash.
And this week, the Office for National Statistics (ONS) revealed people infected with the Kent variant are more likely to get symptoms than those who have caught older strains, but they are less likely to lose their smell and taste.
The ONS found cough, sore throat, fatigue and muscle aches were all more common in the new variant than the older strains.
All viruses mutate – replication involves making many errors – and this is why the flu vaccine must be modified every year to ensure that it is effective against new strains. Compared with the flu virus, SARS-CoV-2 is changing much more slowly as it spreads.
This is because, unlike the flu virus, coronaviruses proof-read their replicated genome.
Experts warned that mutations of SARS-CoV-2 were inevitable, but it is only really in recent months that it has become a matter of real concern for the public here.
This follows the emergence of a number of strains, including one that appears to have originated in Kent, which subsequently ripped throughout the UK and prompted Prime Minister Boris Johnson to limit Christmas relaxation plans.
While most mutations are not a huge cause for concern, sometimes they make a virus more infectious, or it can result in a more severe disease.
There has been disagreement over whether the Kent strain is making people sicker, although it believed it may be up to 70% more transmissible.
This, in itself, makes it more dangerous, because the more people it infects, the more people who can potentially end up seriously ill in hospital, while the chief medical officer, Dr Michael McBride, has stressed it will make the job of flattening the curve in Northern Ireland “twice as hard”.
As well as the Kent strain, there are also concerns over new strains that have originated in South Africa and Brazil.
Work is ongoing to establish the risk posed by all of the strains, but it has brought to the fore how important it is that we do everything we can to stop the emergence of a vaccine resistant strain.
With striking speed, UK regulators granted emergency use authorisation to the Pfizer-BioNTech vaccine at the start of December. Less than a week later, the first dose was administered to the nurse heading up the roll out of the vaccine programme in Belfast. Within a few weeks, the Oxford/AstraZeneca was also approved.
The Pfizer vaccine must be stored at minus 70c, while the AstraZeneca vaccine can be stored in a normal fridge. This means it is being distributed to GPs for them to administer to their patients, beginning with those who are aged 80 and over.
The trusts have instead been given responsibility for administering the Pfizer vaccines, primarily at mass vaccination centres, but they have also successfully rolled it out to care home residents and staff.
The vaccination programme has not been without controversy – the British Medical Association has accused the Government of treating healthcare workers as guinea pigs after it decided to delay the second dose of vaccines to 12 weeks.
The UK’s chief medical officers lengthened the gap between doses to allow more people to receive the first dose and therefore the number of people with a proportion of protection from the virus.
However, a range of organisations, including the US Food and Drug Administration, European Medicines Agency and even Pfizer have all said there is not enough evidence to guarantee the delay is safe.
More recently, anger has erupted over the fact that healthcare staff working from home, their family members and people aged between 65 and 69 are being vaccinated ahead of over-80s and people who are clinically extremely vulnerable.
Brexit has been made even more complicated as a result of Northern Ireland’s unique relationship between the Republic of Ireland and Britain. That same relationship has caused headaches when it comes to the pandemic response.
The control of borders has played a crucial part in suppressing the spread of Covid-19 in countries such as New Zealand, Thailand and Australia.
But how do you deal with borders when they are as controversial as in Northern Ireland? The Executive has been repeatedly urged to implement an all-Ireland response and while it has given assurances that it links closely with Dublin, there has been a significant issue over the sharing of information.
Almost one year on, the authorities in Dublin are still refusing to hand over data from passenger locator forms that would allow officials here to monitor the movement of international arrivals into the Republic who cross the border into Northern Ireland.
Helen Dolk is a Professor of Epidemiology and Health Services Research at Ulster University and she is also a member of the Independent Scientific Advocacy Group, which is made up of a group of experts calling for an elimination strategy for the island of Ireland.
Not only has she expressed her disappointment at the failure to reach an agreement on the sharing of passenger data, but she has also said plans to force arrivals from some countries to quarantine in hotels do not go far enough.
“I would favour a blanket hotel quarantine requirement, and then see where exemptions can safely be made, rather than the other way round,” she said.
Dr McBride recently said he was not convinced quarantine hotels will be effective in stopping the spread of variants, although Mr Swann has said he is in favour of the measure.
However, whether Northern Ireland follows England’s lead, or develops its own policy, remains to be seen.
The vaccines have been hailed as the road map out of the pandemic, but until they take effect, lockdowns appear to be the weapon of choice for the Government.
The first lockdown was imposed in March last year and at the time, Prime Minister Boris Johnson announced it would be reviewed within three weeks.
As it turned out, the weeks turned into months and measures only started to lift in the summer as the virus was finally brought under control.
Before that came weeks of health professionals crying out for proper PPE and the care home sector claiming it had been forgotten by authorities, leading to a succession of deadly outbreaks in facilities across Northern Ireland.
By the end of June, only a handful of cases were being diagnosed each day in Northern Ireland, but the reprieve was short-lived.
First came Eat Out to Help Out, which a study from the University of Warwick subsequently found contributed to a “significant” rise in new Covid-19 infections.
Next, despite claims to the contrary by officials, the track-and-trace system when schools reopened in September was woefully inadequate, which contributed to the virus regaining the advantage.
On September 1, Northern Ireland recorded 49 new cases; on September 30, 424 new cases were reported.
The Public Health Agency (PHA) itself said it had underestimated the demand the return of schools would have on the test system.
Since then, Northern Ireland has consistently struggled to contain the virus, culminating in the latest lockdown, which we now know will drag on until at least March.
Mr Swann has said there will be a review of the Government response to the pandemic but has largely stood by the decisions that have been taken.
Although, he recently admitted that the relaxation of restrictions over Christmas was a mistake due to the subsequent devastation wreaked on the health service.
Funding of public services
Just over a year ago, thousands of healthcare workers took the unprecedented step of strike action in a fight over pay and conditions.
The industrial action shone a spotlight on the effects of years of chronic underfunding of the health service.
No one could ever have imagined that within weeks of unions reaching a deal with Mr Swann and suspending the strike, that the decades of cuts would have such a devastating impact on the population.
Northern Ireland’s health service was fragile before the pandemic; now, one year in, it has been decimated.
There were not enough nurses beforehand and after a relentless and traumatic 12 months, staff are reaching breaking point, with some exhausted staff walking away from their jobs.
As well as the impact on workers, thousands of operations have been cancelled and hospital waiting times are expected to spiral further, with chronic underfunding and a lack of workforce planning both playing a role in the crisis.
It isn’t just the health service that was massively under prepared for the ravages of a pandemic.
Martin McKee, a Professor of European Public Health at the London School of Hygiene and Tropical Medicine, said underfunding of the education system has also made homeschooling during the lockdowns even more difficult.
“If you look at other countries, they have invested more in their schools over the years, they have invested in things like text books,” he said.
“Simple things like that have made it much easier for families in those countries, whereas we haven’t invested the same and so textbooks aren’t as common, meaning parents and pupils are relying on printouts and computers to do school work at home.
“Then, when you look at the preparations for the return of schools in September, so much more could have been done, including putting in proper ventilation systems to reduce the spread of the virus.”
Lisa Smyth is the Belfast Telegraph’s health correspondent