Coronavirus: Can NI 'learn to live' with Covid-19?

Early in the pandemic, Northern Ireland was praised for its approach to tackling Covid-19.

Now, as new cases of the virus have soared and restrictions have been re-imposed, some politicians are saying we must "learn to live" with coronavirus. But what does that mean and is it feasible?

In Northern Ireland 24 days was all it took for pubs to go from reopening their doors after months of lockdown, to closing again. They had eagerly waited for 23 September to be able to welcome back punters.

On 16 October, all of the hospitality sector and some other businesses were forced to shut, as part of fresh interventions agreed by the NI Executive to reduce rising numbers of coronavirus cases.

In those 24 days, the number of cases in NI had jumped from 9,761 up to 25,177, with rising hospital admissions and more patients needing intensive care.

Health officials were concerned that the service, facing into the winter flu season, could quickly become overwhelmed.

A decision was also taken to reactivate Northern Ireland's Nightingale facility.

Located at the City Hospital's yellow tower block, a familiar part of Belfast's skyline, its re-establishment further marks the seriousness of what Stormont is dealing with.

It was a reminder of just how quickly the situation could change, and the pressure Covid-19 is putting on the health service has continued to build over the past fortnight.

On the hill, ministers know that their choices are only becoming more complicated.

They faced a backlash after evidence that formed the basis for the executive's decision-making was published - and described as "flimsy" by business leaders, angry that their sectors had been hit hardest by the new restrictions.

Pointing to the statistics, the executive insisted that doing nothing to curb the rise in cases simply was not an option.

Northern Ireland's Nightingale facility was reinstated on 14 October, as cases of coronavirus began to swell

The restrictions are in place until 13 November - with hospitality and close-contact services shut, while schools got an extended half-term break - to try and get Northern Ireland's R-number back below one.

The executive admits it has bought time: time to get the rate of infection down, time to help the health service and time to put in place a new plan.

Governments in other parts of the UK and Republic of Ireland are taking similar approaches.

NI's Chief Medical Officer, Dr Michael McBride, has said anyone who believes things will return to normal in two weeks' time with an easing of restrictions is "misplaced".

But standing at a press podium, First Minister Arlene Foster couldn't have been clearer - the strategy of repeatedly imposing short periods of tough restrictions will ultimately be a "failure", and NI has to learn to live with Covid-19, she said.

Sinn Féin struck a similar note a day later with Deputy First Minister Michelle O'Neill, fresh out of self-isolation after a family member contracted the virus, also urging against a "cycle of lockdowns".

Executive ministers want to develop a long-term approach where Northern Ireland can manage coronavirus while keeping as much of society open as possible, in the absence of a vaccine.

But what are their options for making that happen?

Improving the Test and Trace system

Northern Ireland was praised for being the first of the four UK administrations to roll out a contact tracing programme, and the Stop Covid NI app then followed, but the executive now accepts the system needs improvement.

The number of tests being carried out has greatly increased since the beginning of the pandemic, but health officials say wider testing does not adequately explain the widespread community transmission of the virus.

Concerns have been raised about pressures on testing, while last week it emerged that thousands of people in NI who have contracted Covid-19 appear not to have been contacted by the Public Health Agency's tracing service.

An app to assist with the ongoing contact tracing programme was launched in July

Dr Connor Bamford, a virologist at Queen's University Belfast, said the system must undergo a "complete revamp".

"The only thing we know that works well against the virus is getting numbers down low, and then bringing in a good test and trace system - we have failed to do that," he told BBC News NI.

He added that even with a strong test and trace programme in place, it would be difficult to rule out periods of tighter restrictions being introduced.

It is thought the executive is looking at increasing funding for the system, and wants more staff to be rapidly recruited.

Ministers have cited this as one of their key priorities, but getting it ready will not happen overnight.

Increasing financial support

Several ministers have likened Northern Ireland's economy to a light switch that "cannot keep being turned on and off", as a means of reducing the spread of the virus.

Dr Bamford argues that without a vaccine, restrictions remain an effective way of bringing down rates of infection. However the executive is aware of what rolling lockdown measures could do to unemployment levels.

Much of the hospitality sector is struggling to maintain jobs due to the latest restrictions that forced many firms to shut

There have been a number of support schemes drawn up to help different sectors, but some businesses argue that Stormont needs to get creative.

Restaurateur Michael Deane told BBC NI's The View programme that a compliance certificate should be designed, to allow those firms adhering properly to the rules to reopen.

There have also been calls for more financial support, including for people who have to self-isolate and take time off work. The Department for Communities offers some grants, subject to certain eligibility criteria.

The executive does not have unlimited spending powers, and will have to continue balancing its approach to tackling the virus with its reliance on the Treasury to pull the biggest financial levers.

Expanding the health service

It is no secret that Northern Ireland's health service has for years been under-funded and under-staffed.

Interventions such as opening the Nightingale and increasing the number of hospital beds and equipment available helped as the pandemic began in March.

Consequently, other aspects of the health service have at times had to give way to the demands of Covid-19.

Some health trusts have cancelled operations, thousands of staff have had to self-isolate and long-awaited plans to rebuild NI's health service and tackle waiting lists have been constrained.

Executive ministers say they want to provide more funding to boost staffing levels, facilities and equipment to ensure the service can fulfil all of its other responsibilities, while the virus continues to exist.

On Thursday, an additional £560m was announced by the Department of Finance in a bid to help.

While the money has been welcomed, some health officials argue that it cannot be a sticking plaster and that real reform is needed.

Adapting messaging and public behaviour

The executive has faced accusations of mixed messaging when it comes to some of the coronavirus regulations and guidance, which have changed frequently since March.

There have also been calls for Stormont and the PSNI to crack down harder on those who breach the rules, with the issue of who oversees enforcement still not entirely clear-cut.

Dr Bamford believes that while many people are still following the advice around hand washing and social distancing, there needs to be total public buy-in.

Arlene Foster and Michelle O'Neill have been giving joint press conferences to encourage people to heed the public health messaging

"Some people have tried to get around the rules, the messaging hasn't been completely bullet-proof and there are misunderstandings about the role of testing and negative tests," he said.

He suggested that Northern Ireland could have been better prepared, as could the rest of the UK, but that people needed to get on board with taking personal responsibility.

Dr Michael McBride said learning to live with the virus really means that society must change its patterns of behaviour and habits.

"We have to double down in terms of behaving very differently when the current period of restrictions comes to an end, otherwise we'll be back to where we were," he warned.

This pandemic has, at times, exposed tensions at the heart of the power-sharing executive over the three Ls - Lives, Livelihoods and Liberties.

Now, ministers may have to put equal emphasis on the three Cs - Communication, Compliance and Confidence - if they want any long-term strategy for dealing with the virus to be successful.