Claire McNeilly talks to Northern Ireland's Chief Medical Officer Dr Michael McBride about his background and dealing with the worst health crisis in decades.
Q. You've been Northern Ireland's CMO for almost 14 years. Is Covid-19 your biggest crisis?
A. It's been the most challenging period that we've faced. Covid-19 is the biggest public health challenge in a generation.
Q. Did you think about going on the front line yourself?
A. My skills as a doctor are now 14 years old. The competencies and abilities that I've acquired over the years are probably best served in doing what I did as chief medical officer and what I'll continue to do as CMO in terms of supporting ministers and coordinating response.
Q. Did you get Covid-19?
A. I have never had a positive test for Covid-19 and I don't believe I've had Covid-19.
Q. When will this all be over?
A. When we have a vaccine. It is unlikely that we will have a vaccine for this autumn or winter. There's a global effort to develop a vaccine. Only then will we be able to say that it's the beginning of an end to this.
Q. Do you worry that people here aren't taking the threat of a second wave seriously because there is such a big gap between the prediction of deaths and the reality? Recently there have been mass gatherings at funerals, Twelfth celebrations, on beaches... people here were so good during lockdown. Are they slipping?
A. We didn't see the numbers of potential worst-case scenario deaths because of the measures we took; the collective decision by the Executive to take draconian steps in restricting our freedom of movement, the advice that we all took to stay at home to protect each other and to protect the health service. Had we not done that the impact of this virus would've been as profound in Northern Ireland as it has been in other countries.
Q. What is your message to people congregating en masse on beaches, at funerals, or elsewhere?
A. I would ask everyone to remember where we were a few months ago. Remember how scary a place that was. Remember the daily death toll, the people who were hospitalised, those in intensive care, those who were bereaved. Just remember that and follow the advice. Avoid crowds. Avoid closed spaces. And avoid close contact other than your own household and family members. There is no doubt that it's been a complicated time for the public in terms of what they can and can't do. The regulations have been complicated, working our way back out of the restrictions has been complicated...
Q. Has it been made more complicated by people making the rules not necessarily following their own advice?
A. The rules are there for everyone. I think it's important that we all follow them.
Q. Do you agree with your Irish counterpart that we should forget foreign holidays?
A. It's very difficult for me to advise on what I would or wouldn't do. People say 'if he would do it then I should do it' - so I need to be cautious. To individuals asking my advice I would say: think about your age - we know Covid-19 is more severe in people over 50, particularly those over 70 - think about your underlying health conditions, such as high blood pressure or diabetes. Then if you are planning to go on a holiday, think about the health service in the country you are travelling to should you fall unwell. And also think about the rate of transmission in that country.
Q. Are you nervous about people flying here from England or high risk countries?
A. People travelling into Northern Ireland - from Dublin or elsewhere - are required by law to fill in the passenger locator form within 48 hours. It's also a legal requirement, unlike the ROI, to quarantine for 14 days in certain situations, such as if you're coming from high risk countries. England and Northern Ireland do spot checks. We take this seriously. The US is currently a country which we regard as high risk.
Q. Do you accept that now, or soon, wealth will have to overtake health otherwise our economy will be damaged beyond repair?
A. I'm deeply concerned about the impact on the economy because that also impacts on people's life opportunities. Some of the most profound challenges that we face from a public health perspective are diseases of poverty - obesity, alcohol consumption, cigarette smoking, In areas of deprivation those are more challenging.
Q. Will the lockdown cost more lives than it saved? Obesity, depression, missed cancer diagnosis... there's bound to be concern in those areas.
A. The action and steps we took at the time were the appropriate steps. In the fullness of time we will probably see that there has been excess mortality as a consequence of the steps we've taken. There will be longer term impacts, particularly around mental health, depression, anxiety. I'm very concerned about the impact its had on children and older people.
Q. There has been some suggestion that the medical thinking behind the decision to keep off licences open was that there would be too many people who are dependant on alcohol seeking hospital services that it was better to allow them access. Is that true?
Q. Alcohol associated illnesses cost Northern Ireland £900m a year in economic terms based on 2016 data. It cost the health service £250m a year. Would you say it's more now?
A. I'm sure it's significantly more now and that's setting aside the impact it has on families and communities. There will also be mental health consequences to deal with.
Q. Where are we in terms of a contact tracing app?
A. We're currently at a very advanced stage of an app for Northern Ireland which will be able to integrate seamlessly with the app in the Republic. The Minister will make it very clear when we're able to launch that app. I don't think that will be in the too distant future.
Q. In hindsight, did we pay too little attention to care homes in the early stages?
A. I don't think that's the case. We need to very cautious about hindsight bias. We knew what we knew at a point in time and we made judgments based on the information we had.
Q. In terms of a potential second wave, can you foresee another general lockdown or would we be looking more at regional lockdowns?
A. If we do the right thing we can impact and reduce the risk of a second wave. It is possible that we might see localised geographical outbreaks and in those sorts of scenarios we may need to apply local measures. We could do down the same route as Leicester, that is possible. Thankfully we have not had very significant clusters this time, but I anticipate we will.
Q. How will you deal with administering the flu vaccine this year?
A. We can't be bringing older, vulnerable people into a GP surgery. We're actively looking at innovative means of administering the vaccine. That could involve outdoor administration or drive-through flu vaccination points. Nothing is off the table in terms of the flu vaccine campaign.
Q. Where do you stand on attempts to gag the press?
A. That's not for me to comment as Chief Medical Officer but as a citizen I would say the hallmark of any democracy is a free press.
Q. You and Catherine (57), a nurse, have three daughters and a son, aged between 27 and 23. Tell us about your childhood.
A. Growing up during the Troubles, I knew individuals who were affected and I remember some of the consequences of the violence. It profoundly affected my view on life and the importance of valuing life and made me acutely aware of the grief and trauma communities had experienced.
Q. Your late parents Eugene and Alice owned a hardware store in north Belfast. Your father died, aged 46, when you were 16 and the eldest of four. What happened to your father?
A. He died suddenly at work. He dropped me off at school. I kissed him goodbye in the car and told him I'd see him later and I remember that, for some reason, that morning I also turned round and waved.
Q. How did his death affect you?
A. He had a cardiac arrest. I remember my uncle coming to school and being advised that dad was unwell. In my role as CMO I've been keen to push bystander resuscitation so that all of us have the skills to administer CPR and also to ensure that defibrillators are available. We were the first part of the UK to have a Community Resuscitation Strategy.
Q. Did your experience shape you as a medic?
A. I remember going into the casualty department in the City Hospital and I saw my dad and he was cold. And then I remember the young doctor and how uncomfortable he felt. I told him not to worry, that I was sure he did all he could. I always remember that no matter how difficult a patient's death is for you as a professional - and it is very difficult - but no matter how hard that is, it's 10 times harder for the families.