1. Preventing transmission
The section on PREVENTING TRANSMISSION includes information on key public health measures that aim to prevent the further spread of the disease. It details how countries are advising the general public and people who (might) have the disease to prevent further spread, as well as measures in place to test and identify cases, trace contacts, and monitor the scale of the outbreak.
1.1 Health communication
Update 3 September 2020: HSE chief warns about the most difficult winter ahead for the health system as high Irish rates of COVID-19 persist
HSE CEO Paul Reid said that this will be ‘a more difficult winter than we’ve ever faced’. Commenting on the long-awaited HSE's winter plan that has been submitted to the Government, he said community assessment hubs will be used to relieve pressure on GP surgeries by identifying other respiratory illnesses.
Speaking at the HSE weekly briefing on 3 September, Mr Reid said Ireland’s rate of COVID-19 cases had continued to increase over the last six weeks, reaching 30.5 per 100,000. He detailed how there was an average number of 120 new cases per day for the last week, reaching levels not seen since April. The numbers of confirmed cases in hospitals have been trending upwards although there are still relatively low as are numbers in ICUs. There have been no new Covid-19 deaths reported during the past fortnight and just four during the month of August. Mr Reid said there were 65,000 COVID-19 tests carried out last week, with a 14% increase in test referral from GPs and the positivity rate remaining low at 1.4%. There is 2.2 day end-to-end test and trace turnaround time.
Speaking at the Department of Health press briefing on 2 September, Acting Chief Medical Officer, Dr Ronan Glynn said that the current surge of COVID-19 can be successfully suppressed through people slightly reducing their daily contacts. At the press briefing, Dr Glynn spoke about how the numbers with COVID-19 is slowly growing in many counties with specific concerns about the numbers of new cases in Dublin and from private parties in people’s homes. Prof Philip Nolan, chairman of the Irish Epidemiological Modelling Advisory Group and member of the National Public Health Emergency Team said that getting the R number below 1 is ‘absolutely realistic’, through a ‘marginal reduction’ in the number of contacts people have each day. The R number represents the average number of people that one infected person will pass the virus on to. A reproduction number of less than 1 means an epidemic is dying out; a figure greater than that signals it is spreading. The reproduction number is at 1 to 1.2, according to Prof Nolan.
Prof Nolan stated his concern about a rise in the number of patients in hospitals at 42, up from a low of under 10 one month ago. Admissions to intensive care remain stable.
Two schools reported cases of COVID-19 during the first full week of schools re-opening. Outbreaks of COVID-19 in schools are being led and managed by the HSE public health teams in the context of a full public health risk assessment, on a case by case basis.
11 June 2020: New public campaign on use of facemasks to start on 15 June 2020
Minister for Health Simon Harris said on 11th June that a public health information campaign in relation to the wearing of facemasks would be launched. Speaking at the now bi-weekly briefing by the Department of Health, Dr Tony Holohan, Chief Medical Officer said that the National Public Health Emergency Team ‘has recommended the development and implementation of a national communications campaign to increase compliance with current recommendations on the use of face-coverings. The campaign will outline best practice for use of face coverings in retail outlets, on public transport and in other public locations, where it may be difficult to maintain social distancing’ (https://www.gov.ie/en/press-release/97da9-statement-from-the-national-public-health-emergency-team-thursday-11-june/).
At the Dáil COVID-19 Committee on 9 June, politicians expressed concern that there is a low uptake by members of the public in relation to facemask use and confusion in relation to facemask guidance (https://www.irishtimes.com/news/ireland/irish-news/coronavirus-eight-more-deaths-recorded-ahead-of-new-push-on-face-coverings-1.4276558?localLinksEnabled=false+Eight+more+deaths+recorded+as+face+mask+policy+is+reviewed ). It is not mandatory to wear them but the official face guidance is as follows: Wearing a cloth face covering is recommended in situations where it is difficult to practise social distancing, for example, in shops or on busy public transport. Wearing of cloth face coverings may help prevent people who do not know they have the virus from spreading it to others. If you wear one, you should still do the important things necessary to prevent the spread of the virus. These include:
• washing your hands properly and often
• covering your mouth and nose with a tissue or your sleeve when you cough and sneeze
• not touching your eyes, nose or mouth if your hands are not clean
• social distancing (keeping at least 2 metres away from other people).
This guidance also covers when to wear a cloth face covering, who should not wear one, how to wear wash and make one, dos and don’ts of wearing masks (https://www.gov.ie/en/publication/aac74c-guidance-on-safe-use-of-face-coverings/. The official guidance also says that Medical masks (surgical and respirator) are for healthcare workers. Some workers in specific jobs also use them. They are vital supplies and are not intended for use by the public in the community. We want to try and make sure that medical face masks are kept for health care workers.
Speaking at the Dail COVID-19 committee on 9 June, Dr Cillian De Gascun, the Director of the UCD National Virus Reference Laboratory said that the evidence around the use of cloth masks is "not fantastic". He told the committee the uptake of masks had not been very large, but added that there was not great evidence that the virus was stopped by non-medical grade or cloth masks. He said that while medical grade masks worked very well, inappropriate mask use could be potentially harmful and could increase the risk of transmission.
Official public advice on COVID-19 was first issued in a press statement for the National Public Health Emergency Team (NPHET) on 07/02/2020 which stated ‘Coronavirus (2019-nCoV) is spread through contact and droplets so good cough and sneeze hygiene, with regular hand washing, is the best way to keep well. The general public is encouraged to inform themselves on prevention measures issued by HSE and to follow HPSC for regular daily updates’. It also specified the possible symptoms of coronavirus, the more severe illness it may cause (e.g. pneumonia and breathing difficulties) and how to reduce risk of contracting coronavirus through proper and regular handwashing and covering your mouth and nose when coughing and sneezing. The weekly Health Service Executive (HSE) media updates on Seasonal Flu and Winter Plan included specific information on COVID-19 (Coronavirus) in its briefing on 31 January 2020. Public health advice and physical distancing posters were made available in early March and a public health booklet was distributed to all households in the last week in March and early April by post (https://www.gov.ie/en/publication/472f64-covid-19-coronavirus-guidance-and-advice/#public-health-advice-posters).
The Irish Health Service Executive (HSE) (https://www2.hse.ie/coronavirus/) is the main source of information for the public on the corona virus. In addition, the Health Protection Surveillance Centre HPSC’s website (https://www.hpsc.ie) is updated at the same time each day with the most up to date figures. According to early NPHET minutes, which can be found on the gov.ie website, ‘this should be regarded as the most accurate and current source of information. The HPSC website links directly to the WHO epidemiological data. Since the onset of the crisis a specific Health Surveillance Monitor webpage has been set up to give up to date figures on COVID-19 related figures (https://geohive.maps.arcgis.com/apps/opsdashboard/index.html#/29dc1fec79164c179d18d8e53df82e96). Deaf Irish Sign Language users can get information about coronavirus using Irish Remote Interpreting Service (IRIS). There are also daily updates on the Irish government website: https://www.gov.ie/en/news/7e0924-latest-updates-on-covid-19-coronavirus/
On 16 March 2020, the government launched a COVID-19 Action plan (https://www.gov.ie/en/publication/47b727-government-publishes-national-action-plan-on-covid-19/). The plan states ‘the two most important ways by which we can fight this disease are through determined public health-mandated measures and changing our individual and collective behaviours’. It specifies the government approach that 'Ireland has taken, and will continue to take, several important, robust and determined public health decisions and actions to contain, delay and prepare for mitigating this virus. Our health and social care services will continue to lead the way in driving the public health approach to COVID-19, using evidence to predict the best responses for Ireland, communicating with everyone, as well as testing, tracing and caring for those who are affected by this disease’. This approach has been continuously communicated to the public since February 2020, with increasing urgency of the measures introduced from mid-March.
Information on outbreak severity and responses comes from the HOPC. This is reported on daily online by the HPSC and daily at the press briefings of National Public Health Emergency Team (NPHET) via the Chief Medical Officer (CMO) and his team as well as the health minister and the HSE. From early March, the CMO has hosted daily press briefings which are available online and since the second half of March on the national public service broadcaster. The HSE also has weekly/bi-weekly press briefings initially reporting on the flu season and winter plans. Since late March, these are broadcast on live TV and twitter live. Members of NPHET, the leadership of the HSE, clinicians, the health minister and other government leaders including the Taoiseach (prime minister) and (deputy prime minister) Tánaiste have appeared regularly on national media and social media distributing information on responses and encouraging citizens to adhere to them. The NPHET made its first public statement on 1/02/2020 announcing that the policy at that point in time was one of containment.
On 20 February 2020, Minister for Health, Simon Harris TD signed the 'Infectious Diseases (Amendment) Regulations 2020' to include Covid-19 on the existing list of notifiable diseases (https://www.gov.ie/en/press-release/290361-minister-for-health-signs-regulations-to-make-covid-19-a-notifiable-/). This obliges doctors to routinely notify the HSE when a case of COVID-19 is diagnosed.
A new media campaign was launched on 15 April by the Department of Justice and Equality on TV, radio and social media to call attention to the danger of domestic abuse. It is a collaborative campaign between Government and frontline services. The campaign aims to reassure victims that services are ‘still here’ even in the midst of the COVID-19 emergency (https://www.gov.ie/en/publication/4abe3c-daily-briefing-on-the-governments-response-to-covid-19-wednesday-15t/).
On 7 May, the HSE’s National Cancer Control Programme (NCCP) launched an awareness campaign on social media encouraging people not to delay seeking medical advice because of COVID-19 (https://www.hse.ie/eng/services/news/media/pressrel/hse-national-cancer-control-programme-encourages-people-who-may-have-cancer-symptoms-to-contact.html). According to the NCCP, there is a decline in the number of patients referred to cancer diagnostic services since the onset of the Covid-19 pandemic. This is a cause of concern for the NCCP as it indicates that people with symptoms of cancer are delaying seeking medical advice.
The HSE and NCCP are clearly stating that all GP and hospital diagnostic cancer services are continuing to operate. Services have been re-organised and precautionary measures taken to ensure surgeries and hospital environments are safe for patients. All health care staff have been trained and equipped to help prevent the spread of COVID-19.
The average number of patients with suspected breast, lung, prostate and skin cancer being referred weekly to hospital clinics has dropped to less than half of that prior to the announcement of Covid-19 public health measures. These are patients who are referred electronically by their GPs. While there has been a slight increase in the number of people being referred in this past week, the NCCP is concerned that people with signs and symptoms of cancer are not contacting their GPs as they may be fearful of attending healthcare services.
Early diagnosis can improve cancer outcomes. The NCCP is advising the public to telephone their GP if they notice any of the following:
• a new lump or bump
• a changing lump or bump
• abnormal bleeding
• changes on your skin
• unexpected weight loss
• they are constantly tired.
Government of Ireland. COVID-19 Action plan for Ireland: https://www.gov.ie/en/publication/47b727-government-publishes-national-action-plan-on-covid-19/
Press releases, Agendas and minutes of the meetings of the National Public Health Emergency Team: https://www.gov.ie/en/collection/691330-national-public-health-emergency-team-covid-19-coronavirus/
Dashboard on COVID-19 related figures: https://geohive.maps.arcgis.com/apps/opsdashboard/index.html#/29dc1fec79164c179d18d8e53df82e96