Policy responses for Ireland - HSRM

Ireland


Policy responses for Ireland

1.5 Testing

Update 19 October 2020: EU-wide contact tracing app linkage

Ireland’s COVID Tracker App, Italy’s Immuni app and Germany’s Corona-Warn-App, are the first national apps to be linked through a European interoperability gateway, developed by the European Commission. Individuals in the three countries with these apps installed on their phones will be alerted if they are a close contact of someone who test positive for COVID-19 and who has one of the three apps installed on their phone.  

Minister for Health Stephen Donnelly said: ‘Ireland has consistently been a leader in the development of contact tracing apps and had one of the world’s most successful contact tracing app launches. The Irish app already works on an all-island basis [in concert with the Northern Ireland app] and today’s launch of the European Federated Gateway Service will facilitate apps working on a pan-European basis.” He added that while the current government advice is against non-essential travel, the system will benefit those who must undertake essential travel to and from Ireland.
 
The Irish app has had 2.1 million registrations since its launch, and has an active user base of 1.31 million. This represents 34 per cent of the adult population (aged 16+) in Ireland. The app notifies a close contact that they have been in contact with someone who has tested positive but does not provide any information about who the person is. To date, over 3,000 users of the COVID Tracker App in Ireland who have tested positive have uploaded their random IDs so that others can be alerted of close contacts. More than 5,800 people have been sent close contact alerts as a result of carrying the app. Some of these may not otherwise have been identified.

Update 22 October 2020: Contact tracing system overwhelmed

In the midst of the second wave of COVID-19 infections in Ireland, the contact tracing system has come under significant pressure without sufficient numbers of staff in place to keep up with the surging need for contact tracing. With a backlog of calls yet to be made and over 2000 positive tests emerging over the weekend of 17 and 18 October, the situation became unsustainable. As a result, the group of people aged 19 to 74 who tested positive that weekend were asked to contact their own contacts. This group of people received a text message to forward to people they had spent more than 15 minutes with alerting them to restrict their movements and to immediately contact their GP to arrange a test.

Health Service Executive (HSE) CEO, Paul Reid publicly apologised to those people and said that the HSE is recruiting 70 people per week for contact tracing, that 220 people have been employed in tracing in the last couple of weeks, with a total of 500 people now involved in testing and tracing.

Minister for Health Stephen Donnelly said this was not a sign of a failure of the contact tracing programme and that in the six weeks prior, contact tracing teams had made 400% more calls than previously. Rather, he said, this was a one-off situation where demand outstripped supply and a one-off operational decision was made to reset the system.

Source:

https://www.rte.ie/news/coronavirus/2020/1022/1173164-covid-contact-tracing/

https://www.irishtimes.com/news/health/covid-19-explainer-why-is-the-contact-tracing-system-getting-swamped-1.4386851

Update 13 October 2020: Text message notifications for those who test positive for COVID-19 and for those identified as close contacts

In a press release issued by the Health Service Executive (HSE) it was announced that, as part of its Technology Improvement Programme, those who test positive will now get a text message informing them about their result. The text message will advise those confirmed to have COVID-19 to self-isolate and ask their household members to restrict their movements. The text will be followed up with a phone call from the HSE contact tracing team for detailed follow up as soon as possible. Until now, an automated text message system was used only for those who tested negative for COVID-19 and those who tested positive have been phoned with the result.

Those identified as close contacts of confirmed cases will also be contacted by text message and advised to restrict their movements. This will be followed up by a phone call from contact tracing to discuss the precautions to be undertaken by a close contact and for testing to be arranged. Parents/guardians of children identified as close contacts in creches and schools will also get a text advising them that other members of the household need to self-isolate only if the child becomes unwell. This will be followed up with a phone call to discuss further steps and testing.

The text message system is part of an effort by the HSE to limit the spread of COVID-19 and reduce its impacts on schools and childcare facilities. Informing people who tested positive or are close contacts about their status as soon as possible is envisaged to enable them to undertake prompt action earlier.


Update 20 August: HSE chief defends test and trace system and says new agreement will be reached with private hospitals

HSE chief, Paul Reid, rejected claims that the test and trace system is not working and described such claims as ‘alarmist and unhelpful’ at a press briefing on 20 August. He said the ‘HSE's escalation plan for testing and tracing is working’, that they are meeting ‘complex demands’ due to the sharp increase in the number of cases (https://www.irishtimes.com/news/health/hse-chief-rejects-claim-that-testing-and-tracing-system-falling-apart-1.4334880).

Mr Reid said ‘55,000 tests were completed in the last seven days’ noting that this is the second highest numbers of tests carried out since the arrival of COVID-19. He explained how they had gone ‘from 50 cases per week to over 600 cases per week, with a particular increase in demand in community swabbing’ (https://www.rte.ie/news/coronavirus/2020/0820/1160262-coronavirus-hse-briefing/). He outlined how there are particular challenges testing and tracing in workplace settings, there were many more close contacts of cases to be traced, in some instances there were up to 50 close contacts of a confirmed case identified and an ‘increasing need to support people for whom English is not their first language’. The increase in cases was not impacted the acute hospital system with just 16 confirmed cases in hospital, six of whom are in intensive care on 20 August 2020.

Mr Reid encouraged people to come forward for testing, saying that the numbers tested last week ‘demonstrated that the system is meeting demand’, he insisted there is the capacity to test and trace 100,000 Covid-19 tests in a week. He acknowledged that the turnaround times have been challenged, with the length of time between a person being referred for a test, the test taken and results given, along with all close contacts being contacted was at 2.8 days last Sunday but had improved to 2.3 days by today.

Mr Reid acknowledged that there were delays getting test centres back up and running from ‘the point of really low numbers’ and apologised to anyone who experienced delays in getting their test results.

When asked about a new agreement with private hospitals, Mr Reid said the HSE is securing services and diagnostics from private hospitals which will be utilised once the funding has been agreed. There is currently a bridging agreement of €25 million to cover the care of public patients in private hospitals and there will be another agreement to provide support for public patients in the event of national surge similar to what they had previously.

Update 20 July 2020: HSE donates contact tracing app to global public health project

The Health Service Executive produced a Covid-19 tracker app which has seen a high uptake among the Irish population with 1.4 million people having downloaded the app. The source code has also been used to build contact tracing apps for Northern Ireland and Gibraltar, along with other countries in Europe, the Middle East and Africa, and the US.

The code has now been donated to the Linux Foundation Public Health initiative as part of an attempt to suppress the coronavirus pandemic globally (https://www.hse.ie/eng/services/news/media/pressrel/covid-tracker-ireland-app-one-of-linux-foundation-public-health-s-first-open-source-projects.html). The Linux Foundation Public Health uses open source software to help public health authorities combat Covid-19 and future epidemics. The code has also been donated to Covid Shield, which is being deployed in Canada (https://www.hse.ie/eng/services/news/media/pressrel/covid-tracker-ireland-app-one-of-linux-foundation-public-health-s-first-open-source-projects.html).

Update 7 July 2020: COVID Tracker App launched

The new Minister for Health, Stephen Donnelly TD launched Ireland’s COVID Tracker App on 7 July 2020 alongside Paul Reid, CEO, HSE, Dr Ronan Glynn, Acting Chief Medical Officer, Department of Health and Dr Sarah Doyle, Specialist in Public Health Medicine, HSE HPSC.
The aim of the App is to enhance existing contact tracing measures, by enabling users to identify close contacts and to alert those who are using the App of the need for COVID-19 testing as quickly as possible.         
                                                                                                                                                                 
The App development process was led by the HSE and the Department of Health, in collaboration with the Office of the Government Chief Information Officer and An Garda Síochána, together with technical partners from the Irish private sector and scientific partners from Science Foundation Ireland. Research found that the majority of people in Ireland are in favour of an App with 82% of respondents willing to install it.

It is intended that the App will work in tandem with key public health measures of social distancing, hand washing, covering our coughs and wearing face coverings, helping us to stay safe and to protect each other.

Paul Reid, CEO, HSE said ‘For those using the app, it can mean a reduction in the time it takes to trace close contacts from days to hours and, importantly, it can also help to identify close contacts who are not known to each other. Every additional contact that the app can trace will improve our existing contact tracing operations’.
The COVID Tracker App is available to download from the App Store and Google Play and has three specific functions:
  • Digital contact tracing of close contacts of confirmed cases of COVID-19.
  • Allows users to record if they have symptoms.
  • Provide daily information about COVID-19 from a trusted source.

The app was developed with privacy by design at its core, employing a decentralised model. This means that it will record if a user is in close contact with another user by exchanging anonymous codes. If a person tests positive for COVID-19, they can choose to anonymously alert other app users who they have been in close contact with. Close contact data is stored on the users’ phone and not a government server. Prior to the launch, the HSE and Department of Health published the Data Privacy Impact Assessment and source code for the app demonstrating the openness and transparency of the app technology.

Within 36 hours of its launch, there were one million downloads of the App.

For more information about the app and to view a series of simple explainer videos please go to https://www.covidtracker.ie/

Update 26 June 2020: COVID-19 tracker app

Work has been underway to develop a national app for contact tracing and real-time symptom tracking (https://www.gov.ie/en/news/d2a00d-national-app-for-covid-19/). On 26 June 2020, the Department of Health and the Health Service Executive published a series of documents to provide insight into the decentralised model and privacy by design approaches that underlie the COVID Tracker App for Ireland (https://www.hse.ie/eng/services/news/newsfeatures/covid19-updates/covid-tracker-app/covid-tracker-app.html). The Data Protection Impact Assessment, the source code, the Product Explainer for the COVID Tracker App, and a series of app design and development reports are available on GitHub (https://github.com/HSEIreland/).

In the development of the COVID-19 tracker app, Ireland has actively participated in the European eHealth Network and engaged with the DPT-3 group (Estonia, Switzerland, and Germany). The EU has a goal of tracing apps being interoperable across all EU countries and that EU citizens should be able to receive alerts of close contacts with a possible case wherever they are in the EU.
84% of the Irish population over the age of 16 own a smart phone and research has shown that the vast majority of these are willing to download a tracking app to their smart phone.

The app has apparently been ready for launch pending Government approval since 24 June (https://www.irishtimes.com/business/technology/hse-s-covid-19-contact-tracing-app-is-ready-for-launch-1.4287162). 


Update 25 June 2020: Reduction in testing centres due to low community transmission

Speaking at the parliamentary COVID committee, the HSE chief clinical officer Dr Colm Henry said the number of testing centres had gone from 48 to two with the number of tests gone from 100,000 to 18,000 a week because of low community transmission. Dr Henry told the Committee the HSE had begun designing a new model of ‘sustainable testing service that will deliver short turnaround times’ with effective contact tracing, to be in operation by late August and in place for at least 18 months (https://www.oireachtas.ie/en/committees/33/special-committee-on-covid-19-response/).

The HSE set a maximum wait time for 72 hours from test to tracing to be completed in mid May. The HSE national lead for contact tracing and testing Niamh O’Beirne told the Committee that under the current infrastructure it ‘isn’t always possible to achieve’ a one-day turnaround for testing in the community and she did not give a commitment of a 24-hour turnaround time. Other presenting to the Committee insisted that there should be 24 hour turnaround time for testing in order prevent community transmission.

Update 5 June 2020: Contact tracing app being tested, due for government approval in June

The HSE said at a press briefing on 5th June that a contract tracing app would go to government for approval in this month. There have been various delays in the app’s development. It was announced that researchers from an expert advisory group formed by Science Foundation Ireland (SFI) will conduct an independent assessment of the effectiveness of aspects of the State’s Covid-19 contact tracing app (https://www.irishtimes.com/news/ireland/irish-news/covid-19-state-s-contact-tracing-app-to-be-tested-for-accuracy-1.4268079).
Gardaí (the Irish police force) will trial the app. They will be asked to install the app on their phones and carry them while circulating on duty. The app was originally scheduled to launch in early April, but has been continuously pushed back due to technical issues and privacy concerns emerged.

Update 21 May 2020: Antibody testing to start in June

The Health Service Executive (HSE), Health Protection Surveillance Centre (HPSC) and the National Virus Reference Laboratory (NVRL) in University College Dublin (UCD), are confident that an antibody test, known as a sero-prevalence study, can start in Ireland in early June (https://www.irishtimes.com/news/politics/coronavirus-ireland-to-start-antibody-testing-early-next-month-1.4259083).

Antibody tests detect if a person has had the infection in the past. Up to now, Ireland has no data on the prevalence of Covid-19 in the population. Currently testing is assessing if somebody has the virus.
 
Speaking on Morning Ireland on 21 May 2020, Dr Cillian de Gascun, director of the NVRL and a member of the National Public Health Emergency Team (NPHET) said ‘At present, we are not planning to test that many people: it’s likely we’ll choose something in the region of 5,000 to start with [from two geographic regions], and repeat that at intervals over the coming year. However, if we find after the first study that the number of people exposed is very low, we might need to increase the sample size for future studies’.

The first case of confirmed COVID-19 in the Republic of Ireland was on 29/02/20. At this point, Ireland was in the containment phase. Everyone who was in contact with the case was contact traced.  

From early March those who had symptoms having returned from affected regions were tested as well as those with whom they were in contact. Three different stages (contain, delay and mitigate) are being utilised in Ireland and different people are being tested depending on the phase and advice from ECDC. The containment phase aims to block transmission and prevent further spread by early detection of imported or local cases. The delay phase aims to slow down transmission of the virus; protect vulnerable populations through preventive measures and clinical management options; reduce burden on health system. The mitigation phase seeks to mitigate outbreak impact, provide essential services, prioritise protection of most vulnerable, reduce excess mortality.

Up to 12 March, Ireland was in the containment phase. On 12 March, NPHET made the decision to move to the Delay Phase. Dr. Tony Holohan, Chief Medical Officer, Department of Health, said: ‘The ECDC have now advised early, decisive, rapid, coordinated and comprehensive implementation of social distancing measures. Ireland has today responded to this advice. The delay phase is designed to interrupt the transmission of the COVID-19 virus, by advising reductions on social interactions’.

On 16 March, the WHO called on all countries to test every suspected case of COVID-19. On this date there were five hospital sites around the country (in addition to the National Virus Reference Laboratory - NVRL) providing testing.

Since 26/03/2020, priority groups for testing is given to symptomatic people in the following groups:
 • Close contacts of a confirmed case
 • Health care workers who are front facing/ have regular patient contact
 • Groups most at risk of severe infection such as persons with diabetes, immunosuppressed, chronic lung disease, chronic heart disease, cerebrovascular disease, chronic renal disease, chronic liver disease and smokers.
 • Household contacts of at-risk groups above
 • Staff and residents of nursing homes and other residential care settings and those in direct provision, homeless, Roma and travelling community settings where symptom management is difficult
 • Prison staff and inmates where it may be difficult to implement self-isolation advice
 • Pregnant women to ensure they can be managed safely in hospital, minimising the risk of spread in the maternity hospital. 

GP, hospital doctors and specialists can refer people for testing. Individuals can ring a helpline where they are encouraged to contact their GP by phone (the HSE helpline is 1850 24 1850). GP and GP out of hours services are carrying out triage over the phone and since mid-March, everyone is encouraged to contact their GP by phone as first point of contact.

Initially, testing took place in hospitals. At the meeting of NPHET of 03/03/2020, it stated ‘NPHET approves the HSE proposal for community-based testing via the National Ambulance Service supplemented by community care teams. The new system will be trialled this week with a view to full implementation next week’.

In the first week of March, the National Ambulance Service began testing in people’s home, on 17 March the first drive-through testing centre opened in the national stadium, Croke Park, Dublin. On 30/03/20 there were 47 testing centres operating, in a variety of different places, including healthcare facilities, sporting grounds and closed airports.

At the NPHET meeting on 10/03/2020, it was noted that ‘a number of queries in relation to turnaround times for test results have been received. It was noted that 98% of tests for COVID-19 to date have been negative and that turnaround times should be reported as being an average of 24 hours and no longer than 48 hours’. 

Throughout March and early April, there were continuous issues with delays in testing with many waiting 7-10 days for test results. On 1 April, the HSE and health minister apologised for delays in test results for Covid-19 citing the global shortage of testing kits, reagents and other essential equipment. The HSE said it making every effort to improve turnaround times. At a daily briefing, a senior official at the Department of the Taoiseach said that not all test centres were open but that the HSE has assured the Government that sufficient centres are open to meet the demand and lab processing capacity. The HSE said that, as indicated previously, laboratories were experiencing challenges in terms of securing supplies of reagent for testing. This is a global problem, with major suppliers rationing supplies across the world. The HSE said it continues to prioritise testing of healthcare workers and patients in acute hospitals and residential facilities. The HSE said it was making every endeavour to improve turnaround times within the current international constraints and emphasised that testing was performed for public health, not for clinical reasons, and that patients waiting for results should continue to self-isolate for 14 days.

On 05/04/2020, HSE CEO Paul Reid stated at a HSE media briefing that the delays were due to acquiring reagents, testing would be at 4,500 tests a day for the week of the 6/04/2020. On 6/04/2020, there are 50 community testing labs with 37,000 tests completed, equivalent to the Hubei province. The positive testing rate changed from 4% to 13% between the third week of March and the 5 April. This reflects the changing case definition and testing of higher risk groups.

From late March, the HSE said that it was beginning direct contact tracing of high-risk groups in advance of test results.

Up to early-mid March, there was one centralised laboratory located in the National Viral Reference Laboratory (NVRL) in University College Dublin. By 27 April there were 27 labs testing results with the capability of processing 10,000 tests a day (https://www.gov.ie/en/collection/50c4dc-daily-briefings-on-the-governments-response-to-covid-19/). By 27 April, 153,054 tests had been carried out in Ireland, 41,470 of which were carried out over the previous week. 37,000 of these tests were carried out in the nursing home sector to both staff and residents.

At the NPHET meeting of 10/03/2020, it was stated that ‘the NVRL tabled a deliberative paper outlining the approach to expanding laboratory testing capacity across the country. This paper outlines the criteria which must be in place before laboratories can provide testing:
 • Accreditation
 • Daily testing, including provision for weekends
 • Electronic reporting to CIDR and GP systems
 • Working with the National Ambulance Service as part of the home testing guidelines.

The NVRL advised that they will provide technical and other support to these laboratories, as well as a validation panel and the provision of a reference laboratory service. It was noted that a commercial testing kit is now available.

HPRA [The Health Products Regulatory Authority] advised they are in a position to provide a national derogation for the use of this testing kit while it awaits a CE mark. In addition, they are preparing an advisory notice on kits for near patient testing to issue this in the coming days. A number of hospitals have expressed an interest in providing the test and are making preparations to do so. The NPHET approved the proposal to expand testing to other sites.’ 

From 10 April 2020, there has been a steady increase in the numbers of people who have COVID-19 mainly due to a backlog of cases including results coming from German laboratories being included in the figures (https://www.irishtimes.com/news/health/coronavirus/harris-challenges-hse-to-speed-up-turnaround-time-for-covid-19-test-results-1.4228062). Previous testing constraints (shortage of reagents and long turnaround time for test results) had led to underreporting.

Cases increased from 6,574 on 9/4, to 8,089 on 10/4, to 8,928 on 11/4, to 9,655 on 12/4, to 10,647 on 13/4. These increases caused some confusion in relation to overall numbers. Figures reported on 13 April confirmed that there have been 365 COVID-19 related deaths in Ireland. A summary of all 365 deaths provided by the HPSC shows that:
  • 215 (59%) of those who died were male, 150 (41%) were female
  • the median age of those who died is 82
  • 247 of these cases were admitted to hospital with 37 admitted to ICU.

At the press briefing on 11 April, it was confirmed that there are in 268 cases long-term residential facilities, 214 of which are nursing homes, and 32 in centres for people with disabilities. Senior health official Kathleen MacLellan said there was “no doubt” that congregated living arrangements in nursing homes and disability centres was posing a “unique challenge” in containing the spread of the virus" (https://www.irishtimes.com/news/health/coronavirus-republic-reports-31-further-deaths-as-cases-pass-10-000-1.4227713).

Speaking at the press briefing, CMO Tony Holohan said “Today marks a milestone in Ireland’s experience of COVID-19 as we see the number of confirmed cases exceed 10,000.”

“The number of community cases of COVID-19 shows why we continue to need the public health measures that we currently have in place. I understand that the current restrictions are tough, especially during a bank holiday weekend when in normal circumstances most of us would have met up with family and friends but I ask that the public continue to work with us and follow the guidelines that are in place.

“The next three weeks will prove crucial to Ireland’s COVID-19 story and by working together we give ourselves the best chance to slow the spread and save lives” (https://www.gov.ie/en/press-release/466968-statement-from-the-national-public-health-emergency-team-monday-13-a/).

At a HSE briefing on 13 April, HSE chief executive Paul Reid said the backlog in testing had been reduced from a high point of about 35,000 people waiting for results to some 11,000. He told the briefing that there are now 25 laboratories were now being used to examine Covid-19 tests, including 20 in hospitals, the national lab in UCD, a Department of Agriculture facility and in labs in Germany. Paul Reid said nearly 8,000 tests were completed on Saturday. There was also concern that 100 people who had been tested were given the wrong test result.

17 April 2020: A series of news reports the week of 13 April 2020 detailed clusters of COVID-19 related deaths in long term residential care settings of older people and vulnerable adults. On 15 April, the national public broadcaster RTE reported nine deaths the previous weekend at a psychiatric residential unit in a St Fintan’s Hospital, Portlaoise, Co Laois (https://www.rte.ie/news/2020/0419/1132460-nursing-homes-ireland-covid-19/). In the same week, two healthcare workers from the one hospital, St Luke’s in Kilkenny died from COVID-19 in a 24-hour period.

At the daily press briefing by Chief Medical Officer Tony Holohan in the Department of Health on 17 April 2020, the following actions in relation to nursing homes were outlined (https://www.gov.ie/en/press-release/78ca7b-statement-from-the-national-public-health-emergency-team-friday-17-a/):

  • to expand testing capacity to 100,000 tests per week operating on a seven-day week basis for a minimum of six months
  • over the course of the next 7 to 10 days, testing of staff and residents in all Long-Term Residential Care (LTRC) facilities to be prioritised
  • a census of mortality across all LTRC facilities to be carried out this weekend to cover all deaths, COVID-19 and non-COVID-19 since 1 January 2020, regardless of where the death occurred.

Meanwhile, Nursing Homes Ireland (NHI), the representative body for private and voluntary nursing homes welcomed the increased priority for nursing homes in particular access to testing for all residents and staff. NHI continued to raise the issue of access to PPE and staffing issues. They also called for representation on two sub-committees of the NPHET on nursing homes and vulnerable adults.

26 April 2020: A formal agreement between the HSE and the Department of Health was agreed the week of 26 April to scale up testing to 100, 000 tests a week (https://www.rte.ie/news/2020/0426/1134850-covid-ireland/). It is estimated it will take up to mid-May before this capacity is in place. 

A new contact tracing app is also expected to be up and running by the end of May to support efforts for a long-term testing and tracing, allowing patients to be identified and isolated more efficiently.

While officially it is stated that tests are being turned around in a 24-36 hour period, there are persistent media reports of delays in testing results for people, especially those in the community (https://www.irishtimes.com/life-and-style/health-family/coronavirus-the-inside-story-of-ireland-s-contact-tracing-operation-1.4225900).

28 April 2020: From 28 April 2020, there was a change in the test criteria issued to GPs by the HSE (https://www2.hse.ie/conditions/coronavirus/testing.html). Everyone in Ireland is encouraged to phone your GP to be assessed for a coronavirus test if they are in one of these situations:
1) Experiencing one of these symptoms and there is no other obvious cause:
   • fever
   • cough
   • shortness of breath
2) Someone who has been in close contact with someone who they think or know has coronavirus in the last 14 days and suddenly experience one of these symptoms:
   • fever
   • cough
   • shortness of breath
   • blocked nose or sinus
   • stuffed or runny nose
   • sore throat
   • wheezing

People are to self-isolate if either of these situations apply. If experiencing any of the above, people need to phone their GP. As up to now, people are advised not go to a GP surgery, pharmacy or hospital. The GP will assess over the phone. GPs assessment and test will be free of charge. Any GP can assess for a test. The public are being told not to ring GP out-of-hours services. They cannot arrange testing. Also the HSELive telephone line cannot order coronavirus tests. It is an information line only.

Some groups are being prioritised for coronavirus tests. Priority groups include people with specific symptoms of coronavirus who are also:
   • close contacts of a confirmed case
   • healthcare workers who are in the frontline and have regular patient contact
   • in groups most at risk of severe infection, such as people with ischaemic heart disease, hypertension, cerebrovascular disease, diabetes, obesity, active malignancy in last 5 years, chronic lung disease, chronic renal disease, chronic liver disease and the extremely medically vulnerable as outlined in the guidance on cocooning
   • people who live with frontline healthcare workers or with people in the at-risk groups listed above
   • staff and residents of nursing homes and other residential care settings and those in direct provision, homeless, Roma and travelling community settings where symptom management is difficult
   • pregnant women to ensure they are managed safely in hospital.

With effect from 6 May, the testing criteria issued to GPs for COVID-19 were broadened. Up to 5 May, only those in at-risk groups including healthcare workers were eligible. From 6 May, patients only need to have sudden onset of a cough, fever or shortness of breath and no other cause that explains their illness in order to be eligible for testing (https://www2.hse.ie/conditions/coronavirus/testing.html).

At a HSE press briefing on 14 May 2020, HSE chief, Paul Reid announced a new target set for testing and tracing pathway. From 18 May, the HSE will have the capacity to carry out 15,000 tests a day with a test to trace turnaround time of under three days for 90% of cases (https://twitter.com/HSELive/status/1260850230553165827). Reid said that there is currently capacity for
  • carrying out 12,000 tests a day in the community and hospitals
  • testing 15,150 tests a day in laboratory
  • swab results will be in available in two days and
  • end to end turnaround time in five days.

A Roadmap to enhance capacity and turnaround for COVID-19 Testing and Tracing was released,  outlining two papers:
  • The review commissioned on the HSE testing and tracing pathway – dated 24 April 2020
  • Progress update on the testing and tracing pathway – dated 14 May 2020 (https://www.hse.ie/eng/services/news/newsfeatures/covid19-updates/covid-19-testing-and-tracing-roadmap.pdf).

14 May 2020: Correspondence released by the Department of Health on 14 May in response to queries from the TD and leader of the Labour Party Alan Kelly show tensions between the HSE and the Department of Health. Both the HSE chief and chair of the HSE board wrote to the secretary general of the Department of Health in the middle of April in relation to concerns over commitments made by the National Public Health Emergency Team (NPHET) that the HSE would provide 100,000 tests per week working on a seven day a week basis for at least six months. The letters from the most senior official in the HSE, Paul Reid, to the Department said the NPHET direction bore ‘absolutely no resemblance to that which we previously discussed and has taken no account of what can be achieved by when’. Reid also specified NPHET’s announcements in relation to testing everyone in residential facilities was also done without adequate consultation with the HSE in relation to ‘detailed operational considerations and clear requirements for guidance on prioritisation, introduces considerable risk to the continuity of service in these settings’ (https://www.gov.ie/en/collection/aa1253-view-the-latest-correspondence-covid-19-department-of-health-hse/).

Update 27 July:  Critique of early COVID-19 testing infrastructure

In April 2020 the National Public Health Emergency Team (NPHET) established a task force to explore COVID-19 testing. Members of that task force have now criticised what they say is a lack of response to their recommendations leading to lost opportunities which would have transformed the efficiency of the State’s testing and tracing system (https://www.irishtimes.com/news/ireland/irish-news/covid-19-testing-concerns-raised-by-expert-taskforce-1.4314011).

Specific critiques include concerns about a lack of capacity to carry out polymerase chain reaction (PCR) testing, the key feature of the State’s testing strategy. In April, the task force report recommended more robust governance, management and co-ordination structures being required. It also cautioned that human resources and infrastructure in universities, industry and research centres was not being fully utilised.

Members of the task force said on 27 July 2020 that their recommendations were ignored and that no feedback was given from NPHET to their report.

A Department of Health spokesperson disputed the idea that suggestions from the task force had been ignored and further said that NPHET relied on advice from the World Health Organisation and European Centre for Disease Prevention and Control, and its own membership.

Sources:

Health Protection Surveillance Centre. COVID-19 interim case definition: https://www.hpsc.ie/a-z/respiratory/coronavirus/novelcoronavirus/casedefinitions/ (Date last updated: 29/03/2020)

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/ 

RTÉ news (01/04/2020). HSE apologises to those waiting for test results, Taoiseach says there will be some delays. https://www.rte.ie/news/coronavirus/2020/0401/1127767-coronavirus-ireland-testing/