’Keep it simple, stupid’ is a worthy phrase for most systems – it has been a hallmark of how the pandemic has been handled in Ireland.
I wonder if this way of thinking has, at least in part, come about with a Taoiseach (Prime Minister) and chief medical officer who are both GPs?
The Irish Republic decided, at the outset, to follow WHO scientific advice alongside the South Korean model of ’isolate, test and trace’, as cornerstones of controlling the pandemic.
Recently, daily deaths were in single figures. Generally, the population and the medical community feel the situation has been handled well.
In many areas, including County Kerry, where I’m based, there were no Covid-19 cases or deaths recorded for more than 28 days.
So how was this achieved?
All Covid-19 deaths – hospital, community, confirmed or suspected – have been counted from the start, making overall deaths (1,775) appear high. However, that openness has paid dividends, aiding the planning process for widespread and focused testing with consequent contact tracing.
It was recognised that GPs were a valuable resource, able to take on the gatekeeper role for the testing program. A simple message went out – if citizens were in an eligible group for testing and concerned, they might have the virus, so should contact their GP, who would arrange a test if appropriate.
A simple email request made by the GP results in a text appointment being sent to the patient.
There is specific mention for the part played by GPs
Early on, a widespread network of drive-in testing centres was developed throughout the Republic.
A large mass media health programme with simple public health messages supported this testing regime. Within that programme, a big message was that anyone developing symptoms must immediately self-isolate, including from others sharing their living accommodation.
Initially, demand for testing outstripped availability. Limitations were placed on groups eligible for testing, more laboratory testing came online, a German lab helped with testing until demand and availability gradually aligned. There were often delays between testing and result availability. Results are currently returned directly to the patient and GP within three days of initial request, with a continued drive to shorten the process further.
Every evening, a panel of medical and epidemiological experts hold a one-hour press conference on the main TV channel. Data is presented in an open, easily understandable way, followed up with intense questioning. The journalists are seen as being important to help get the right public health messages out to the population.
No politicians are present at these events. They deliver their message separately from the scientists, and dictate how the health advice should be incorporated into everyday life. There is praise for the frontline workers and the public, with specific mention for the part played by GPs.
Lockdown commenced on 13 March, and further tightening of the restrictions occurred on 24 March. Between those dates, the number of cases had gone from 90 to 1,329 and further lockdown measures were deemed essential to limit this rapid increase in incidence. Within a few days of the stronger measures being introduced, the number of cases plateaued.
At the start, there were in excess of 30 contacts per case identified. That rate came down to two to three.
A five-stage phased opening of society has started, shortly moving to phase two, with each phase lasting three weeks. The R number reduced to around 0.5.
Contact tracers were mobilised to include non-public health personnel for the less complex cases. Patients found to be positive are contacted immediately, and all recent contacts of those who test positive are tested at day one and seven, whether symptomatic or not.
The capacity for testing is much greater than demand, but it’s a wise insurance policy to have in place.
Residential institutions have been badly affected by this pandemic, and 63% of notified deaths have occurred in these institutions. When it became apparent that there was significant spread and mortality, all residents and staff were tested for Covid-19.
The risk is now that imported cases will reignite the pandemic – all travellers to the Irish Republic have to quarantine for 14 days on arrival.
It looks like I will be here for a while yet.
Dr Eamonn Jessup is a locum GP in Southern Ireland and North Wales
