The pandemic response in Ireland has understandably led to quite a bit of confusion and things are changing rapidly, from lockdowns to school closures. So I thought I’d write a thread on what might, and might not, work well in a country like Ireland with over 1000 cases per day..
..Recurring lockdowns don’t work. Well, it depends on what you mean by “work”. They’re v good at getting cases numbers low. But they don’t change any of the underlying conditions that allowed the virus to multiply in the first place. So, once society opens up, cases go up again..
..I’m slightly concerned that people are being fed a narrative that reads “if we do this lockdown right, we can stop this virus”. It may well get us low cases for Xmas, but I’d anticipate another lockdown around Easter, though I hope I’m wrong about that...
...”Contact tracing/Test trace isolate” are among the many (incorrect) terms people use to describe the work that public health units around the country do. Whatever you want to call it, this type of investigation and control work is what we’re good at. But it was never, ever...
...designed for 1000+ cases per day. It is used in household meningitis outbreaks, for example. It’s a great tool, but people saying that we need to “improve our test, trace, isolate system” are looking at the wrong solution. Of course, public health units should be DROWNING...
....in resources (instead of being some of the worst resourced in Europe), but we can’t expect them to perform investigate and control duties on so many cases. Sadly, the important interventions at this level of cases are population level restrictions ie people limiting their..
...contacts, while my world-class Irish public health colleagues focus on managing outbreaks in high-risk settings. There may be some, but I don’t know of any country successfully and rapidly managing 1000 individual cases per day....
...”Things” don’t work well. Some people are very passionate about masks or ventilation systems or aerosol precautions, and more power to them. But those of us who manage outbreaks for a living can tell you that when some interventions get more media attention than others, it...
...skews public behaviour towards some things being more important than others. In reality, while there is some difference in efficacy of different interventions, it all really only works if people are doing all/most of it. So we need to educate people about all of the....
...protective measures they need to take. The public need to know what their “pandemic protectors” are and should be encouraged to use the whole package. Individual intervention evangelism doesn’t help, and may harm.....
....”Pandemic politicisation” doesn’t work. When you have more political advisors than public health doctors working for government, you have a culture problem. Think of your experts as a resource, but a political nuisance. Be Jacinda, not Boris or Donald....
....Vilifying groups doesn’t work. Young people, for example, are getting a hard time. Not only is it not nice to see, but fear of blame stops them coming forward for testing when they’re sick, which leads to further chains of transmission. We need to be kinder in that regard...
....So, what works in a high-incidence setting? Testing is super important. You don’t need mass testing (outside of specific outbreak settings). You can get out of the hole by concentrating on testing sick people. But it needs to be walk-in testing at a time that suits. Needing..
...referrals for testing is bad for testing coverage. Testing criteria needs to be widened, as Ireland’s is too narrow and will miss cases. Ultimately, testing capacity needs to be increased significantly. Don’t know why it hasn’t happened up to now. I’d love to hear from my....
...laboratory colleagues about how this should happen. I hope they’ve been asked. I’m afraid that they might not have been, though. Which brings me into my next point....
....Listening to your experts works. Ireland is very lucky to have some proper world-class public health doctors. They’re the country’s foremost experts in outbreak management. It’s a niche skillset and very few people have it. These guys have it in spades. But there’s only 1....
...frontline public health unit doctor on NPHET, and many of my colleagues back home tell me that they have no way to make their ideas heard. When your outbreak experts aren’t being listened to in an outbreak, you have a culture problem......
..Trusting your experts works. Many people can name very many TV and media pundits in the covid space in Ireland. Most of them have never managed an outbreak of anything in their life or a case of covid, yet are beaming advice into Irish living rooms every night. The HSE rarely..
...puts their public health doctors forward to give advice to the public. This can only be because they want to control the narrative. It suggests they don’t trust their experts. This bewilders me, as our public health doctors are so highly regarded globally. Yet we gag them...
...Honesty works. Ireland has adopted a strategy of recurring lockdowns. That’s how lockdowns work. They recur. I disagree with this strategy, but I’ve not been elected to run the country. When you’re adopting a strategy that has serious implications for particular groups, you..
...really need to be honest with those groups. I absolutely understand the need to avoid panic. But, in a recurring lockdown strategy, we need to talk to the elderly and vulnerable about their need to cocoon in the medium term, well into next year. We need to be very clear that..
..this isn’t the last lockdown. We need an honest discussion as a society about what we value and about what we’re willing to do to protect the most vulnerable among us. We can’t give the elderly and vulnerable false hope about what the next year holds. Trust them with the info..
...Strict laws work. I hate to say it, as I’m generally against using legal avenues in a public health context. But strict laws are needed for the few who will continually put others at risk with their behaviour. You can (rightly) be fined for smoking in a pub, so you should be..
...fined for travelling to the same pub when you’re a close contact of a case. Lots of countries have these penalties built into their public health act. And the truth is they’re not enforced all that often. The threat of enforcement is usually enough...
....Incentives work. It’s not just about laws. Sick pay + other financial assistance packages work well. PUP is a great idea. People often do what we regard as foolish things out of necessity. Staying out of work while unwell isn’t an option for some. Helping them also helps us..
...Resourcing regional public health units works. If I had the power to suggest a strategy for Ireland it would be “impose mandatory border quarantine and then let the regional public health units get on with their job”. Most people probably don’t know where their local PHU is...
..There are 8 of these units around the country. They’re not “the HSE” or “public health officials”. They are specialist doctors, nurses and scientists, who have been managing the country’s outbreaks for decades. The fact that they can remain so low key shows how good they are...
...at their jobs. I’ve worked with them, so I’ve seen it first-hand. The problem is that, when I left in December, they were vastly under-resourced just to manage local outbreaks. They’ve never been resourced for proper pandemic planning. You can’t get public health doctors...
...in Ireland because they get treated worse than other specialist doctors in Ireland. I get very few cases of civid to manage in Oz these days, yet I have a team of 16. My Irish colleagues are managing many many more cases then me, yet a doctor in an Irish PHU might have....
...1 or 2 people helping them, and they won’t have their own team. These guys desperately need to be resourced. You need to use the lockdown to let them build up their teams, to drown them in resources. Whether the HSE does this or not will have a VERY significant impact on...
...the trajectory of the pandemic in the next year.
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