Enhanced surveillance to drill down into Covid-19 spread in community settings
During September, 27 deaths associated with Covid-19 have occurred between September 2 and 24, and 20 of those who died had underlying conditions, the final meeting of the Oireachtas Special Covid-19 Committee heard this week (September 29).
Interim Director, Health Protection Surveillance Centre (HPSC) Dr John Cuddihy told the meeting that the median age of those who died was 79 and the mean age was 73 years.
It emerged during discussion on intensive and critical care capacity (ICU) that 55 ICU beds, added since March, had brought the number of available beds from 225 to 280 at present. There was also funding for an additional 17 ICU beds in the Winter Plan 2020/21.
Committee Chair, Independent Clare TD Michael McNamara, requested details on the recording of Covid-19 deaths from Dr Cuddihy.
If an asymptomatic case had been admitted to hospital with another condition or due to an accident, which proved fatal, he queried if such a case were recorded as a Covid-19 death, if they had tested positive on admission.
In the scenario as described, Dr Cuddihy confirmed that such a case would initially be recorded as Covid-19, however, following ongoing validation could be amended or removed from the list of Covid-19 associated deaths at a later stage, or following a Coroner’s Inquest.
He said the HPSC adhered to the World Health Organization (WHO) case definition of Covid-19 in terms of the recording and reporting of deaths.
The WHO definition, updated at the beginning of last month, looks to criteria for ‘Suspect Covid-19’ cases; ‘Probable Covid-19’ cases and ‘Confirmed Covid-19’ cases.
Committee members heard that the HPSC is to start an enhanced surveillance project as early as next week, in relation to retrospective contact tracing.
The HPSC is to look at the previous 14 days for the more recent community transmission cases, and to incorporate that into the contact tracing system afterwards, Dr Cuddihy told Social Democrat Co-Leader Deputy Róisín Shortall.
Deputy Shortall had sought greater detail on settings, and where people in households had originally picked up Covid-19.
In response, Dr Cuddihy said that at present they recorded a more detailed listing of settings in outbreak reports, such as sporting venues, cafés, hotels, and universities. He undertook to make the broader listing available to members this week.
He told the Chair that a questionnaire and diary for the previous 14 days had also been designed which went into detail about various places and people the confirmed case may have interacted with.
The issue of what would be done for doctors who had returned to Ireland to join the national effort of Be on Call for Ireland, was raised by Deputy Matt Shanahan.
The Independent politician referred to doctors who had returned to Ireland, signed up for work as part of the Be on Call for Ireland initiative, and whose work contracts were not being extended and would be without work.
Health Service Executive Chief Executive Paul Rei, said that there had been a net increase in consultant numbers this year by 152 and other doctors by 1,000 and they were continuously on a recruitment campaign, and were recruiting for winter.
The meeting opened on Tuesday morning with members acknowledging the professionalism, and frontline work, of the members of the National Public Health Emergency Team (NPHET) but voicing concerns that NPET had not accepted an invitation to attend the Committee meeting for two weeks in a row.
TDs stressed their belief that it would improve decision-making processes if they were to discuss the decisions and underscored that they would be in no way undermining NPET by doing so.
Reid told Committee members that over the past few months, they had focused on restoring services that had either reduced or suspended activity following the NPHET decision of March 27.
He added that the HSE Winter Plan 2020/21, launched on September 24, aimed to ensure that our health service was prepared for these expected pressures while delivering services in the context of the continued presence of Covid-19.
“It is increasingly evident that we can expect and should therefore plan for subsequent waves of Covid-19,” he said.
Several TDs referred to international adoption of rapid antigen testing. HSE Chief Clinical Officer Dr Colm Henry underlined reverse transcription polymerase chain reaction (RT-PCR) testing as the gold standard, with the highest sensitivity of all, which was needed to identify people carrying the virus.
He said a lot of the tests coming forward had been validated on very small groups of people. He agreed antigen testing could be carried out “very rapidly” and may have a role in lower risk outbreaks but had a lower sensitivity.