A year ago this week Sean Bresnan found himself on Google Translate, looking up how to say "happy Saint Patrick's Day" in Chinese. Head of procurement for the HSE, he was negotiating the biggest and most complex procurement operation in the history of the State and needed any help he could get. "It was small gestures likes that opened a constructive dialogue."
On March 17th – "probably the most memorable St Patrick's Day I've ever had" – a deal worth about €260 million was struck with the state-owned China Resources Pharmaceutical Group for a supply of PPE for the following 14 weeks. Before Covid the State spent €15 million a year on PPE.
Two weeks later, on March 29th, the first flight from Beijing landed in Dublin airport. It was, Bresnan says, "a very emotional day" involving "a huge national effort [from] the IDA, Aer Lingus, the Defence Forces".
He recalls standing on the tarmac “with a tear in my eye”.
Even Bono got involved in the effort "off his own bat". He was particularly helpful when it came to sourcing and delivering surgical masks. "He was a huge asset to us."
After that first flight there were 260 more between Dublin and Beijing over the following 14 weeks, clocking up 4.75 million kilometres, transporting 86 million pieces of PPE. “One Airbus A330 fully laden with gowns was enough to do us for half a day.”
The first anniversary of Covid arriving in Ireland, the first recorded death and the first lockdown have attracted a lot of coverage and reflection. But the story of the past year has not yet been told through the prism of those who worked away from the frontline and the TV cameras – the men and women who worked with the IDA to secure an early supply of PPE; the teams who oversaw the building of the first pop-up test centres and learned how to swab, even those who came out of retirement to help with the effort.
The public impression of the HSE, which is the largest employer in the State with 100,000 staff, is – rightly or wrongly – at times of an unwieldy, inefficient behemoth. Some of those shortcomings have been laid bare over the past year, but it’s also true that individuals and teams have reacted at speed to changing circumstances, working long hours and making significant personal sacrifices.
The virus arrives
When Prof Martin Cormican, the HSE's head of infection control, first began having conversations in early January about the new strain or coronavirus emerging in China, "I thought we might see a few and if we manage the first few very well, hopefully it won't spread" .
The virus had other plans. “It’s hard to see it coming. At the start we were talking about cough, shortness of breath, fever… It turns out that some of the people with Covid didn’t fit that description.”
And that, he says, “complicates everything.”
By February it had become clear that more hospital capacity and more extensive testing infrastructure was required.
Anna Boch, an estates manager with the HSE, was working on a digital transformation project when Covid arrived. That project was put on ice as her team was asked to deliver "what seemed like a mind-boggling amount of beds".
“It was like, what? What are those numbers?….It was like that sense of running ahead of a wave, and you had to pedal really fast and that you wouldn’t get swallowed up by it.”
While others in her team were focused on finding sites for field hospitals and increasing morgue capacity, Boch’s responsibility was co-ordinating sites for testing centres. Like Bresnan, she recalls a sense of people from all walks of life working together. “People were offering up facilities – GAA clubs were phenomenal, local businesses.”
Within the HSE itself “it didn’t matter what office you were in or what your grade was. Everybody pulled together”.
“There was no issue if there was phone calls happening at half seven in the morning, or you were emailing at 11 o’clock at night. I’ve never seen that,” she says.
Pat McCreanor retired from his job as deputy director of the National Ambulance Service in July 2019, after 44 years with the HSE. When the call came in March to know if he would come back, his immediate reaction was, “of course, why wouldn’t I?”
A week later he was back, working on overseeing the building of a digital Covid hub for the ambulance service, a job that demanded six- or seven-day weeks.
“We understood that. Everybody worked away, nobody turned around and said, ‘I’m not staying late’.”
Maria McCarthy’s phone rang around the same time. An assistant director of public health nursing with the HSE, she was about to go out on leave when she got the call on March 12th to “go up to Shamrocks Rovers to help swabbing for a bit”.
“So we went up on Thursday afternoon, and we started swabbing out of the back of an ambulance.”
The National Ambulance Service was on site for the first week, and then McCarthy and her colleagues were left to run a football stadium as a fully-fledged testing centre.
Over that first weekend, “we were swabbing a very sick cohort of people”; people with a “temperature, very blue, and absolutely terrified. We were terrified as well. And we weren’t sure exactly what we were supposed to be doing.”
There were delays with the delivery of PPE some days, and her team had to handwrite the labels on samples. When she went home at night, “I was taking off all my clothes in the driveway, putting it into the car, and the shower would be bellowing steam for three or four hours.”
A year on everything has been streamlined. PPE is plentiful, labels are printed, and over 90,000 swabs have been processed between Tallaght and Citywest. And McCarthy has yet to take her holiday.
Balancing risk
Sandra Tuohy is the HSE assistant national director in the community operations division with a specific focus on older people. At the beginning, she says, "globally, we had very limited understanding of what Covid was, and how it particularly affected older people".
In the beginning there was a delay in banning visits to nursing homes, something that later came in for criticism.
“We were very cautious at the beginning of the pandemic, recognising that the biggest part of a person’s life in a nursing home is their visits …We were trying to balance the needs of the people living in there with the balance of the probability of them contracting the virus,” Tuohy says.
In those early weeks they all “worked flat at the mat seven days a week for 14 hour days”, dealing with evolving guidance on infection controls and responding to outbreaks.
Early on “we realised private nursing homes don’t necessarily have the standby expertise to solve this on their own”. Her division “stood up 26 Covid response teams, made up of infection prevention control, clinical governance experts, nursing experts. And they were the people that managed every single nursing home across the country through a confirmed outbreak.”
When she looks back over the year the low point was “emerging information about the number of deaths in nursing homes”.
“That was particularly upsetting. That did take a toll on our team who were dealing with it day-in and day-out… No doubt we’ll always question ourselves, were we right with that piece of guidance, were we right with this? Were we wrong? You’ll never get it all right.”
Following the science
Masks are one of the most visible examples of where the approach changed as the science evolved. By summer, amidst mounting international evidence of their role in reducing transmission, masks were beginning to be advised in all indoor settings.
Achieving consensus on issues such as that involved robust exchanges of views at times over the year. “There would be very little point in having an expert group if there wasn’t. The whole point is that we challenge each other. That’s sometimes portrayed as a negative thing, but it’s the whole point,” says Prof Cormican.
Now an emerging worry is around the role of airborne transmission with the new variants. “There’s much greater awareness of the worry of airborne transmission now than there was, particularly with some of the new variants,” he says. Ye again experts are divided on its role.
The darkest days for Prof Cormican came in January 2021. “The number of people who acquired Covid in hospital in January was really grim. They were really bad days. It was terribly discouraging when you know the efforts that people… are making to try and manage this, and it wasn’t enough.”
He draws the analogy of a building being engulfed by fire. “You have the fire extinguisher and the fire doors, and it wasn’t that the fire extinguisher or the fire doors stopped working – there are just too many fires.”
Public perception
Has the public and media criticism of the HSE’s approach been hard to take at times? “There has been a lot of people who have acknowledged that nobody gets it right all the time. The public recognises that most of us who are doing this are trying to do our best in difficult and rapidly changing environments,” says Prof Cormican.
“My own perception is that perception of the agency has improved. I hope it has,” says Boch. “Mike Ryan’s comment at the beginning of Covid stuck with a lot of us, that if you don’t make the decision, if you stand still, you don’t stand a fighting chance.”
Tuohy says: “It would be dishonest of me not to say we might have done things differently” if all of the information about the virus had been available at the start. Yet one of the positives to come out of the pandemic is increased support for people who choose to remain in their homes.
“Long-term care has a place in the continuum of care. But I think we want to reduce the amount of time people spend in long-term care facilities.”
On that, “we’ve been able to achieve in a year what we wouldn’t have done probably in 10 years”, including 5 million additional home-support hours. “We’re going to help people remain in their own communities. That’s so massive.”
Much of the early uncertainties about the virus have been answered. But the big question now – and the one no one can answer – is how does this end?
Prof Cormican doesn’t believe the virus “will ever go away”.
“I think we are going to be living with it for the rest of our lives.”
Yet he does not mean in the sense of “some sort of dystopian future where we live like this forever. The virus and humanity will adapt to each other.”
He predicts “a combination of therapies, vaccines, some changes in how we live. So that we find a new equilibrium.
“The focus needs to be on managing the harm – controlling the virus is a key to controlling the harm.”
