Sir, – As clinical microbiologists, we have been responsible for setting up and running diagnostic services for Covid-19 and advising hospital management on how to protect patients and healthcare workers from the disease.
The last months have been extremely challenging for Irish healthcare services, and we would like to acknowledge the enormous effort and commitment that has been made in order to control Covid-19 by all our healthcare colleagues, the HSE, the Health Protection Surveillance Centre, the Government and the Irish public.
We have learned many lessons over the past four months and anticipate numerous challenges for the next 12 months and longer.
Establishing rapid laboratory testing in individual hospitals and other sites played a key role in controlling the spread of Covid-19.
This resulted in prompt identification of infected patients, which was crucial to limiting the spread of infection.
The current pandemic has highlighted the important role of rapid diagnostics in the management of infection, particularly in the outbreak setting.
Laboratory modernisation, introduction of molecular technologies with faster turnaround times, and appropriate staffing levels are key to providing rapid test results allowing patients to receive the care they require and facilitating swift contact tracing. To expedite rapid communication of new cases, robust IT systems between diagnostic laboratories and public health services are essential to facilitate immediate isolation of newly diagnosed Covid-19 patients and notification and follow-up of their contacts.
A national laboratory information system that communicates across all hospitals in Ireland is long awaited and would allow prompt communication of results between hospitals, public health and residential facilities.
This pandemic has highlighted many of the deficiencies in the infrastructure and staffing of Irish healthcare institutions which are central to preventing the spread of any infection.
Irish hospitals are overcrowded and lack single rooms which are an essential component to prevent transmission in hospital settings. Emergency departments frequently have to accommodate patients on trolleys while they are waiting for an inpatient bed and inpatient wards have only a limited number of single/isolation rooms, resulting in many patients having to share an inadequate number of toilets. Unsurprisingly, under these circumstances, efficient control of transmissible diseases is extremely challenging.
While a “Zero-Covid island” might represent the ideal, it is naive to think that it can be achieved and maintained in the context of persistent infection worldwide. For the years ahead the continuously changing epidemiology of Covid-19 will have to be monitored closely to allow public life to resume as far as possible but also to enable control measures to be adapted quickly and accordingly. It is of the utmost importance that our health service is able to deal with ongoing cases of Covid-19 while maintaining routine services for all our other patients.
There is no doubt we will continue to see cases and clusters of Covid-19 for some time to come. Above all, the most important factor which will determine whether we will be able to live with Covid-19 as a society until a vaccine, effective treatments or other solutions are available is our willingness and ability to adopt behavioural strategies to prevent virus transmission. If we universally observe these behavioural changes in the context of an advanced diagnostic service for rapid identification and intervention of any possible cluster events, we should be in a position to maintain low levels of Covid-19 community transmission while returning to a relatively normal life. – Yours, etc,
Prof KIRSTEN SCHAFFER
President,
Dr NUALA O’CONNELL ,
Treasurer,
Irish Society of Clinical
Microbiologists,
Dublin 4.