Two weeks ago, a young man went to the pub to celebrate with his friends after a match. The virus was already unknown in his system. Some of his relatives were already harboring Covid. The day after his match celebration, he got sick and tested positive for the virus.
At the health department in Tullamore, Co Offaly, a team of experts on the trail of the rapidly multiplying virus found that a group of young people who tested positive for Covid-19 had visited the same pub the weekend before.
One of them was a university student who shared accommodation with four roommates. The four were followed up and all tested positive for the virus.
They also tested positive.
In the meantime, the parents of one of the four roommates picked him up from his student accommodation after he was identified as a close contact and before he tested positive. Then his sister fell ill with the virus. She worked part-time in a nursing home, which was a particular concern for public health staff given the potential exposure to vulnerable people.
Fortunately, it was not contagious while it was contagious so there was no effect on the nursing home. This is how cases get into health care and it was a close run, ”said Dr. Una Fallon, Director of Public Health, Health Service Executive Midlands Region. “This shows what is happening and how the virus is spreading.”
Dr. Una Fallon. Photo: Jeff Harvey
That was not the only thread of infection from this “spider web”. A Leaving Cert student was also in the pub to celebrate after the game. At school, she became contagious and 28 of her classmates had to be excluded and screened for Covid-19, said Dr. Fallon. It turned out that no one caught the virus, but they were out of school for 14 days.
In the past week, a health worker husband developed symptoms that he attributed to the flu vaccine. However, both he and his wife tested positive for Covid-19.
Then there are the workers who bundle cars together every day. Dr. Fallon could go on. She and her team handled 10 cases in September. That doubled to 24 cases a day, and on Friday 87 cases were on her list.
There are so many ways the escalating virus has manifested itself among public health teams across the country.
In the last two weeks the chief physician Dr. Tony Holohan warned with increasing urgency that Covid-19 is getting worse and worse.
“All of the major indicators of this disease have worsened – our concerns are getting bigger and faster,” he said a week ago after the government rejected advice from the National Public Health Emergency Team (Nphet) to move the country to Level 5 .
On Friday, he warned that the virus was “out of control”, its trajectory was rapidly deteriorating, and forecast a potential of 2,500 cases per day by the end of the month.
His alarming predictions are based not only on math and modeling, but also on the vital work of public health doctors investigating the causes of the escalating outbreaks that have brought the country to the verge of lockdown.
In the Midlands, teams of public health doctors deal with outbreaks in seven schools on a daily basis as the virus penetrates communities.
“We had no interaction with schools in the first week of September,” said Dr. Fallon.
Then the outbreaks began – small at first. They initially checked about four schools a week, which increased to 13 schools that were screened for the virus last weekend alone. For the past seven days, they examined about seven schools a day.
According to Dr. Fallon, the infection rate in schools is around 2 percent – less than the wider community. Of the 8,606 staff and students in 354 schools that have been or are being screened, 172 tested positive. “We’re trying to find out what the case is related to, whether it’s a different source, and they invariably are,” she said.
They have found that children usually pick it up from someone in their home or community – an elderly relative who has been to a party, for example.
“We don’t find a lot of transmission in schools, a little, but not a lot, and that fits the international picture,” she said.
The spread appears to be in communities, with young adults being the main drivers. According to Dr. Fallon people in the age group from 19 to 24 years of age are extremely mobile and social and “suffered” significantly from their health during the last lockdown.
The list of people with Covid-19 sent to public health centers every day is growing and the connections between these people have become increasingly labyrinthine. At the Department of Health in Galway, public health teams are tracking the complex cases of Covid-19, tracking the virus as it moves from one person to the next.
Two weeks ago, Dr. Breda Smyth, HSE director of public health at Galway, Mayo and Roscommon, and her team have linked 30 cases of Covid-19 to a couple’s week, with the virus rising almost everywhere.
Dr. Smyth said yesterday that over the past week 100 people who were infected with the virus were reconnected to a source through various complex pathways.
The exponential growth of the virus contrasts with health ministry research showing mounting fear and a desire for more restrictions. But there is a time lag, said Dr. Smyth. The cases public health doctors investigated last week likely occurred 10 days earlier.
Tracking the virus is complex. When the lockdown was lifted, shops were open and people were moving. “If they are infected, they bring the virus with them,” said Dr. Smyth. “We see very complex outbreaks that involve many contacts.”
People often don’t know they have it because they are asymptomatic or pre-symptomatic and keep moving.
“We see a special broadcast in bars and restaurants when they were open, which resulted in another broadcast. It jumps across counties and regions, depending on where people are moving. ”
She cited cases of funerals and communion services where a relative traveled from another county, stopped at a retail store en route, and went back to work in a supermarket in another county.
At the moment the virus is “out of control”. It reproduces at such a rate that “you can no longer control it and just take it off,” she said. “This is exactly what has happened in the last fortnight. There are too many mushrooms. ”
One of the most worrying manifestations of exponential growth over the past two weeks has been the increase in outbreaks in nursing homes.
“We are now seeing outbreaks in vulnerable environments like nursing homes and we just don’t want this to escalate further,” said Dr. Smyth.
Dr. Sarah Doyle, public health doctor and HSE clinical director for the contact management program, said the past fortnight’s rising case numbers included outbreaks in nursing homes, at sporting events, and a significant increase in cases in the traveler community.
The country has entered a “peak” of Covid-19 and the priorities for contact tracing have changed. Now they are looking for a relay: they are looking for their next victim instead of finding out where it has been.
The health departments continue to investigate complex cases. However, the contact tracer does not have the resources to keep the virus scan up to date.
“We ask if you have been in contact with someone who has symptoms and advise them to take a test, but yes, we are at a stage where the ability to do so for each case is not there . What we are trying to do this is to identify the high risk situations and the associated cases, “said Dr. Smyth.
As the country comes under lockdown again, public health doctors are examining the wreckage of Covid-19 from a point few can enjoy: they can see the human behavior that is clearing the way for the virus to grow and multiply.
Dr. Doyle said, “Whatever it is, for me it’s about people understanding what is being asked of them. I think one of the problems is whether people are doing level 3. Now if I have Covid-19, I will spread it “And how many people will I spread it to?”
With the debate centered on the possible transition to Level 5, Dr. Doyle believes this is a question everyone should be asking.
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