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Virus ensnares communities in complex spiderweb

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Two weeks ago, a young man went to the pub to celebrate with his mates after a match. Unknown to him, the virus was already in his system. Some of his relatives were already harbouring Covid. The day after his match celebration he became ill and tested positive for the virus.

At the public health department in Tullamore, Co Offaly, a team of experts on the trail of the rapidly multiplying virus noticed 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 housemates. The four were contact-traced and all tested positive for the virus.

The contact tracing did not stop there. The university student who unwittingly carried the virus back with him had also visited two other students who lived in a nearby flat where they all viewed an online course together.

They also tested positive.

Meanwhile, the parents of one of the four housemates collected him from his student accommodation after he was identified as a close contact and before he tested positive. Then his sister contracted the virus. She worked part-time in a nursing home, which made public health staff particularly worried, given the potential exposure of vulnerable people.

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Dr Una Fallon. Photo: Jeff Harvey Dr Una Fallon. Photo: Jeff Harvey

Dr Una Fallon. Photo: Jeff Harvey

Dr Una Fallon. Photo: Jeff Harvey

“Luckily, she was not at work while infectious so there was no impact on the nursing home. That is how cases get into health care and this was a narrow escape,” said Dr Una Fallon, director of public health in the Health Service Executive’s midlands region. “This is indicative of what happens and how the virus spreads.”

That was not the only thread of infection from that “spiderweb”. A Leaving Cert student was also at the pub for that post-match celebration. She became infectious while in school and 28 of her classmates had to be excluded and screened for Covid-19, said Dr Fallon. It turned out none contracted the virus but they were out of school for 14 days.

In the past week, the husband of a health worker developed symptoms, which he put down to getting the flu vaccine. However, both he and his wife tested positive for Covid-19.

Then there are the workers who pool cars each day. Dr Fallon could go on. She and her team were dealing with 10 cases in September. That doubled to 24 cases per day and on Friday there were 87 cases on their list.

There are so many ways the escalating virus has manifested itself to the public health teams around the country.

For the past two weeks, the chief medical officer Dr Tony Holohan, has warned with ever-increasing urgency that Covid-19 is getting worse.

“All of the major indicators of this disease have gotten worse – our concern is getting greater and faster,” he said a week ago after the Government rejected the National Public Health Emergency Team (Nphet) advice to move the country to Level 5 lockdown.

On Friday, he warned that the virus was “not in control”, its trajectory was rapidly deteriorating, and he predicted a potential 2,500 cases a day by the end of the month.

His alarming predictions are based not just on maths and modelling, but on the vital work of public health doctors who investigate the sources of the escalating outbreaks that have brought the country to the brink of lockdown.

In the midlands, teams of public health doctors are dealing with outbreaks in seven schools per day as the virus rips through communities.

“We had no interaction with schools in the first week of September,” said Dr Fallon.

Then the outbreaks started – small at first. Initially, they screened about four schools a week, that increased to 13 schools screened for the virus last weekend alone. In the past seven days, they have been screening about seven schools a day.

According to Dr Fallon, the infection rate in schools is around 2pc – less than in the wider community. Of the 8,606 staff and students in 354 schools that have or are being screened, 172 have tested positive. “We try to determine what the case is linked to, whether it is some other source, and they invariably are,” she said.

They have found that children usually pick it up from someone in their home or community environment – an older relative who’s been to a party for instance.

“We are not finding major transmission in the schools, a little but not much and that is consistent with the international picture,” she said.

The spread, it seems, is happening in communities, with young adults as the primary drivers. According to Dr Fallon, people in the 19 to 24 age group are extremely mobile and social and, she said, “suffered” a significant impact on their health under the last lockdown.

The list of people with Covid-19 dispatched to public health centres each day gets longer and the connections between those people has become increasingly labyrinthine. At the Department of Public Health in Galway, public health teams trace the complex cases of Covid-19, tracking the virus as it seeds from one person to next.

Two weeks ago, Dr Breda Smyth, HSE director of public health for Galway, Mayo and Roscommon, and her team linked 30 cases of Covid-19 back to one couple’s week away, the virus mushrooming almost everywhere they went.

Yesterday, Dr Smyth said in the past week 100 people who were infected with the virus all connected back, through various complex routes, to one source.

The exponential growth in the virus contrasts with research published by the Department of Health that shows increasing anxiety and a desire for more restrictions. But there is a time lag, said Dr Smyth. The cases that public health doctors have been investigating for the past week probably seeded 10 days before that.

Tracing the virus is complex. When lockdown lifted, businesses were open, people were moving. “If they are infected, they are bringing the virus with them,” Dr Smyth said. “We are seeing very complex outbreaks that involve a lot of contacts.”

People often don’t know they have it because they are asymptomatic or pre-symptomatic and keep moving.

“We’re seeing particularly transmission into bars and restaurants, when they were open, which led to further transmission. It jumps across counties and regions, depending on where people are moving to.”

She cited cases of funerals and communion parties, where a relative has travelled from another county, stopped at a retail outlet on the way, and returned to work in a supermarket in a different county again.

Right now, the virus is “out of control”. It is reproducing at such a rate that “you can no longer control it and it just takes off”, she said. “That is what’s happening in the last fortnight. There are too many mushrooms.”

One of the most worrying manifestations of the exponential growth over the past two weeks has been an increase in outbreaks in nursing homes.

“We are now seeing outbreaks in vulnerable settings such as nursing homes and we simply do not want this to escalate any further,” Dr Smyth said.

Dr Sarah Doyle, public health specialist and the HSE’s clinical lead for the contact management programme, said rising case numbers of the past fortnight included outbreaks in nursing homes, in sports events and a marked increase in cases among the Traveller community.

The country has moved into a “high phase” of Covid-19 and the contact-tracing priorities have changed. Now they look for onward transmission: looking for its next victim, as opposed to hunting out where it’s been.

Public health departments continue to investigate complex cases. But the contact-tracing programme does not have the resources to keep up the detailed level of virus investigation it has been doing.

“We do ask if you were in contact with anyone who has symptoms, and advise them to get a test, but, yeah, we are in a phase now where the capacity to do that for every case isn’t there. What we are trying to do is identify the high-risk situations and the linked cases,” Dr Smyth said.

As the country faces another lockdown, public health doctors survey the wreckage of Covid-19 from a vantage point few can enjoy: they can see the human behaviours that clear a pathway for the virus to grow and multiply.

Dr Doyle said: “Whatever level it is, to me this is about people understanding what is required of them. I think one of the concerns is whether people were complying with Level 3. If I have Covid-19 now, am I spreading it? And how many people will I spread it to?”

As debate focuses on the potential move to Level 5, Dr Doyle believes these are question everyone should ask themselves.

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