Management of response 'extremely challenging' as health services in Midlands 'were quickly overwhelmed by the Covid-19 surge'

HEALTH services in the Midlands were “quickly overwhelmed” by the Covid-19 surge and the management of the response proved “extremely challenging”, a leading public health consultant in the region has revealed.

Dr Douglas Hamilton, a Specialist Consultant in Public Health Medicine with the HSE in the Midlands region, said the initial Covid challenge was enormous with up to 40 cases a day in the four counties [Laois, Offaly, Westmeath and Longford].

“We had the onslaught from the end of March until the end of April and the work burden was great,” he outlined.
Dr Hamilton said waves and waves of new patients had to be treated right throughout April but the rate of infection “tapered off quite remarkably in early May.”

“There were nearly 30 cases per day at the end of April, seven per day a week later and two per day in the middle of May. Something happened . . . we cracked it,” he outlined.

The Tullamore based Medical Officer of Health, who was directly responsible for counties Longford and Westmeath, said there was huge pressure on resources and PPE [Personal Protection Equipment] was a major problem.

He revealed his team had to deal with multiple outbreaks in nursing homes, supermarkets, direct provision centres and meat factories, many of which were linked.

Outbreaks related to public houses, to people returning from the Cheltenham Races and from groups watching the races in pubs and other settings also had to be dealt with.

In total, there were Covid outbreaks in 26 nursing homes in the four counties but, as of Monday last, there are no cases in the region in such facilities.

He said the lockdown was the key to fighting the Covid threat and commended people for really following the directions and regulations which, he said, reduced the community spread.

Many of those at risk of infection, noted Dr Hamilton, work in minimum wage employment sectors such as supermarkets, nursing homes and meat factories and called for a greater appreciation of their role in Irish society.

Speaking in a personal capacity, Dr Hamilton said he is a firm believer in the use of face masks and views them as Public Protection Equipment.

“My advice would be to wear masks in close spaces where you will be within two metres of others,” outlined Dr Hamilton.
He said Covid was spread by droplets emanating from the mouths of people onto their hands, furniture and other people. “All these then become vehicles for further transmission which would not happen if you wore a mask.”

“You might not know you are infected as many are asymptomatic and those who become symptomatic have no symptoms two days prior to that.”

He said face masks did not provide protection to the wearer but to other people and that is why he favours the term Public Protection Equipment for them.

Dr Hamilton said the use of hand sanitisers was also key as was the repeated cleaning of surfaces.

“Anywhere you have tea or coffee as those are places where you will not have a mask on.”

Originally from Sweden but now living in Banagher, Dr Hamilton is highly critical of the controversial approach to Covid taken by health authorities in his native country.

“I think Sweden will always suffer in terms of its reputation as a result, Sweden dropped the ball. They didn't realise that this would affect the vulnerable, especially the elderly, and based their interventions on theory,” he pointed out.

Dr Hamilton added: “In Ireland we tried to protect everyone, it was our instinct, from the youngest to the oldest, from the poorest to the richest.”

In the four counties of the Midlands, to date, there has been a total of 1,732 Covid cases of which 184 were hospitalised, 30 in ICU [Intensive Care].

Total confirmed deaths in the region stand at 58 with a further seven possible/ probable deaths from Covid. At the outset of the pandemic, Dr Hamilton said he and his colleagues had to decide, in view of their very limited staff numbers in what would be regarded as a fairly small public health department, how their capacity would be split up and how they could draw from other areas, particularly community health resources.

“The management of the response was extremely challenging as we were quickly overwhelmed by the surge from St Patrick's Day towards the end of March. Some of those initial cases related to outbreaks in pubs and to people coming back from Cheltenham and other events such as funerals.”

He recalled the lockdown commenced on the evening of March 12 with the surge occurring in the weeks following because many had been infected prior to lockdown and continued to infect each other in households and other places.

“Our job was to identify all the cases and investigate each and everyone of them,” outlined Dr Hamilton.

He said they had to uncover how each case originated, how many were infected from that source and who were the contacts that might get it.

“The whole idea was to identify the source, the close contacts, separate them, test them and to make sure that isolation occurred right across all those contacts for 14 days,” pointed out the Medical Officer of Health.

He said the task was enormous and not just in terms of the Covid burden. “The work burden was greater as you had to protect those not infected, protect the population against a hazard. The main work was protecting everybody else and we had to identify those most at risk.”

Dr Hamilton said experience from other health situations such as flu outbreaks was drawn upon in identifying the key risks and developing tailor-made interventions.

“Sometimes this involved interpreting national guidelines and making them appropriate for a regional level,” he explained.
Dr Hamilton said there was a huge pressure on resources with PPE being a major problem. There was also pressure on human resources in hospitals and nursing homes.

Staff were under huge pressure and some of them became sick themselves and they had to receive the right clinical care.
He said that many of the outbreaks in nursing homes, supermarkets, direct provision centres and meat factories were linked.

“There is definitely a social gradient here as well in a work context as where you have a large proportion of minimum wage workers they are more vulnerable,” he outlined.

Dr Hamilton said he hoped the work of people in such settings was now appreciated a bit more by society.

He said there was also a huge language barrier for many of the minimum wage workers.

“How do we ensure that these workers we depend on are protected, get information in the right language, get access to primary care and social protection and understand public health directives.”

Dr Hamilton, who speaks Portuguese fluently having spent seven years working in Mozambique with Irish Aid and the European Commission, said there was a particular issue dealing with Brazilian workers in meat factories in the Midlands.

“I got to speak to them specifically and understand how vulnerable they were with many on short term permits, with no access to primary health care which is a basic human right,” he outlined.

He continued: “When they became ill I had to ensure they got the care they required.”

“Minimum wage workers, in particular permit holders, are not protected the way they should be,” pointed out Dr Hamilton who added that many had to keep working through illness in order to get paid.

“They have a tremendous work ethic, like the Irish who emigrated to the United States . . . many will work until they drop,” he outlined.

Dr Hamilton added that these workers had been unfairly blamed for outbreaks in meat factories.

He revealed that mass screenings of workers were conducted in meat factories so that he and his colleagues could gain an understanding of the magnitude of the problem.

Dr Hamilton praised the work of human resource departments in the meat factories he dealt with.

He said management in the factories was supportive while representatives of the Gardai and the local authorities spoke directly to workers to convey a message of unity against the virus.

“It was not a case of Brazilians against Poles against Irish or the people against meat factory workers,” outlined Dr Hamilton.
The public health consultant also revealed that outbreaks had been identified specifically in only three pubs in the region though there were other social gatherings where outbreaks occurred such as funerals.

“If you look at pubs and funerals you can understand why this would happen. People in pubs are very close at the bar and at funerals people come in close physical contact to sympathise.”

Despite his experiences, Dr Hamilton said he was confident normal life will return but there will be changes in behaviour.
“We have learned not to shake each others hands and to sit two metres away from each other,” he noted.

He continued: “Everything is risk containment and the risk is much less in terms of transmission if we maintain the behaviour that we have learned.”

“We have not had Covid-19 before, it is totally new to the human race and is a dangerous disease.”

Dr Hamiton said people had lived with other diseases such as measles for thousands of years, many had developed immunity and most had been vaccinated. He added that the Midlands had the highest vaccination rate in the country with over 90 per cent of people vaccinated.

How do we ensure that these workers we depend on are protected, get information in the right language, get access to primary care and social protection and
understand public health directives.”

“In Ireland we tried to protect everyone, it was our instinct, from the youngest to the oldest, from the poorest to the richest.”

“The whole idea was to identify the source, the close contacts, separate them, test them and to make sure that isolation occurred right across all those contacts for 14 days.”

“In terms of Covid some of us have developed immunity but hopefully we will have a vaccine in the future,” added Dr Hamilton.