Last week the European Commission published guidelines for EU member states to ease the emergency measures and restrictions put in place to stem the spread of Covid-19.
Among the main points, the commission said relaxing measures would unavoidably lead to an increase in new cases, and that restrictive policies may have to be reintroduced from time to time. It emphasised that extensive monitoring systems would need to be in place to accurately track the spread of the disease.
Our monitoring systems are not yet at the required standard, though our testing is slowly becoming more efficient. Recently many have waited two weeks or more to find out about their result. More recently still, this has reduced to one week and even to three days in some cases.
For optimal performance we need test results reported within 24 hours of testing. Nineteen new testing machines with plentiful reagent have been sourced from China. It is hoped that these will be operational in two weeks and may propel Ireland close to the top of the testing-per-capita table.
Another difficulty with Ireland’s current testing regime is that the criteria for testing are overly strict. To meet the criteria, not only must a person have a temperature plus a respiratory symptom such as cough or shortness of breath but they must also meet an additional criterion such as being in an at-risk group or being a healthcare worker. Until we have regular testing of even those without symptoms, we will not reach South Korean standards of testing.
Contact tracing is a difficult and time-consuming process. Many reports have emerged of GPs notifying patients about a positive coronavirus result before public health has. This means that vital time has been lost in contact tracing. A phone-tracking app could greatly aid in this regard.
Unfortunately a GDPR-compliant, opt-in phone-tracking app is still a little way off. Both Apple and Google recently encouraged health services worldwide to build contact-tracing apps that allow individuals to know when they’ve been in contact with an infected person but prevent governments from using that data to build a picture of population movements. Some health services, such as the NHS and our own HSE, were already in advanced stages of app development. This announcement may delay the introduction of the opt-in phone tracking app here.
Simply put, we don’t yet have either the widespread testing or the speedy contact tracing to detect clusters and outbreaks at an embryonic stage and thus respond quickly to control them. However, our health services may soon reach the required standard. In the meantime, an offer of help is emerging from primary care. This development will even augment the improved testing regime envisioned by the HSE.
Primary care assesses the largest number of patients in our health service, many with milder symptoms and at the earlier stages of illness. General practice is on the very frontline and could potentially serve as an early warning system to alert public health to the outbreak of clusters. A GDPR-compliant method of linking daily Covid-19 data from every GP in Ireland could serve as a powerful tool in up-to-date tracking of this coronavirus.
The Covid-19 GP community tracker has been live for more than three weeks. Every day hundreds of GPs throughout Ireland input each new case of Covid-19 they have diagnosed that day into a central database. No patient details are sent, only the county, the number of people sent for a swab and the number diagnosed with Covid-19. The power of this tracker is that it includes clinically suspected Covid-19 cases as well as laboratory diagnosed cases. This gives a more accurate representation of the true number of new cases as our testing criteria are still quite strict.
The initiative was realised through a not-for-profit collaboration of a group of people committed to improving data collection and analysis of potential Covid-19 cases in general practice. The group consists of GPBuddy (Dr Shane McKeogh, Dr Darach Ó Ciardha and chief executive Joe Newell), which is a website offering a number of resources to GPs nationwide, Dr Knut Moe, a Dublin-based GP, Tony Ryan, chief executive of Medvault.ie, and Dr Dylan Crean, a data analyst at the Institute for Population Health at Trinity College Dublin.
The tracker captures information from GPs about what they are seeing on the ground and takes less than 60 seconds to complete. GPs are encouraged to fill it in even if they have not diagnosed any cases in practice that day as it helps identify potential differences in Covid-19 activity across different locations. So far 700 GPs have contributed.
This could prove a powerful tool in the early detection of clusters of Covid-19 and a valuable help to our public health authorities.
Dr Domhnall Heron is a pharmacist and GP registrar