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Asking GPs to help deal with a backlog of close contacts of Covid-19 cases will cause “further confusion” and add to an already “overburdened” primary care sector, doctors said Wednesday.
The Irish Times revealed Tuesday night that the HSE will not contact thousands of close contacts of positive Covid-19 cases over a three-day period because the contact tracing system was overwhelmed by cases over the weekend. past.
The HSE has said it will send a text message today to between 2,000 and 2,500 people, who have already been informed by text of their infection, asking them to tell their own close contacts to contact their GPs immediately to search. a Covid-19 test. .
Typically, contact trackers call newly infected people to ask about their close contacts and then call those close contacts to arrange for tests to stop transmission of the disease.
However, HSE contact trackers faced an unprecedented number of confirmed cases last weekend, resulting in a backlog of cases over three days, Friday through Sunday.
The issue was raised in the Dáil on Wednesday morning when the Oireachtas health committee said it would hold a special meeting next week on issues affecting the Covid-19 contact tracing system.
Dr Illona Duffy, GP of Monaghan, said doctors had been predicting for some time that the contact tracing system was being overwhelmed. It was disappointing to learn that the problem was now “catching up” on already “overburdened” GPs.
Arranging tests for close contacts would further increase her workload, while at the same time mean delays for other patients trying to reach their GP, she told RTÉ Radio’s Today with Claire Byrne.
He also questioned how effective the measure would be. Patients would feel unnecessary guilt for having contracted the virus and would be reluctant to report this to their contacts or would not be able to do so if they did not have details of all the people they had been in contact with, he said.
Dublin GP Maitiu O Tuathail noted that contact trackers were professionally trained and waiting for patients to alert their contacts undermined the system.
“GPs have been saying for days that the contact tracing system had broken down.”
There was a great risk, he said, that large numbers of close contacts would not be informed. “If we didn’t have a reason to block two days ago, we have it now.”
If someone was sick with Covid, the last thing they wanted to do was start contacting people, he added.
“This is going to create more confusion and more problems.”
Dr. O Tuathail explained that the term “close contact” means anyone who lives in the same house; anyone with whom you have spent more than 15 minutes; anyone who has been in the same room with for more than two hours and anyone who has sat closer than two seats on public transportation.
“There are so many nuances.”
‘Reset button’
Defending HSE’s decision, its national leader for contact tracing, Niamh O’Beirne, said it would allow the system to “push a reset button” to get ahead of the disease again.
“During the week we just couldn’t reach everyone. While not ideal, today we are texting everyone we couldn’t reach. We ask that you forward that text message to your close contacts. “
Ms O’Beirne confirmed on RTÉ Radio’s Morning Ireland that not everyone who took the test on Friday, Saturday and Sunday would receive the text message. Certain groups have been “withdrawn,” he said. These include children ages 4-19 and older people who may need more support.
“It’s not ideal, but it’s really important with the speed of the disease as we deal with the most recent cases, that we try to get by.”
He said an additional 70 people were being hired each week to develop the state’s contact tracing capacity. Interviews continued to fill positions and the goal was to try to stay ahead of demand and have the capacity to handle 1,500 cases per day if needed.
However, highlighting what she saw as an anomaly, Dr. Duffy cited the case of a GP who had volunteered to work at the contact tracing center but had to complete a large amount of paperwork and he had been asked for details of his departure certificate. This person would have been ideal for contact tracing work, he said.
“Why didn’t they prepare in advance? … This shouldn’t be a surprise, we knew it was coming.”
The HSE was in competition with the NHS for staff to work on the Covid-19 pandemic, the head of the Oireachtas health committee said on Wednesday.
The Executive Director of the Irish Medical Organization (IMO), Susan Clyne, said that public health specialists who played key roles in contact tracing were now “like gold dust” and were being recruited by the authorities, particularly in Wales. and Scotland. He added that they were told they could work for the NHS while still living in Ireland.
Professor Philip Nolan, chair of the Irish Epidemiological Modeling Advisory Group of the National Public Health Emergency Team (Nphet), said the move was disappointing, but was the right thing to do.
The HSE had tried to improve the contact tracing system and needed to continue to do so so that the system was better prepared, he told Newstalk Breakfast.
“A lot of this was done over the summer,” he said.
GP workload
A professional body representing GPs asked members to cooperate with the HSE initiative, while recognizing the additional workload.
In a letter to IMO GPs Tuesday evening, Dr. Denis McCauley, President of IMO GP, told colleagues that GPs have so far only referred patients with symptoms for testing. .
“However, given the rapid and significant increase in numbers, there is extreme pressure on our public health medical colleagues and contact tracing systems.
“This has affected their ability to respond quickly to close contacts and our public health specialists are prioritizing outbreaks in the workplace, educational and residential facilities,” said Dr. McCauley.
Regardless of whether patients were symptomatic or not, they would be referred for testing and recommended to self-isolate for 14 days.
If a patient’s test was negative, it would be recommended that they continue to restrict their movement for 14 days.
If the result is positive, the patient would be advised to continue self-isolation for 10 days or five days after “the fever is gone, whichever is later,” Dr. McCauley said.
“This is a short-term problem that will be resolved within the next 10-day week. During this short period of time, GPs are asked to assist in the referral process for tests for a particular category of patients who identify themselves as close contacts and present themselves to their practice.
“This is an important question from GPs who are already under pressure; however, we believe it is needed at this time due to the surge in all communities and in support of our public health colleagues for a defined period of time while additional staff are recruited / trained and IT improvements are implemented.
“Under no circumstances will GPs be asked to conduct contact tracing or to identify patients who fall into this category. It is fully recognized that public health are experts in contact tracing and GPs have no role in that process. “
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