'Off the charts': Ireland's contact tracers face return of sleepless nights
In the first months of the coronavirus pandemic, Ireland’s contact tracers often made calls to people who were very sick, with some struggling to breathe.
“In a lot of cases people were suffering extreme physical distress,” said Eamonn Gormley, a tracer at University College Dublin. “One person collapsed on the floor and we could hear them gasping for air. You got questions like: ‘Am I going to die?’ Some nights I had trouble sleeping.”
Such harrowing calls are rare – and hospital admissions have fallen to a trickle. But contact tracers, who notify people who have tested positive for the virus and find out whom they have been in contact with, have a new reason to lie awake at night.
Many infected people are revealing multiple close contacts in multiple locations such as homes, schools, restaurants, pubs, beauty salons and planes. Little surprise then that the virus is flaring across Ireland.
Daily infection rates, which dwindled to a handful in June and July have since August climbed back up to several hundred. There have been 2,077 outbreaks in private houses, an increase of 61 in a week, the Health Protection Surveillance Centre said on Wednesday. Since the pandemic began Ireland has recorded 31,799 infections and 1,788 deaths.
“We’re seeing crazy numbers,” said Karl Conyard, an operational lead at UCD’s tracing centre.
During lockdown, infected people tended to have close contact with just a few other people but the median number of contacts is about 10, with some infected individuals disclosing close contact with 25, 30, even 50 people, said Conyard.
During the Guardian’s visit the tracing centre team learned of an infected person with 83 close contacts, a number deemed “off the charts”.
Coronavirus cases in Dublin have increased tenfold in the past month. The capital’s 14-day incidence rate is 104 per 100,000, almost double the national rate of 53.
The equivalent incidence rates vary widely across Europe, with Spain at 281, the UK at 55, Italy at 32 and Poland at 19.
Philip Nolan, chair of the Irish Epidemiological Modelling Advisory Group, said on Wednesday the reproduction number was between 1.3 – 1.7 nationally. “I am more concerned than I have been at any point since late April. Case numbers appear to be growing exponentially and are likely to double every 10 to 14 days if every one of us does not immediately act to break chains of transmission of the virus.”
On Tuesday, cabinet ministers were told to restrict their movements and parliament was briefly suspended after the health minister, Stephen Donnelly, reported feeling unwell. His Covid test came back negative, averting the spectre of a coronavirus outbreak at the heart of government.
The scare came hours after the government unveiled a new coronavirus national plan. Based on a riskranking system, with one the lowest and five the highest, the plan was aimed at regaining control over the pandemic and restoring public trust after political controversies and distractions.
Contact tracers, who work with a phone, laptop and reams of forms, have a unique window on the pandemic. They make three types of call. Call one notifies someone who has tested positive. Call two is a follow-up to obtain names and phone numbers of those with whom they had close contact. Call three is to those people, saying they have been in contact with an infected person and should get tested.
Ireland has about 280 contact tracers, with hundreds more on standby, making more than 1,000 calls daily from centres in Cork, Dublin, Galway and Limerick.
Surveillance information, work schedules and system updates change rapidly, said Mary Codd, who runs the centre at UCD. “If you’re gone from here for one day you’re out of date.”
The campus has 70 tracers spread over three rooms. Twenty are environmental health officers. The rest are volunteers, mainly faculty staff from different departments and graduate students from the MA in public health programme.
Devisri Sundaram, a graduate student, made her first call one last week to a woman in Dublin who tested positive after dining with an infected friend at a restaurant.
The woman, a white-collar professional in her 20s, told Sundaram that despite having a headache, sore throat and fatigue she had again dined out, went shopping, went to the gym, had a long session with a stylist and visited her boyfriend, who was hosting visitors from abroad, an itinerary that put her in close contact with at least nine people.
“She’s been all over the place, even when symptomatic. People need to be more responsible,” said Sundaram.
Tracers do not scold those who admit flouting rules and advice. The goal is to obtain information and a commitment to self-isolate. “If you’re not friendly, they wouldn’t tell you that they’ve been out pubbing and clubbing,” said Sundaram.
Codd, a professor at the school of public health, physiotherapy and sports science, said despite surging numbers the testing and tracing system, and the public’s compliance with physical distancing, masks and other measures, was “keeping a lid” on the pandemic.
The recent pattern of several hundred cases a day could continue without a dramatic spike, said Codd. “I do believe it’s sustainable with a big effort by everyone.”
The tracing system scaled back in June after lockdown had suppressed the virus, then scaled back up last month, with the help of an app, when infection rates increased, said Codd. “It’s being managed, the capability is there. We’ve managed this for five weeks now. We have to try to continue to manage it.”