The frontline workers at the coalface are ready to do battle against invisible enemy

Those at the coalface of the crisis are changing how they work to protect against Covid-19, writes Wayne O’Connor

THE HSE’s warroom in the battle against coronavirus is affectionately known as “that big yella’ building next to Heuston” to country folk who regularly get trains to Dublin.

The HSE calls the building Dr Steevens’ Hospital after Dr Richard Steevens, an eminent 18th-century physician who bequeathed money to establish a medical facility. In 1803, it was kept under guard to protect the injured victims of an explosion at a nearby ammunition depot prior to the rebellion against British rule. It now serves as the HSE’s headquarters but soldiers are back there again this weekend.

Defence Forces cadets in military fatigues are manning phones after contact-tracing methods were ramped up to detect coronavirus carriers. Using information provided by people who have tested positive, the cadets trace recent contacts, explain the nature of the phone call, offer reassurance and ask key questions.

“Are you a healthcare worker? Do you have any symptoms associated with Covid-19?”

The soldiers, and everyone else in the building, are here to support efforts of doctors, nurses, virus-testers and healthcare workers in the trenches who could come in direct contact with the virus.

But it is not only at Dr Steevens’ Hospital where the modus operandi has changed to combat the threat of Covid-19. On the frontline, where the risk of coming in to contact with coronavirus is greatest, thousands of people have adjusted routines to battle this new disease.

Instead of having patients attend GP surgeries for repeat prescriptions, some doctors are filling out scripts and delivering, emailing or faxing them to local pharmacies. Stricter control measures are also in place to minimise the risk of spreading Covid-19.

Pharmacists are among those adapting how they work and their public contacts. Others may have to, too.

SOUTH DOC

SouthDoc, an out-of-hours GP service made up of 520 doctors in Cork and Kerry, will continue to treat patients but has altered how it does so.

The same number of staff remains on duty but will operate from only half of the group’s 20 treatment centres. It will not be treating potential coronavirus carriers because the official advice is to refer them elsewhere for testing.

Other patients cannot present to centres without an appointment and extra triaging is in place to prevent potential coronavirus carriers from coming in to contact with others, SouthDoc medical director Dr Gary Stack told the Sunday Independent.

Patients face questions from a call-taker, then a nurse before speaking to a doctor.

“The doctor will call the patient from the treatment centre and we will decide if the patient can be dealt with at the treatment centre or on the phone,” Dr Stack said.

“The idea behind that is we will have better control over what cases are coming in.

“If they need to be seen they will be given an appointment to come to the treatment centre. They will be asked to press the intercom at the door and asked to wait in the car to be brought in individually.

“It is a greater strain but it is the safest way of doing things. We have to protect the staff, receptionists, drivers and doctors because if they get sick we will have less support staff.” These measures will remain in place beyond the March 29 date the Government has put in place for containment measures.

GPs

Dr Stack wants to see the role of GPs in this crisis more clearly defined, and suggested they are best placed to deal with the traditional ailments people have always presented to doctors with. Coronavirus does not stop people falling ill with other complaints. But he feels it is only a matter of time before people start presenting to GPs with the virus.

He thinks testing should be carried out at designated centres to ensure community practitioners can continue to operate relatively normally.

“It would be better for some people to have driven their car and sat at a centre, a McDonald’s-type spot — a drive-in where testing can be done in the car by staff.”

TESTING

At present, most testing is done by ambulance crews.

However, the health service plans to open 12 testing hubs this week. This number will rise, HSE chief operations officer Anne O’Connor said.

“Numbers don’t mean a lot at the minute because everything changes so quickly, so at the minute we were saying maybe 25 or 27.

“There will be two functions out in the community around these centres. One will be testing. Ambulances are doing that at the moment in people’s homes, but, ultimately, we want to have centres people can go to — particularly where there are higher populations and depending on the advice they receive when they make a phone call.

“The second purpose of it is important too because we will also have capacity in these centres for people who may think they are starting to feel unwell. Their symptoms might become more pronounced and cause worry. We don’t want those people turning up in hospitals so they will be able to go to the clinicians in the hub. The clinicians will be able to assess if they are in need of further intervention or treatment.”

What they also do not want is coronavirus patients presenting to GPs. “We need GPs to do what GPs do. They are a scarce and valuable resource, they don’t need to be here [in testing hubs] but they may be. It will depend on the model in a given area.”

PHARMACIES

For many, a local pharmacy is the first port of call when illness strikes, so the sector has had to make adjustments to cope with the looming coronavirus threat.

A pharmacy in Meath no longer asks medical card patients to sign for medicines because of concerns about the virus being passed by sharing pens. Kathy Maher, who owns and runs Haven Pharmacy in Duleek with her husband Tom, is happy delivering medication to homes and having customers park outside the pharmacy to have medication brought to their car.

“It might be a requirement by the State to have patients sign medical card prescriptions when they collect medicines, and long-term illness forms, but we have stopped asking them to sign it to reassure the public and staff that we are minimising contact.

“If the situation was to deteriorate in the coming days we would look at restricting the entrance and look at whether we need to have more stringent social distancing, have demarcations in the pharmacy or let people in one or two at a time.”

An arrangement with other pharmacies in the area and nearby Drogheda means all their businesses and staff will be protected financially if they are forced into self-isolation.

“If we had to self-isolate our staff we would be forced to close and financially that would cripple us, so we have all agreed to share staff if it comes to that. We have that contingency in the back of our minds and can reassure staff it will be OK.”

OPTICIANS

American scientists have linked coronavirus to conjunctivitis so now opticians and ophthalmologists are being advised to use Perspex barriers covering their face when conducting eye exams.

Professor Michael O’Keeffe, a consultant ophthalmologist at the Mater Private, said coronavirus had wide-reaching implications for everyone in the health sector.

“Some people have presented with eye involvement so eye doctors are susceptible and this weekend some have been advised to put perspex on their microscopes.”

ISOLATION

The HSE is in discussions to use hotels as non-acute isolation facilities, Ms O’Connor said at a HSE briefing last Friday. “We have different types of beds that we need,” she added.

This raises questions about implications for hospitality staff who may also be on the frontline. O’Connor said beds for moderate and acute care would be found at facilities that can provide specialist support, but “other beds purely for isolation that are not beds for sick people” could be sought in hotels.

HSE chief executive Paul Reid said these would be a “contingency if required”.

Elsewhere, other HSE staff are likely to find themselves redeployed to battle the virus. Officials anticipate many will be trained to work alongside the Defence Forces cadets in “that big yella’ building next to Heuston” as contact-tracing efforts step up further and more cases become known.

“We are redeploying significant numbers of staff to cover key tasks,” O’Connor said.

“All of our staff are being prioritised to address this challenge and we are working with other agencies because there are certain types of tasks where we can bring in people who are not healthcare professionals, for example contact tracing.”

Europe has surpassed China as the epicentre for the disease, so health officials will appreciate all the help they can get.